Clare Slaney Counselling Home

27/5/2020

Returning To Face To Face Work

In writing this policy I’ve tried to keep as up to date with research as possible, bearing in mind that C19 is a new virus and new knowledge is emerging all the time.

At the time of writing the UK has the largest number of C19 deaths per million people in the world.

London seems to have lower rates of transmission than some other cities though the virus is still very active. In other pandemics a second increase in infections and deaths has occurred when a population returns to normal life.

The impact of C19 can range from no symptoms at all, aches and pains, long term respiratory problems, stokes, heart attacks and other blood clotting problems, to multi organ failure and death. Being ventilated entails being put into an artificial coma and having a 23cm tube inserted into the trachea. Families of people who are terminally ill, or dying from C19 are not allowed to visit their loved ones and those people will die with a very kind stranger by their bed. Recovery from C19 is by no means straightforward and, being a new disease, not well understood.

People can carry the virus without having symptoms but still be highly infectious.

The viral load – how many viruses are in the air – seems to become critical at around 15 minutes in a closed space, even if the 2m exclusion zone is maintained.

"Given how little is known about the production and airborne behavior of infectious respiratory droplets, it is difficult to define a safe distance for social distancing. Assuming SARS-CoV-2 virions are contained in submicron aerosols, as is the case for influenza virus, a good comparison is exhaled cigarette smoke, which also contains submicron particles and will likely follow comparable flows and dilution patterns. The distance from a smoker at which one smells cigarette smoke indicates the distance in those surroundings at which one could inhale infectious aerosols. In an enclosed room with asymptomatic individuals, infectious aerosol concentrations can increase over time. Overall, the probability of becoming infected indoors will depend on the total amount of SARS-CoV-2 inhaled. Ultimately, the amount of ventilation, number of people, how long one visits an indoor facility, and activities that affect air flow will all modulate viral transmission pathways and exposure (10). For these reasons, it is important to wear properly fitted masks indoors even when 6 ft apart."

For me, wearing a mask while being with a client complicates matters more than working online without masks. If a client begins crying how do they manage that while wearing a mask? Using a mask to to protect against C19 is complex. And this is before any psychological considerations.

If I am asymptomatic, have the virus and come into work I am highly likely to transmit it to a client. Both of us, using public transport, will be at very serious risk both of infecting others and being infected.

Hairdressers, pubs and restaurants have been told not to open before July 4th "at the earliest" and I'll review my decision to remain working on line then.

Worldwide, the huge majority of therapy clients have transitioned to either phone or video work and have continued to find it useful. Many clients are saying that they appreciate the time saved in not having to travel to and from therapy, some say that they can feel and say more because they don’t have to immediately adapt to the world outside of the therapy room, and feel less embarrassed about crying in their own home rather than in their therapists office.

For me, face to face therapy is the gold standard and video therapy the silver gilt. Nothing is worth risking your, my own or public health when it can be easily protected.

25/5/2020

Life On The Other Side Of Normal.

Increasing numbers of us are becoming restless to get back to normal. What 'normal' means in this context is a return to life that was exactly the same as before, which is reasonable when that means being able to embrace family and friends, to treat other people as people rather than potential vectors of infection and to go on holiday. But the reason we're being told to get back to work is to service the economy.

Like all other nations Britain has been up to its neck in debt since national debt was invented. We began paying off our WW1 debts in 2014 and still haven’t paid off those incurred by the Napoleonic wars. The equivalent of £17bn was paid to 46,000 UK slave owners in 1833 as compensation for the loss of their human 'property' which was only paid off in 2015. Running a national and international economy is not like home budgeting, economics is entirely based in ideology, not maths. At the end of WW2 Britain's debt exceeded 200% of GDP the country was in ruins and we created the NHS, a decent welfare system and built nearly a million council homes. That was profoundly abnormal. Our current debt is 85.2% of GDP

So while we do need to speed our economy up there’s no natural law - like the sun coming up or the inevitability of death - that says that nothing must change. C19 has illuminated just what a choice “normal” is. For years, disabled people have been saying that they can work and study effectively from home and have been told that it would be too difficult to organise. They’re also unwilling experts in the effects of social and cultural isolation yet within the space of two weeks museums, theatres, galleries, opera houses and other institutions became accessible to everyone. Instant experts on screen fatigue are being consulted by business keen to reduce their liability, while disabled people have been managing it for over two decades.

Two women a week are routinely murdered by a current or ex-partner and under C19 those numbers have more than doubled: are we content to return to normal?

Of course children trapped in abusive households must be rescued, but hasn’t that always been the case? We didn’t seem to care as much about education being a respite for them pre-pandemic.

Children must be educated but we’ve clearly seen that education’s current foundational purpose is childcare so that both parents can work. A child’s need for loving, caring touch and attention can be provided by family if all members of the family don’t have to work all the time, and if the family is more than units of isolated couples or single parents. Extended families were normal before the 1980’s, then we were told to 'get on your bike' to seek employment as a means to avoid being identified as a scrounger, and atomisation became the new normal.

What is not being talked about is the very positive impact lockdown is having on mental and physical health for a great many people.

Commuting is an expensive, dismal stress and gaining two hours a day to do with as you please is very welcome. Workplace bullying has been an epidemic from before the Industrial Revolution and working from home offers some respite from it: physical spite is reduced to zero, gossip is limited. While some research shows that some people find the social aspects of working life great fun, more research shows that when fewer leading questions are asked and more time is given for respondents to answer fully, working culture thrives on purposefully constructed competition. For most of us work is a burdensome toil that’s performed for a sense of identity rather than income, more panopticon than anything else.

Quieter voices are daring to say that lockdown has offered them time, peace, pleasure, privacy, opportunity. Never before have parents been expected both to work and to educate their children and many, realising how unreasonable this is, have prioritised domestic harmony over competitive productivity. Educating their children has less to do with comparison emerging as a period of mutual curiosity, pleasure in time spent together and new conversations – nothing heavy, just having the time to talk with each other about anything at all, agenda-free.

Children are relaxing, resting, playing more, discovering boredom and absolutely relishing being with their family.

For these people walking through deserted streets is delightful not unsettling. As a middle aged woman, I can tell you that a 2m-exclusion zone, even if seldom respected, is a joy. I can walk in a straight line rather than having to constantly calculate whether someone has seen me or if they’re going to barge into me. The cessation of construction, traffic and other human noise allows birdsong, the sound of the wind or rain or even – rare as hens teeth – silence; not boring or disconcerting but a balm. These quieter voices are saying that they greatly appreciate the time to think, to observe - not to fulfil a quota of ‘mindfulness’ but because they would like to spend 5 uninterrupted minutes looking at, listening to, being with something. For them, the routine of waking, working, eating, sleeping and the organisation that supports it all, has fallen softly and naturally into place without the noisy demands of an extravert, neurotic society warping the authentic shape of their lives. Their stress levels are way down.

And many say that that they won’t share their contentment too widely because they’ve been accused of not caring about people dying from C19.

We live in a world driven by other people’s anxiety and inability to be still, to endure or even to be aware of the noise in their head. Therapists are noticing that some patients who, pre-C19, were anxious or depressed are now much less so. What was making them anxious and depressed was the manner in which they were forced to live, utterly against their nature. These are not dreamy poets, they’re ordinary people who are unable to warp their nature sufficiently to feel comfortable in the world. Neither are they particularly privileged: I’ve spoken informally with middle managers, bus drivers, horticultural, restaurant, retail and local authority workers and precarious freelancers from a great many sectors.

Perhaps most interestingly people on benefits are suddenly able to relax. Freed from the bitter enmity of the DWP they have the space to recover and to seek opportunities in a very different world. This is a world where 1.8 million people suddenly had to apply for Universal Credit and where everyone is forced to have a small taste of the very curtailed life that claimants must endure full time. Bear in mind that almost overnight the DWP was able to increase the standard rate of UC and local housing allowance, issue 700,000 advance payments, make statutory sick payment available from day 1 of illness and be generally agile and helpful, so that new claimants really are not experiencing the shock and cold fear of being subjected to a sadistic sausage factory of poverty and contempt. But every little helps.

The world that benefit claimants, the disabled, the working poor live in is now somewhat shared by all and it’s not a ‘lifestyle choice’ for any. Growing numbers of ordinary people are discovering that there might be a choice in the way we move forward, that there is life beyond commute/perform/repeat; that family life can be rich and rewarding; that the majority of children and parents thrive most of the time when they're allowed that time; that boredom can be amazingly creative. How brutally abnormal life has become when we have to be reminded that sleep is necessary, not an inconvenience or luxury but as imperative as water.

As pressure mounts for a return to normal, have the bravery to listen to the voice that resists it, not through fear but through determination to make a life that’s better for you, the you that is more than a cog in a machine or an economic unit. You’ve seen what happens to cogs and units that are considered worn out or unproductive: you’re worthy of better than that. Everyone is.

9/5/2020

Returning To Reality.

An article about the neglect that BAME people experience in my borough was posted to a Facebook page for locals a couple of days ago: “Kensington and Chelsea's unemployment rate is 6.7%, which is within the lowest performing third of all the London local authorities. Additionally, for bad/very bad health and limiting long term illnesses Kensington and Chelsea's poorest wards find themselves in the worst 20%.”

The first reply to it began with “Absolute bollocks!” and went on to detail how wonderful it was in the good old days.

North Kensington was a slum until about 35 years ago. When the piggeries and potteries of the 1820’s where people “were found to be living at a density of about 130 to the acre, and the number of pigs was 'upwards of 3000'..” were finally demolished the only way money came into households was from women taking in laundry . Rachman and other slum landlords made a fortune here on the back of brutal racism, men ruled the bombed out streets and local murderer John Cristie was able to hide bodies in the walls of his home.

What the poster was remembering is fiction. Perhaps his family and neighbours were great fun and helped each other out as most very poor families and neighbours do, because not to means absolute destitution, terrible isolation and scapegoating. You all stick together because otherwise you all fall apart.

Communities remain tight here, there are fewer postcode gangs than street- or building gangs. Under stress, identity bases itself more on who you are against rather than who you support. All communities are built on exclusion, often much more so than inclusion.

The divergence between reality and belief is nothing new, we all do it all the time and it’s so powerful that we often don’t know that we’re doing it at all. It’s how advertising works: advertisers tell us what they want us to believe via actors pretending to be people who are fictional, aspirational versions of ourselves. So it is with Covid 19 deaths. We have only a vague idea how many people have died from Covid 19 because either C19 has to be mentioned on the death certificate or the deceased has to have been tested for C19.

What we do know is that we have the highest death toll from C19 in Europe. Immediately that was announced, rebuttals emerged about population densities and evidence bases but there’s a very stark contrast between the soberness and shock with which the UK observed Italy’s motorcades of corpses and the ways in which we’re responding to a near doubling of that in our own numbers.

Therapy is at heart an opportunity to examine from all angles what you believe to be true. Distress emerges when beliefs become intolerably strained and one remedy for that is a doubling down into those beliefs. People who continue to retreat in that way are much less likely to seek therapy than those who are instinctively more curious. A 30 second internet search disproves the Facebook poster’s beliefs but he’s not interested in reality, his need is to hold on to his identity because that identity is spun glass fragile and he fears losing everything – friends, respect, social life, support, perhaps even family and personal safety if he changes his mind. He depends on the contempt of people he considers enemies because it strengthens his identity and so he invites harsh judgments. Without them, and without the support of people who hold similar, easily disproved opinions, he would naturally begin to question his beliefs and his identity.

Mr Johnson is going to tell us how his government will begin lifting C19 restrictions tomorrow. Whatever is announced, we know that until a safe vaccine is in widespread use, increases in deaths and permanent disability from C19 will be linked to a reduction in restrictions. That’s the way it’s been with plagues throughout history. It’s worth being reminded by the Director of the London School of Hygiene & Tropical Medicine, who contracted C19 in mid-March, wasn’t ventilated and is still barely able to climb a flight of stairs, about the impact of C19:

“Many people will be left with chronic kidney and heart problems. Even their neural system is disrupted. There will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives.”

There is no simple way to live with C19, any relaxation of restrictions is a balance between managing restless people, increasing GDP and exposing people to the virus in numbers that the NHS can cope with.

A useful question - a question about the value of your own and others lives - is how much does your identity depend on being a positive thinking, hard working tax payer?

Since March huge numbers of people have had the choice between contagion and eviction, many have had to continue working at minimum wage in supermarkets, pharmacies, cafes and other businesses that refused to shut down or were told to remain open. Most people who are unable to work from home are low paid key workers. It’s notable that most people who have been able to work from home are not low paid, and many have already been told not to expect to return to the office until September at the earliest. It's going to be people who need money to keep a roof over their heads, who will go bankrupt if their business fails, or whose bosses interpret 'stay alert' as an excuse to end furloughing who will be forced by circumstances beyond their control to risk their health and their lives.

In some small areas of the world there’s been a frisson of hope that society will emerge into the daylight of a post C19 dawn with a fresh awareness of what’s valuable and worthwhile, but as a nation we are showing zero desire for anything but a return to life as it ever was. C19 illuminated the cracks and strains that have existed in society for decades, from just-in-time supply lines to the highly precarious lives of low paid workers and the elderly and a few weeks spent more or less indoors isn’t going to change decades, perhaps centuries, of culture.

Nevertheless, this is an opportunity for individual people – for you - to reconsider how much you are willing to sacrifice yourself and your family, perhaps literally, so that you can maintain your identity as a passionate, committed, respectable working person. We’ve been doing this for years: both parents going to work so that they can afford to pay someone to bring up the children; despising cheap, secure social housing because only the mad, bad or dangerous to know live like that; getting into debt because only the stupid don’t go to university and ‘A man who, beyond the age of 26, finds himself on a bus can count himself as a failure.’

The ugly paradox is that the more able you are to make that choice the less likely you are to have to. But even the most prosperous can feel trapped by the expectations of their family and social circles, their employers and colleagues, other mothers at the school gates. Competition at that level can be febrile, destructive, very nearly insane and it’s based on the same premise as the belief that life in a slum was decent: “I am living this life, therefore it must fundamentally be good.”

When your life is considered or you consider someone else’s life to be less important than The Economy ™ that is not a good life. The more you argue with that the closer you move towards someone who thinks that living in a slum was wonderful.

YOUR CART

Returning To Face To Face Work

Life On The Other Side Of Normal.

Returning To Reality.

Categories

Archives

Categories