by Alexis Tomarken

Even in Isolation, Don’t Forget to Say Goodnight

On my morning commute to my psychotherapy practice, I overhear two young women on the F train. ”What if I get sick, will you help me with the kids?” The other says, “We’re all on our own with this.” The first drops her head, “Right, yes. We are on our own.” 

Medical containment of COVID-19, defined by social distancing and voluntary quarantines, is isolation from others who may be a threat to your existence.  

Psychological containment, on the other hand, a term coined by psychoanalyst W. R. Bion in the 1960s, is a caretaker holding what is frightening to a child and offering it back in manageable form.  This kind of containment describes the earliest social support and minimization of isolation that are essential for our survival. 

Many of us will survive COVID-19’s attack on our immune system, but we cannot endure long stretches of isolation without detrimental effects to our mental health.  We survive an attack on the body at the expense of the mind.   

After 9/11, our country began its process of healing through the close companionship we offered each other.  In New York City, photographs of loved ones were tacked to outdoor surfaces for passersby to witness and hold in mind.  We stopped to absorb these faces and read the words that described siblings, lovers, children, and parents. Commuters walked across bridges en masse, comforting each other, and others took in an acquaintance for the night when highways, bridges, and public transportation were shut down.  And when we reached for our cell phones to connect with people who might have been close to the twin towers, we flooded the system.  

During the Northeast blackout in the summer of 2003, we congregated in outdoor restaurants until the wine ran dry and the ice cream pooled over its paper tubs.  Hurricane Sandy huddled families together in the safety of each other’s homes, trying to sleep on stiff couches through howling wind gusts.  These spontaneous gatherings were all to ensure shelter and safety–and support during a time of uncertainty.  

A viral outbreak is no different in its need for social support and solidarity.  In fact, research has consistently demonstrated that social support and disaster preparedness reduce traumatic responses to stressful life events, like the illness, hospitalization, death, and prolonged isolation that we are all facing now.

So we need to mentally prepare ourselves for more time alone, and engage now in a new type of disaster planning. This includes talking with the people in our families and our lives about what to expect, and planning together how to maintain emotional contact through what looks like it will be a time of prolonged physical distance.

Without continued psychological connection to each other our minds can quickly shift into defensive mode. We can become depersonalized and numb as our own psychological containment shuts down without frequent reminders that we’re still connected to each other.

Many of us rely on physical connection to contain us, to hold us—a family member’s hug, a friend’s pat on the back, or a child’s hand reminds us that we are loved and kept in mind. Without that, we can lose our sense of connection to each other, and––strange as it may sound––to our own selves.   

Depersonalization feels like a prolonged state of disbelief, in which our circumstances feel unreal. Today, the unreal feelings mirror the surreal background of our cities’ closing down. But when we depersonalize something frightening in our life, we stop problem-solving, or even recognizing that there is a problem to solve.  

When our minds become isolated, we drift through days in a fog, failing to recognize our own needs and the needs of others.  We fall into resignation, chronic fatigue and immobility. 

This psychic numbing makes us more vulnerable to harm (both mental and physical), because we are not able to absorb the important information we need to ensure our own and others’ safety. To combat this depersonalization, we need consistent contact with others. Connecting with someone else and the synergy that this creates is like a vaccine against psychic numbing.  

A patient asked me during a phone session this week, “How do you manage hearing so many people tell you their fears right now?”  I told her that we all need someone to share these circumstances with.  That mutual connection is what actually protects each of us from alienation and ensures psychological containment.   

Psychological containment means starting to plan, share, and collect emergency contact lists in the event of illness and hospitalization.  These lists not only offer some comfort about who will care for your children or pets, but they also remind us of our accountability to each other. 

Psychic containment means checking on others who may not have adequate resources or family support.  When you check on your elderly neighbor down the hall, it is helpful to her, and it also reminds you that you are not alone.

Psychological containment means lowering demands for ourselves and others, as day-to-day schedules drastically change.  This is particularly important for parents who have suddenly stepped into the new job of homeschooling. Impprtantly, children need time to ask questions and to plan with parents about how to weave school into their home life.  Giving children a say in how the day will be structured, and slowly integrating their ideas, will help create a collective containment to navigate these uncharted waters.  

 Psychological containment means daily video or phone calls with friends and family.  This is particularly important near the end of the day, when the silence and darkness of COVID’s viral overload becomes more real without the distractions of work and family.  

Connecting with others before bedtime should become a ritual––even similar to lullabies and the stories we read to children at night to soothe them to sleep.  Just as children need to hear the comfort of another’s voice to calm their minds at night, so will all of us.  

Our need for connection to each other, laid down in infancy, is the most basic and enduring part of our existence. Each of us has a different strategy to maintain our emotional wholeness, and our needs will change as the length of time exceeds our comfort levels. 

To protect ourselves as a collective, these plans need to be initiated now, evaluated regularly, and shared often to protect us from unnecessary psychological isolation.  Medical and social distancing measures, as recommended by the CDC, must not devolve into solitary confinement.   

Without a vaccine to contain this novel viral threat, we must hold onto our oldest and most valuable resources to ensure our survival together.