I am standing in front of my bathroom mirror trying to control my breathing. It is the morning after the election, and I learned the results when I woke about one hour ago. I had gotten up, showered, dressed, prepared breakfast and school lunches, ran to school drop-off, and returned home, a bit of a wreck with a few minutes to spare.
I look down at my watch. It is 8:06, and I have exactly nine minutes to cry intensely, and then compose myself for my first therapy session of the day. I count as I breathe and command the tears to go away. I remember a professor in graduate school telling us that best thing you can do for a distressed patient, before you say or do anything else, is to remain calm. “And how in the world am I supposed to do that right now?” I imagine yelling at him.
I know, of course, that the concept is important. I want to be that therapist from the movies, grounded, unclouded by emotional thinking, creating a tranquil space of openness, curiosity, and equanimity.
But the truth is that I am lost somewhere in the space between the idea of who I aspire to be and the inarticulate jumble of distress lodged in my upper abdomen. Time is of the essence. With two minutes left, I am still breathing rapidly and I am definitely not calm. I splash water on my face, apply concealer under my eyes. Get out of your head, I tell myself. Open your charts, open Zoom, refocus outwards, this day is not about you. Go.
The day moves quickly as I jump from session to session. I knew the topic of the elections was going to come up in sessions, as tends to happen when large social or political events of scale and consequence strike. For many, the election results are front and center, the only topic that we discuss. Emotions are generally loud: despair, rage, disappointment, fear, disgust, hopelessness. Past histories of trauma and abuse are rekindled.
Because I live in the Boston area, many of the patients I work with share similar perspectives to mine. Hearing words I agree with feels connecting. It brings some sort of unspoken synchrony to our experience, patients articulating words that my mind has not yet had time to verbalize. I need to understand the particular meaning and impact the election results have had for patients, and how it plays out in their lives. For those patients who have generally similar perspectives, it is easy to empathize, but I do not want to fall in the trap of overidentifying, assuming we think the same, and risk losing their personal experience in the process. I have other patients who I know feel differently than I, and it is important for me to acknowledge and respect their perspectives too.
I imagine what therapists all over the country are hearing today and get that I am only seeing a sliver of the emotional spectrum. Other patients and therapists, I imagine, feel tremendously upbeat and invigorated, a reality that I would have a hard time sitting with. In other sessions, the election is mentioned in passing or not brought up at all, and we pick up on the theme we left on last week.
I am uncertain how to handle themes of angst and existential dread. Some patients bring up the end of democracy as we know it, mass deportations and the threat of nuclear war. I would likely have questioned these scenarios a few years ago and urged us to question the factual basis of this anxiety. Today, these thoughts don’t seem all that far-fetched. “What do I do now?” a patient asks in between sobs. “What is going to happen to our world? Are we going to be OK?” It is a strange feeling to acknowledge that my answer is “I don’t know.” I think in particular about patients who I see from vulnerable communities with whom I work: LGBTQ+ people, immigrants, undocumented migrants, members of minority groups, and others who have been attacked by hate speech. I think it is likely many of us will not be OK.
A 30-year old-woman, who gives me permission to write about her, voices her anger. She tells me about how naïve she was to what she now sees as people’s lack of humanity. Over the past year, she has suffered tremendous angst, depression, and rage about being unfairly terminated from a job where she had been sexually assaulted. “The world is so backwards. I’m at a loss. I just don’t know what to say,” she tells me.
The outside world interlaces into personal lives; the result of an election is a fact, the way its reality comes to weave itself into life is a deeply individual experience. I validate her experience, saying something to the effect of it being hard to trust the world. I talk about needing to stay grounded, respecting the emotional process, refocusing on what is meaningful, coming back to the present, coming back to what we can control. I am staggering to string some words together. I am doing therapy feeling like a cartoon character that fell out of the tree with twinkling stars twirling around my head. I am working in a daze and notice that I fumble on my words.
Later in the day, I reflect on the wisdom patients have summoned to cope with intense emotions: “I’ve stopped watching the news.” “I made a resolution that I’m going to be kind to others.” “Rather than staying powerless, I’m going to focus on the things that I can do.” “I spent some time outside and decompressed.” “I cleaned.” “I called my friends.” “I held my cat.” (What a great idea, I thought, and reached over to pull my own cat onto my lap.)
A supervisor once told me that when working with patients experiencing strong emotion and turmoil, we must first stop and take a breath. I lie down at night with my 8-year-old and listen to him breathe as he falls asleep. I hold him close and finally my breathing slows down a bit. There are choppy waters ahead for all of us. One step at a time, I think. For now, I continue to try to breathe slowly. And I prepare for four years of telling my clients to do the same.
Sarah Darghouth is a clinical psychologist in the Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School. She also has a private practice in Brookline.