HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals


  • Katia CharalabakiPsychiatrist, Family Psychotherapist, coordinating director of Family Therapy Unit of Attica Psychiatric Hospital

A dear childhood friend of mine who lives in Heraklion, Crete had sent me a weird notebook as a gift several years ago. Elegant, slim, long and narrow, it resembled an accounting book of an old grocery store. It was a publication from the "Nikos Kazantzakis" Museum and it was identical to the great Cretan writer’s notebook from the 1920s when he was in middle school on the island of Naxos. On the inside of its covers, it has poems, proverbs, physics and algebra exercises of the pupil from Heraklion. It was so beautiful that I didn’t want to taint it. Ten years later, however, amidst the violent financial crisis of 2010, and during the formulation of our online journal, I started to use it, from time to time, to take notes regarding the journal’s goals, our psychotherapeutic work, and most of all regarding the effects that the financial, social and healthcare crises had on this work. From these notes, I single out ten points.

First, the trauma

I will begin by saying that the ten years and twenty issues of our journal make us reflect upon its time and upon the reasons that led to its creation: It was in the heart of the financial socio-political crisis that the decision for its creation was made. That might have been a therapeutic (or self-therapeutic) action on our part against the collective, political and cultural trauma. At the same time, it was an attempt to achieve a deeper understanding of the individual and collective psychopathology of adults, but also adolescents and children. The wider context’s regression resulted, not only, in children not growing but also in them regressing even more alongside the regression of the adults. A common experience was that it was as if "we went back" ... And what played an important part in this was the de-intellectualization of society and the decrease of reflection and deeper thought, which intensified the functioning of primitive instincts... An example here, in the case of the second major crisis of Covid-19, is that of adult anti-vaxxers and the effects that their attitude has on their children, their relatives and their social circle...

The financial, political and health related context, especially when it is particularly hard, relentless and inhumane penetrates everything, including families, which it can deteriorate and destroy. The pathological problems of society develop into the pathological problems of the family. Every therapist has a right to his own political choices; however, democratic and humanistic values are necessary conditions for psychotherapy to function properly. In my opinion, whether we like it or not, psychotherapy is connected to political values.

Second, annihilation anxiety

We experienced it back then, the same as now... Here we can introduce the concept of "asymmetric threat", meaning the threat that escapes human control (let me note here that Chernobyl has been mentioned as an example of this as well...). Adults feel as helpless to comprehend the situation and to intervene as their children do... In psychotherapy, we have, for many years, investigated and experienced the problems that usually manifest as delinquency or the child rejecting school, violence or the dissolution of the couple and other similar family difficulties. During the financial crisis, however, there is also (and possibly in a prominent position) the father’s and/or the mother’s financial death too. In the healthcare crisis, the biological death from the virus threatens all generations and exacerbates all existing problems. Even if it is not articulated by patients, the fog exists,and the therapist is expected to deal with it in exceptionally adverse conditions.

Third, the loss of belonging

"Belonging" does not mean being in a team and following the leaders’ orders. It means that I am not alone. We are together with other people with which we have similar concerns, common roots or common preferences and it is a place of security and mutual support. Losing these relations is the great loss. An enormous unsolved "puzzle".

During the financial and political crisis, a destructive side of "belonging" emerged through a fragmentation of human relations. There were quarrels about views regarding the financial crisis, political views, family spending, the capability to go on vacation, tuition fees for the children’s foreign language lessons and sports and about which party one votes for. "We used to be on the same side. Why did you leave now? You defected to the opposite side etc." ... "We were both against the memorandums, but did you vote "yes" or "no" in the referendum?". Thus, an element that dominated the period was that of the dissolution of the concept of "structure" (in the systemic sense of the term), in other words of "belonging" ... Dissolution within sick socio-political environments and under inconceivable for any reasonable person social conditions of "memorandums", "lists..." etc. not to mention the things pertaining to our own professions... A fertile ground for planting and growing reactions ranging from psychopathy to dementia and psychosis... In the second phase, during the Covid-19 pandemic the extreme confrontations between people on a realistic level do not exist like in the previous phase of the financial crisis. There is, however, the fracture of close social relations imposed by the mandatory measures for containing the spread of the virus. You cannot see your cousin, your old classmate, your political, sport or artistic group. "Belonging" is ultimately oppressively – and perhaps noxiously – confined to relatives of the first or second degree. At the same time, in this manner the metaphysical element penetrates life and human relations to operate destructively. It is the devil, supernatural powers, fairies (who are beautiful but also evil), conspiracy theories against the Jews or the communist that have entered our lives and turned them upside down... (Hence, the anti-vaxxer priests, bishops, retired military men and even nurses and doctors fighting against the devil on earth...). We caneven see this serpent’s egg growing within society in families.

One of the basic goals of psychotherapy is to seek forms of restoring reality and to simultaneously detect and discover ways of unification and resurrection of a positive "belonging" ... And one more thing: We are not the only ones acting psychotherapeutically. Family customs and traditions, habits and rituals contain psychotherapeutic elements. Many close relatives gather around the deathbed, and perceive their relations beyond quarreling and misunderstandings, with more sincere and deep standards (not to say that there are no disputes about how the inheritance will be divided). At the funeral, the psalms soothe the mourners. At the funeral dinner (which may develop into a festivity) life is restructured into new conditions. This kind of psychotherapy through traditions has, in effect, been eradicated by the coronavirus restrictions making the therapist’s job even harder.

Fourth, the dilemmas

Progressively greater conflicts emerge, with enormous contradictory dimensions to them, which make reaching a decision all the harder. Should I go to the theatre, or should I stay home? Should I see my siblings and friends or should I self isolate in immune safety? Political dilemmas are similar: Are we for or against a lockdown, even with Covid cases reaching n thousand (as we saw yesterday or heard scientists or government officials announce). In this manner, the element of uncertainty, doubt, distrust, indecision, penetrates a family and leads to a generalized instability for the entire family system. It is not easy, but, ultimately, the therapist must be capable of contributing to the creation of a relatively stable environment within the family and of deconstructing the fragile and possibly noxious argument.

Fifth, a transgenerational "Pandora’s Box"

Transgenerational trauma transmission, trauma repetition... A conscious or unconscious re-emergence of old traumatic situations... Here we will talk about history, knowledge of history and its repetition (which, as Marx said, repeats itself the first time as a tragedy and the second as a farce). One example is the position of the scapegoat. "My great grandfather was subservient during the Turkish occupation, my grandfather was executed during the German occupation, my father was tortured during the dictatorship. Now I want to throw bombs, demonstrate, fight other citizens or the police, while I have been isolated from other students and professors in school and in university... I will not experience loneliness, sadness, disappointment again; I will be the aggressive one...". And there are many more examples that we unfortunately come across in the news daily. In every session with the family, the therapist may possibly find "Pandora’s box" open. And in order for the foul clouds of the family history to be pulled apart, inquisitiveness, consideration, persistence and also kindness are needed.

Sixth, the therapist’s "disease"

What happens with the therapist and his problems? How does he deal with them in his personal and also his professional life, so that they do not enter the therapeutic context catastrophically (but only constructively)? The therapist experiences a general atmosphere of debacle of emotional attachment, socioeconomic, political, institutional and also medical frameworks. This debacle results in major upheavals, both in his home and in the therapy room. What can he, as a therapist, do? Some thoughts: First of all, he should not ignore the intrusion of the elements of external reality into the therapeutic context, but rather he should utilize them in therapy. An example is the restoration of the patients’ capability of symbolization (which they have usually lost and speak of material goods, health, money, etc. per se, ignoring what they may represent). He should restore the capability of abstract thought, prioritization, discrimination, differentiation, symbolization, meta-communication and construction of meaning. He should also be able to comprehend, give meaning and deal with entirely novel phenomena, which he has neither learned during his training nor faced again with such intensity in his professional carrier. Moreover, he should reflect on and give meaning to the self-referential paradox: "Am I more at risk of being infected with the disease I am expected to cure, or am I more capable of curing the disease with which I have been infected?" On the one hand, the therapist is no longer the idealized object. He is instead human, earthly, vulnerable. He too may also suffer emotionally and face problems in his personal life and relationships. However, he must not collapse emotionally and feel incapable of effective therapeutic work. Thus, a new resonance may appear, where through the poverty of external reality, the wealth that exists within the individuals, the relationships, the systems and their history is allowed to emerge... (My great grandfather fought alongside Venizelos in Therisos, my grandfather participated valiantly in the resistance against the Nazis, my father participated in the student movement against the dictatorship and I... I will work constructively and contribute to better conditions at home, in my neighborhood, in my workplace...).

Seventh, mourning

Here I will add two more concepts: The concept of "Mourning" and the concept of "Resilience". Can we mourn for the things that we have lost instead of resolving to "maniacal defenses"? Is it possible that endurance, strength and resilience, which are the tools we need in order to survive as humans and as therapists, can emerge through the process of mourning? Can the children’s "leaving home" (both our biological children and our patients metaphorically) occur, at least symbolically?

Eighth, self-criticism

Let’s not forget self-criticism! It is part of our maturing process (as long as we are not psychopaths) ... I will give some personal examples now that my service at the Family Therapy Unit at the Attica Psychiatric Hospital has come to an end. My narcissism: Is it normal, healthy and useful or do I lean towards a narcissistic personality disorder? My envy: I discovered it when I found myself feeling uneasy concerning the progress and recognition of others, and when I caught myself feeling good when others had difficulties... Do I recognize my own mistakes? I have often said "He/her is to blame", and after a while, I wonder and question from what emotion or thought these accusations cave sprouted... I now regret everything negative (concerning people and events) I have repeatedly mentioned to my psychoanalyst... What had gotten into me regarding X or Y? Today I have excellent relationships with both of them, albeit from afar... However, I am now beginning to have a problem with A and B! What does that mean? Is it a repetition of the rivalry? Yet, I should give myself credit for some positives, like the fact that I felt respect and love for the people who, during the first crisis, offered so much of their time to "Community Clinics" and "Solidarity Clinics"...

Ninth, nostalgia

What part does it play in our lives? There are certainly bad and painful memories: My mother’s death, and my father before that... Or other things as well: I remember that one night somebody broke into our house and stole two wedding rings and my husband’s cigars that we had left in the hallway (fortunately they did not hurt or kill us). But there are also sweet recollections. This is where nostalgia comes into play as a positive of existence. Reminiscing becomes a beautiful taste and sweetens our life... The outside world is ugly, the inside of my house is beautiful... It is comforting for me to look at my grandmother’s lamp and buffet cabinet, my grandfather’s phonograph, my mother’s embroidery and my great grandmother’s patchwork that I have framed made out of Cretan handkerchiefs... We finally had our booster shot, we sit quietly on our couch holding books or crossword puzzles. Farewell comrades and friends... And on the day that it snowed, when everything outside was white, we experienced our home as even prettier... We had cuddled next to the fireplace, nesting in a safe and warm refuge – a "belonging" – of bodies, souls and the environment ("systemic" through and through). Fortunately, we did not have a power shortage! What would have we experienced if the electricity was cut like in so many areas of Athens? How would have we experienced the disorganization, deprivation and insufficiency? The first ones, however, are sweet memories that create nostalgia and function like healing herbs...

Tenth, two-way empathy

I will finish with a final thought/proposition: We should share our pain. An old classmate of mine called me to ask for insomnia medication and to confide how awful she has been feeling lately... "We are growing old," she says (as in the song "Mom, I’m growing old" by Tania Tsanaklidou). I gave her medication, I supported her, comforted her etc. But it was as though she offered psychotherapy to me. I think about her and feel better; I therapeutically coexist with her... Before, I felt alone, isolated, desolate... Now, I can say with relief: I am not the only one suffering... With her, I feel that I "belong" somewhere again... Ultimately, we are all human... vulnerable... mortal... Yet, could the fact that I experience other people’s pain positively, that I feel relieved when others too are not well mean that I am overwhelmed by envy, malice, and aggressiveness? No! This is not about envy and aggressiveness, but about reciprocity and two-way empathy. So that we can gaze upon a better and healthier landscape together. Our final wish and struggle, collectively (but through that also individually), is to return to normality. But we should move from "Every man should save himself" (that the Delphic oracle had told the Greeks regarding the Persian invasion) towards "I am getting saved, you are getting saved, we are all getting saved" ...

Read the next article:

ARTICLE 4/ ISSUE 20, April 2022

Three Poems

Dimitris Kokkalis, Child psychiatrist - Psychotherapist
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