Maria Quarato – Italian, expatriate, psychologist, psychotherapist.
I took courage this morning and went out. I’m an Italian, living in Vienna. Although there’s been quite a difference in the management of the COVID19 infection emergency between Italy and Austria, I preferred to follow the Italian rules for cultural identification and autobiographical coherence, together with my children, who were born in Austria.
So, we spent 40 consecutive days in quarantine at home, even if in Austria it is allowed to go out and walk with their own cohabitants, while still maintaining safety distances from others.
As a matter of fact, for us has been rather easy to stay at home, since a very important and fun homework engagement kept myself and my three kids busy, it was the renovation of my new medical office adjoining the apartment where we’re living at. Undoubtedly this experience was a good experience for children that school usually does not offer.
Luckily, we have a big garden with a private playground set up for football and other sports entertainment for children. This was also possible thanks to the Austrian construction policies which always have a keen eye on the growth of children.
They, therefore, have spent most of the time outdoors taking hostage, in turns, one of the parents. But I have to say it isn’t the same for all children in Italy. Many of them live in very small apartments and are therefore forced to do very repetitive activities. This is not fun. Children’s energies are inexhaustible while those of the parents (depending on age and other socio-cultural variables) feel always on the edge of exhaustion. I can imagine how hard can be for all those single-parent families to cope with the pressure of being the only relation for children who are full of energy with needs to constantly be met.
These days have been fun for my children, a bit less for us parents who had to take on the role of performers of needs: ”I’m thirsty Mom, water please – I’m hungry Dad – which clothes should I wear Mom? – open the door Dad – listen Mom, I want to tell you a story – etc.” We feel like their butlers without having the chance to think for more than 10 minutes in a row. Actually, this affects me much more than my husband because of his work dealing with the international electricity market, being concerned with the risk of running out of electricity. I therefore find myself always running, without any breaks during office hours, sometimes leaving people waiting for advice for their sufferings/distresses. No doubt I have become one less resource for the Italian community.
In Austria, kindergartens and schools remained open mainly to assist parents who must work and also to avoid that children be brought at their grandparents who are considered being the riskiest category for COVID-19 infection. My kid’s school director calls me every week to find out if we want to take them to school, but at the moment we chose to keep our children at our home.
40 days though are too much for me as well. I do not disdain motherhood or loneliness (I often take advantage for thinking, reading or writing). I also have my work as a psychologist but during this Italian-like quarantine this is the first and only writing that I could produce, and I do so while my kids are sleeping.
Often this parenting role doesn’t allow me enough energy to write. Whoever thinks it is easy to stay in quarantine at home with children should be allowed to experience it for themselves.
In this period, I took much of my energy from the blossoming spring outside my window: the magnolia in the adjacent Italian consulate garden gave me soft colors of pink and white; I saw the horse chestnuts at my windows managing buds that have become leaves; everything is becoming green now. I lived for 40 days on the slow pace of mother nature miracle, waking up from winter rest back to life.
This morning though, in full springtime, I woke myself up on “Austrian mode” and tired of being isolated at home, staring at sun rays entering from my windows with the same inclination, with some hesitation, at 8 a.m., I jumped into my car and drove to the bricolage shop.
In Austria, on the way into stores, surgery masks are given for free, not those for protecting yourself but those to protect other people around, and if you think about it, assuming that everybody uses these masks, everyone is ultimately protected. The shop assistants are also provided with gloves, masks and protective visors by their employers, so to protect themselves and, consequently, all clients still maintaining the 1.5 meters social distancing.
By the way, what does this say about the working conditions of healthcare personnel inside Italian hospitals?
Furthermore, at the store entrance, one of the assistants was disinfecting the trolleys as well as providing disinfectant gel for the customer’s hands. Think about this again, if everybody entered the stores with cleaned hands and with masks, no items would be contaminated.
As I was walking along the shelves looking for items I needed, the customers looked at each other in the eye at any time and any lane or intersection of the store. With that look, we were thereby deciding who was to move first in order not to infringe the rule of social distancing. Magically people dismissed their eyes from mobile phones directing them towards people. After 40 days those highly respectful looks, sharing a feeling of loss and renegotiation of social rules, turned into a sentiment of generalized belonging to a wider humanity rather than one’s own family, cohabitants or single persons living in their loneliness. Courtesy gestures that transform the fear of contagion into social skills to be united against a common enemy, the virus COVID-19.
But what’s happening in Italy? Why it looks like people are against one another ready to denounce and make each other suspicious? The key words to understand these feelings are fear and stress. The breaking point of minds that constantly feed on the same thoughts without giving them air to breathe. But the “air of the mind” is generated in relationships and in constructive interactions, not blocked at home declined in the same totalizing roles.
Stress is not the effect of an event in itself, but the perception we have to face an unusual situation that changes the fate/destiny/future of those who find themselves affected by sudden change. Clearly, our problem is not the virus in itself but the way it spread, contaminates and infects.
How do we acquire the skills to manage the socio-hygienic emergency we have to face? With the formation and protection by the State who ought to provide the cognitive and operational tools to face the world and our neighbors without fear of contagion, cooperating so that relational and social solutions can be found in order to return people to the various worlds to which they belong to.
Since only one world (the home one) is not enough to guarantee everyone’s mental health, some at home become distressed, suicides are increasing, healthcare workers always in uniform are exhausted by the fear of not having adequate protection.
Even expectations on the future have become bleak, without work, without money, so some chose, with little fresh relational air in their minds, to spare themselves the dark future that they are anticipating sitting on their sofas, aiming for the end-of-life choice. Choices made under mental conditions of relational aridity, fear induced by the way information is told/given and data interpreted. Maybe this thinking is too technical, but it must be clear that whenever an observer is in a process of knowledge, his saying is always constructed by the communicative intention. So, everyone constructs and describes data in his own way as he likes, according to his role and area of knowledge, which are sometimes not enough to better manage very complex social events.
Always the damage of cognitive insufficiency.
A socio-hygienic emergency is faced with more communities and complexity experts, and fewer politicians or reductionist scientists. Well, in the beginning, we were all scared and called for virologists, but now it is clear that their knowledge is not enough to cope with a problem that is mainly a social one: on the road, in people gestures, in the manner of human exchange and meeting, in the precarious anti-virus protocols and in the responses of each person’s immune system and not hidden in a slide.
What about epidemiologists, social and health psychologists, hygienists, immunologists, crisis and complexity experts – Where are they? If there is really no money to hire experts, then consult a germ-phobic: in such a case, his acquired knowledge, thought and refined over time with exercises, could help everyone.
Try to see if there are germ-phobic among the infected. You wouldn’t find any, just because what you call ‘mental illness’ is only a deviant way of thinking, which ceases to be a disease when it becomes functional to the context in which it occurs.
Psychiatry: the science of the obligation to adhere to the norm. The norm has changed and also changes whatever can be defined deviant and erroneously made pathological.
Leaving the epistemology aside and going back to “end-of-life choices”, as always people need to glimpse an adequate future to cope with the difficulties of the present. There is one aspect that is driving many people crazy, that is, the difficulty of anticipating their future, which at the moment is delegated to Government that decides for us which is the best solution.
In the field, I deal with (psychotherapy), this is called “mandatory medical treatment”. When people are not considered capable of taking care of their own health, risking becoming dangerous for themselves and for others, their freedom is taken away and they are obliged to be treated. The precondition for this power action is that people are not aware of the disease. But WOW, this is what it’s just happening.
We were told that we must all consider ourselves sick, right? Have they already made you feel inadequate and antisocial if you leave home or if you run in the park to get some “fresh air”; have they already sanctioned you for this antisocial behavior aimed at just keeping your body healthy and in shape, have they already called you selfish for this?
I bought myself a treadmill which I placed just in front of my window overlooking the verdant horse chestnut. I never run in the park since I’d be distracted by my own thinking while running and this could be dangerous for myself and others. I’ve always chosen to run indoor in the same space, avoiding the risk to overwhelm something or someone. But clearly not everyone can do the same. Stretching your legs and activating blood circulation should be everybody’s right: I suppose there are people with bedsores by now. If not corporal, “mental sores” for sure.
Where have the immunologists ended up? Nobody says that practicing sport, or at least, body movement is life and contributes to a good immune system? Why do they all talk about a halted economy and nobody talks of stiff bodies and minds? What can you do with an economy without healthy bodies and minds? To whom sick bodies and terrified minds, stimulated by media and psychotic political thinking, may be useful? It is a rhetorical question and leaves room for everyone to reflect of course.
Why did they not think to provide us with knowledge and operational tools to cope with social behavior risk contamination?
Where the hygienists ended up?
How come that in time of elections the letters of invitation to vote arrive quickly and now we do not get at all a nice package containing sanitary item such as visors, gloves, disinfectants, face mask as well as some instructions given as a gesture of civilization and not as a threat addressed to irresponsible and deviant people.
Sociologist I. Lemert would have a lot to tell you about building a deviant. Wow, this is exactly the way of building deviants, by treating Italians as infected, irresponsible and unable to understand the danger. The State treats Italians as unreasonable patients to whom perform a TSO (mandatory medical treatment), leaving them alone locked in their homes, looking at themselves in a frenzied manner, with no management tools and the right mood to face a social-hygienic emergency. This is what it is all about. The word “social” cannot be ignored, yet nothing social has been seen.
According to the World Health Organization (WHO), health is defined as follows:
“State of complete physical, psychological and social well-being and not simply absence of disease”, health is considered a right. The State is committed to the promotion of health for each individual.
I am not sure that the State is dealing with the health of its citizens according to the international definition, as we can see in other States, including Austria, but I believe that, in the end, they’re only trying seeking for “the absence of COVID-19”, that is just “body health”. Closed at home, unless other “psychic and social” protection criteria are applied, other diseases may occur.
Health promotion, in this case, would be sending an anti-contamination kit and encourage people to have confidence and not terror, solidarity and non-sinister control of others.
I deal with research and psychotherapy of hallucinations and psychosis. A thinking modality that we could define as follows: ideas and behaviors developed from an imaginative process that has the function of maintaining an existential and emotional balance, that can deviate from the shared and social reality and that feeds itself from a relational impoverishment.
I try to say this in an easier way. People I meet are, generally, very lonely. Emptied of any role and forced to a position of patients, observed by all as dangerously ill. This is not a good life. Well, we could say that these people are now looking at us rubbing with satisfaction their hands and saying: come on, tell me, how do you like living this way? Do you understand it now, healthy human, how is your life with this prejudice on you?
Now we are all considered sick and tormented by fear, which in isolation grows into terror and terrified people dry up and tend to safeguard only their own world. This manner of living in the world can, however, lead to “end-of-life choices”: one’s own life or that one of others.
Our mind is nothing but a theory: stories that are thought, told and experienced, that we build, renegotiate and adapt day by day, that are fed by knowledge and relational exchanges. Change, to which we are all subject, is always promoted by some sort of relationship and interaction.
If the role played in the relationships is constructive and satisfactory, people stop living in imaginary, hallucinated, self-reported and destructive worlds. It is obvious that the more relationships we have, the more social roles we engage in, more aspects of us emerge and our thoughts change, and if thoughts change, our neurochemistry and immune system changes, and yet suicidal ideas are scaled-down. If everyone legitimately develops their own complexity, the many roles that everyone resides, there is a better chance of entering into relationships with someone or something that makes us feel good.
Many times, we succeed managing and bearing roles and identities for which we suffer, simply by taking advantage of other roles and relationships from which we gain vital energy. For instance, in a contemplative dimension, I draw from nature the necessary energy to face the difficulties that affect everyone in life and get some mental fresh air. This allows me to better undertake my role as a mother and housewife on a 24-hour-shift, provisionally giving up to my private social work.
This is what is called health, which also involves the psychic and social dimension and not only the absence of disease. We are all made up of multiple roles and identities that need to be lived to remain in an emotional balance.
When I meet people defined as psychotic, I don’t cure anything, I only care that they amplify their relational networks and try to understand the advantage they get from the self-reported worlds, analyzing their need satisfied by the hallucination.
Let’s try to analyse what it’s happenings nowadays in Italy. What are the thoughts always recurring in the Italian’s mind? What narrative mode was built and used on COVID-19 virus?
“If you leave your home, you die, because we’re at war.” This is an exponential amplification of what is happening and that terrifies everyone. According to the psychopathological manuals (which I never use), this mode of defining reality is psychotic, because it does not correspond to the “true”, yet, this is the way people are experiencing this social-hygienic emergency, and starting from this assertion, states of mind, end of life choices and family conflicts are built, though it is all a lie.
Who has built this untruthful narrative mode, psychotic, as it would be defined by the “psycho-diagnostic”? With what goals?
Let’s try to renegotiate the statement by doing a psychotherapeutic exercise.
“There’s a virus out there that has a very high rate of transmission and contamination, unusual, that kills many of the elderly (the fact that Italy was a country of old people, was already known as emergency data, so it is clear that we have more deaths in that old age range than in other European countries), the most fragile persons and health care professionals: that means, all those persons who frequently attend hospitals. The Italian State does not have sufficient resources to face the emergency.”
Have we already forgotten about the infected blood bags that have been able to circulate in Italian hospitals? My maternal grandfather got hepatitis in the ’90s during a hospital practice.
So, what is the problem? The risk of contamination and contagion? They are both words that imply some form of relationship. How is it possible that we’re not aiming to plan low-risk relationships, but just isolating people, seriously putting in danger everyone’s health?
Can we really reopen commercial activities without providing adequate cognitive and operational tools to deal with relationships at risk of infections? Everyone gropes in confusion, frightened. What better way to make people sick? So, how can we deal with this virus if we are not given the resources by the State to enter into a relationship while minimizing the chances of infection?
The hospital in Naples that has managed to develop relational protocols which prevented infections among health care professionals, shows us that the problem is not the virus, but functional illiteracy even in those who supervise hospitals.
The pre-existing illiteracy to the COVID 19: in fact, in Italy, there is an emergency for hospital infections, also of a different type.
The difference is that this virus is more affectionate than the others, and once outside the hospitals it attaches to people more easily.
A psychiatrist friend of mine, who I got accustomed to talking with on the phone every day since I can feel him very tense, like a violin string, and every day he is increasingly frightened, tells me that in the hospital where he works, infected people are made to pass through common walkways; the air in the psychiatry ward is the same as the one of the infected ward. Gross mistakes that cost the lives of those who are making it available to society.
I remember when I also used to work at the hospital, the training chief complained that old-generation nurses didn’t want to wear and change gloves for each patient, while the young ones were picky enough and willing to follow protocol. I also remember nurses complaining of having to disinfect wounds with cheap materials, bought to save money. But these are just examples. If we were to interview health professionals about mistakes made at risk of contagion, there would be an immensity.
Do I have to say that in Austrian houses it is not allowed to walk in with shoes? That the pediatricians allow entrance into their medical surgery only with socks (which they make available to patients)? This is a normal procedure, and not only now. Should I also have to say that in Vienna they set up a single hospital for the infected and do not mix pathologies?
But now doctors in Italy are really upset with the State, with the population getting infected. Who knows where, considering the frequency with which the doctors have fallen ill? Where physician’s organization and all other health professional institutions ended up? What happened to the doctor’s department and all the other health professionals? Workers must be protected since sending them to hospital wards without relational equipment against contagion and without specific training is a serious error that multiplies the infections.
Closing people up in their own houses without ensuring them the right of health as defined by the World Health Organization is a serious mistake.
Do you really think that the problem is the freedom of Italian citizens? Runners, children walking with their mothers? Do you really think that “stay home mode” is the most appropriate solution that a Government ought to propose? No, they’re not offering anything. They’re trying to protect health by taking citizens’ health.
I do not know why in Italy two fundamental universal principles for individual protection have failed; I only know that the Italians, people of Saints, Poets and Inventors, being for this a worldwide excellence, in these decades have been making the mistake of giving decision-making positions only to those who had friends in high places, the poems became jackal journalism, and yet we brought our inventions, abroad, where there is still money for research and where divergent thinking can be still valuable.
I just feel like saying: please return to us the Italy of our history books, and if you really cannot, get out of the way and leave room to those deserving persons who have not sold themselves to their ancestors just for an extra loaf of bread.
In these weeks, with closed borders, for all Italians abroad sounds like being in exile, and yet, we’re not at war.
By Maria Quarato, author of the book: Hallucinations: symptoms or abilities? Tales of diagnostic errors, solutions, rebellion and freedom.