“In the Universe, there are things that are known, and things that are unknown, and in between them, there are doors.” —William Blake
Psychiatrist Daniel Siegel explains how the brain is like a folded hand. A fist. The thumb against the palm represents the limbic regions, brain zones dealing with emotions, stress. The folded fingers are the cerebral cortex, which help with rational thought and regulating moods. The fingernails are the prefrontal cortex, the part of the brain used for decision making, ethics, and morality. All these zones work together as a team. Faced with panic, the fingers spring up, we lose rationality, ethics, and are left with our emotions. We often rely on our basic instincts: fight, flight, or freeze. We may feel disorganized, unable to concentrate or make decisions, suffer from mood swings, frustration, and bouts of adrenaline. The trick is to find a way to bring those fingers down. Keep everything connected.
We’ve been in confinement in France for over two months. Here in Brittany, under lockdown, when I’m not writing or online lecturing, I’ve been working as a clinical arts therapist. Three days a week, I leave the cherry tree blossoming in our garden and head along empty roads to a psychiatric hospital. On the car seat to my right is the file I dutifully compiled the first day of confinement. It contains my regulatory paperwork, proving my right to leave my house, forms ticked and completed: name, date of birth, address, hour of departure, arrival. A photocopy of my passport. A stamped document from my employer. Everything is signed.
On Monday, I work with a patient with severe schizophrenia. We discuss how he is coping: “It’s reality. The real. The real. You have to be responsible.” He repeats this calmly, in an echolalia fashion, pacing up and down a corridor. I think of this virus and Lacan’s idea about the real as “that which is strictly unthinkable.” The real needs to be masked. Literally or metaphorically. We clothe the real that terrifies us in words, music, images and jokes. We cloak it in culture. We metamorphose the nightmare.
My file is bright orange. I have drawn flowers inside, thinking of spring, Frida Kahlo, fecundity, ephemeral beauty. Khalo wrote: “I paint flowers so they will not die.” In my garden, the cherry tree blossoms, a delicate pale pink abundance in an azure sky. These flowers of mine seem like hope, a ritual opening and closing, in an unprecedented time when the notions of touch, language, and barriers have been fundamentally modified. Restricted. My five-year-old daughter pronounces the word coronavirus perfectly, articulating every syllable. The word feels wrong when it falls from her mouth: Co-ro-na-vi-rus
When I arrive at work, the hospital gates, usually open, are locked. Doors normally left ajar require a badge or key. Before walking into rooms and units, I string a mask over my face and disinfect my hands. I create barriers against disease, infection. What Foucault described as “the tangible space of the body” has been neutralized, objectified. We place arrows on the floor in sticky orange tape. Put up NO ENTRY signs. Restrict space. In January, in what seems another version of my professional life, I encouraged a patient to throw paint, Jackson Pollock–style, onto a tabletop-size canvas. “You are allowed to make mess. Follow your instincts,” I said, encouraging freedom of expression, singularity. In February, with a female drama-therapy group, we played trust games, tumbling into each other arms. “We can touch and be safe,” I reassured. Kandinsky wrote, “There is no ‘must’ in art, which is forever free,” I told another art-therapy sculpture group in early spring (just before lockdown began), as we built imagined worlds from papier-mâché balloons. One female patient constructed a globe with scraps of recycled antique maps: tainted borders realigned, geographies and topographies altered. At this point, no one was wearing masks. Instructions were to disinfect hands, implement social-distancing, alter boundaries.
Since the start of the pandemic, there are days when everything is calm, and others when trauma seems to pour from the sky. During one sunny lunch break, a social work student—whom I have only just met—confides to me that her estranged father has just died. How to get a death certificate, organize a funeral, empty a flat, enact the rituals of grief and loss during lockdown?
Compassion and solidarity are pillars in the architecture of these moments. Even if we cannot reach out and touch each other, our ears can still listen, our eyes communicate. “Solidarity is essential,” I repeat to other members of staff as we talk about our daily professional ventures into new practices, new rules, new ways of being, caring, and losing.
Research shows that infectious diseases have associations with mental illness. There is an increased risk of OCD, Tourette’s syndrome, depression, anxiety or panic. Confinement can cause post-traumatic stress disorder. The Chinese government has been using mental health care tools employed during the Wenchuan earthquake in 2008, treating the current crisis, in terms of health strategy, on the same level as a major trauma.
The notion of order is always on my mind. Suddenly, I have found myself redeployed, wearing a mask and white coat, la blouse blanche. When I take a selfie, I realize my mask is upside down. This seems apt, since the world is inside out, and upside down, and we are all turning around. “It is a double confinement,” a nurse comments; for patients hospitalized full-time, or in locked wards, their confined space has shrunk further. No afternoons out. No visitors. No walks in the park. Physical movement is restrained, defined. There is no wandering, no exploring. No flaneur or flaneuse. To save lives, patients and staff must respect the rules. Yet, as Foucault wrote in Discipline and Punish, “Surveillance is permanent in its effects, even if it is discontinuous in its action.” Psychiatry is the medicine of the spirit, the mind. In the midst of a sanitary crisis, how to provide the space so a soul can breath?
We have a COVID ward, providing specialized care for people suffering from COVID-19 and mental illness. Patients arrive and leave.
In outpatient units, to reduce contagion, we receive only emergency cases, or clients with CTOs (Compulsory Treatment Orders). Otherwise, we schedule telephone interviews, or carry out home visits. For hours, I listen to voices, silences, pauses and inflections, pitch and tone. I try to fathom, catch what is between the lines. Many of our patients are at high-risk from the virus, as they suffer from comorbidities psychiatric and somatic. We are treating both their physical and mental health. Ring us whenever you need, we tell patients on the phone. “How are you? Your physical health? Your mental health? We are here.”
One day, I accompany a distressed patient from a closed ward, and we make a silver handbag from empty coffee packets, plaiting strips and stapling sections into place. In this act of punk tailoring, she makes decisions, exercises freedom. Kandinsky believed that “Art must always be a choice.” This imagining of something new counterbalances Lacan’s real. We create a reality that is thinkable, touchable, and beautiful, beau. Small acts provide pockets in which to place our hope.
From mid-March onwards, our medical directives change nearly daily: what we must do, not do, try to achieve. We pin information on noticeboards: crisis management, disinfection procedure. Risk. Security. Protect. Diagrams with arrows, stages, beginnings and ends. Some patients are destabilized, others stable, certain patients seem slightly better.
The days pass, and both staff and patients, as Louise Bourgeois said, are doing, undoing, and redoing. Doing, undoing, and redoing, trying to keep our hands closed.
This week, with a patient, we joked about doing music therapy on the phone. In our usual sessions, we pass a drum in a circle, transferring it from hand to hand. Suddenly, he begins singing, a song we learned together and sang every week with the group. An old campfire song, one I learned years ago. Through the receiver, I hear his voice, perfectly in tune, his hand tapping the rhythm, the beat.
“Today,” he sings “I feel older.” Tap, Tap. “Than I’ve ever felt.” Tap. “In my life.” Tap. Tap. Tap. I join him, and we sing the lyrics together. “That’s not surprising really.” Tap “I am.” We burst into laughter.
In that moment, I am filled with hope. Despite the pandemic, the telephone, the distance, connection is possible. Realities are possible. Creative realities, imagined realities. Recently, wearing gloves and masks, I accompanied a patient making an improvised collage poem, randomly choosing cutout words. Instead of leaning on the painted spotted wooden workshop table, we worked on a neutral plastic disinfected surface. Two meters apart. Yet, the words she selected were not bland, indifferent, or sanitized. Our eyes met, above our masks, as she read out the opening lines: “Je vais partir … I will leave. Arrive. Return. On the road. The landscape evolving. But where are we? Seek…” In What is Politics? Hannah Arendt writes, “the only believers in the world are artists. The persistence of the art work reflects the persistence of the world.” The resilience of the human spirit blossoms. It flowers in unexpected spaces.
Susanna Crossman is the co-author of L’Hôspital, Le dessous des Cartes (LEH, 2015). Her debut novel, Dark Island, will be published in French in 2021 (Editions Delcourt).