A Few Certain Things About Living With Uncertainty

For some time, I’ve been meaning to write about the mounting situation of living with uncertainty, but I was uncertain about when exactly to do so. I have read many op-eds from the CDC, The Washington Post, and The New York Times that come daily. Just when one of these articles seems to have a pretty good bead on the situation, the situation itself changes radically.

At the start of 2022, the surge in Omicron infections hit everyone in some way. For my colleagues and me, preparing to reopen our offices suddenly felt risky again. I had expected to begin seeing patients in person, in my office, first in September and then in the new year. Now I have to say: “Who knows?” The oscillation, the isolation, the dawning of new hope that just maybe we are seeing the light at the end of the tunnel, only to see it disappear again: It’s safe to say we are all tired of this.

We are living during a time of extraordinary uncertainty: a kind of never-ending wash of feelings, of contradictory ideas about what we should do.

What we know:

While it may feel like we can count on nothing, here are a few certain things about this uncertain era.

It’s not over yet. My colleague, Jeff Taxman, serves on the COVID-19 Advisory Committee of the American Psychoanalytic Association, which I co-chair. Back in 2020, he surmised that the most difficult phase of this pandemic would not be the beginning when it was “all hands on deck,” but rather during the long haul of the pandemic. Between the ubiquitous mental health crisis, supply shortages, and medical professionals facing everything from infection to burnout, we are still in the thick of it!

It’s not just you. The pandemic has been hard on everyone; today, perhaps more than ever, we are all facing some version of the same struggle. We all have chronic and repeated doses of PTSE: post-trauma stress experience. It’s not a disease but a shared experience of continuing social and personal stress that affects our patients and us.

No one anticipated the toll on the unsung first responders, like delivery and food workers, meat packers. We could anticipate that any large-scale crisis would fall most heavily on the poor and low-resource population, but I think it’s fair to say that no one could foresee the crisis in education, supply chain disruption, and the grinding mental health crisis that have now come to pass. And, in the beginning, we could not anticipate how political polarization would skew the entire picture, the entire country, and so much of the world.

Teletherapy is here to stay. In a way, my closest colleagues and I were better prepared for the mental health needs than many. We have been working online for the dissemination of our training programs, for seeing patients, and for supervision. We know it can work for most people, although less well for young children.

We have been involved in sharing the learning that our experience has offered, and that has kept us feeling relevant, and for the most part, still able to work effectively with our colleagues, students, and patients. The Sigourney Award in Psychoanalysis that Jill Scharff and I received at the end of last year was in recognition for that aspect of our work in disseminating psychoanalysis, psychotherapy, and psychoanalytic education widely in the United States and to many other countries, including China and Russia. Teletherapy is and will remain a central component of the mental health landscape.

It’s not the same (and we all know it). We, too, are subject to the attacks of uncertainty. Yes, we can use Zoom, and I personally do so pretty much without the “Zoom fatigue” that so many experience. But we long to have our patients back in our offices.

We accommodate. When I feel I cannot treat a child effectively individually on Zoom, I invite the parents into family sessions (a mode of therapy I value highly), and, while that is not a completely satisfactory substitute in some cases, it keeps the work going well enough. But for many patients, there is something missing, and having them in the office would help a lot. I know they miss it. And I miss it too.

No one is at their best (and that’s okay). Any parent will tell you that the few hours after school can be a time of tantrums, willfulness, and poor listening; psychologists call this phenomenon “restraint collapse.”

As we face ongoing restrictions in our lives, we may all experience our own version of restraint collapse in one form or another—and, of course, this can be especially true with our children. School administrators, state and city leaders, all waver with each accumulation of changes in the COVID and Omicron picture, with the fatigue and hopelessness they face in administering and governing.

Everyone is wondering the same things. When will this be over? What will life look like after the pandemic? Will I always feel this way? This is the despair that makes so many things worse—the desperation on all sides, the set of new hopes with each hint there may be new treatments—and then the waves of new infections and disappointment.

As mental health therapists, our job is to help our own patients with this situation of cascading uncertainties: to zero in on the things we can still count on and build from there. We have the difficult job of treating those who suffer the most: those living with depression and suicidality, the mental health sequelae of physical illness, and the effects of strain on families when schools shut down. But we also have to speak, to ourselves and our patients, about the long-haul mental health toll of living in a world with so much uncertainty.

What to do about uncertainty:

While no one has the answers, here are some simple steps to look after yourself and your clients right now.

Get plenty of peer and social support yourself. Regular social events, in person or online, will create a routine in your life, which will create a feeling of normality.

Take time to power down. Remember, it’s not just you: You are not immune from a situation that affects us all. Make a conscious effort, every day, to step away from screens and recharge your nervous system.

Look for patterns. Keep an eye out for how this situation recalls, resonates with, and exacerbates old issues for patients. It is not uncommon to see regression, particularly in younger clients.

Normalize pandemic fatigue. Your clients need to feel safe before opening up; that starts with validating their feelings, however odd it might feel to them.

Celebrate resilience. We all have the capacity for tremendous resilience. Celebrate your clients’ successes, however small they may seem in the moment.

We will need all our resources, all our resilience, to get through the tail end of this mental health pandemic and thereby to be fully available to help our patients survive and thrive. Of that, we can be certain!