How are you doing? I feel the weight of the world so I reached out to some experts on trauma to offer some insight into navigating our personal challenges, our encounters with the anti-maskers, and more as queer people. These are really long reads because the topics are intense and novel (couldn’t resist.) I hope you find this useful.
I actually asked quite a few folks, but it was not easy to find someone willing to respond. And with the shuttering of so many LGBTQ organizations and supports, I decided to reach out to Allies for Health + Wellbeing (formerly the Pittsburgh AIDS Task Force.) I do not personally know Matthew, but was referred to him by the Executive Director of the organization. I was hoping to also include the physical health perspective, but their staff person wasn’t available.
This is Matthew Reinhart from Allies for Health + Wellbeing.
Name: Matthew Reinhart
Your Role at Alllies: Mental Health Therapist
How do you describe your identity? I identify as a cisgender white gay male
Tell us about the ways in which COVID-19 has impacted your work and the clients affiliated with your organization. Covid-19 has impacted all of the clients I am seeing for individual therapy. There has a general increase in the number of referrals asking for support whom attribute their mental health concerns directly to the fall out of the pandemic.
The population I work with spans many different groups, so their experiences vary. All in all, my client’s decompensation patterns have been ramped up, we are seeing higher levels of anxiety, depression, and general malaise around significant existential questions about their futures both during and post pandemic. Also many clients are requesting phone or tele-health sessions in order to avoid exposure while in public/on the bus, etc. While this is definitely not ideal in regards to building rapport with a client in the therapeutic setting, their concerns is understandable and we have to be flexible in these situations. Meeting my clients where they are at is important in this work, so I must also adapt to the circumstances.
There’s been a lot of attention on face masks, a very important conversation, but I’d like to ask you about social distancing, that is maintaining at least a 6 foot distance from people who are not in our households. My understanding is that masks and social distancing go hand-in-hand, that the priority is keeping distance and the mask is part of that plan. But we struggle as a society with keeping our distance. How is this manifesting in physical and mental healthcare? Great question. We have new protocols for both clients and staff entering our agency. Everyone has their temperature taken when they arrive, and are screened before they are allowed up to the office. They are given a mask if they do not already have one, and are asked to keep it on during their time at Allies. In regards to the therapy that I am doing, It can be awkward to do talk therapy while we have masks on but we are making the best of it. We maintain the necessary social distancing in my office, and continue to wear masks. We are also regularly disinfecting the space with a Moonbeam UV light system. It is truly reassuring to have leadership here that is making these investments in our agency; many other places would not have the means or motivation to develop and implement the policies and procedures that Allies has.
I’ve realized lately that our ideas of “being safe” in regard go COVID-19 are not always in sync, causing more stress because people trying to plan or discuss an activity are talking past each other. If you start with the basics – stay home as much as you can, 6 foot distance, wear a mask, wash your hands – how do we end up distorting that into so many versions of safety protocols? Is that a lack of information/awareness or something emotional? This is a question for the ages. How are so many people interpret a basic set of instructions so differently? The short answer is cognitive dissonance combined with a varying set of circumstances from person to person.
As human beings, we have this nifty trick we do where we can believe one thing, say another, and then behave in a way that contradicts everything that came before. There is no easy answer as to why this happens, but the consequences have real world impact. The distortion of safety protocols may also be influenced by some rather unpredictable variables or internal machinations. Can certain person become less vigilant over time? Yes. Are there political motivations? For some people, of course. Do people just want to be contrarians or provocateurs? Definitely.
95 percent of the people I see are already living with HIV and in turn are acutely aware of their compromised immune systems. So in general my clients haven’t expressed many qualms with mask wearing, social distancing, or other recommendations. But I would not go so far as to say that they are completely unannoyed with the new normal. Like anyone, being forced to incorporate a new behavior or habit is not easy.
How do we bring the COVID-19 conversation back into sync and remind each other that we all want to be safe? In my practice, I strive to validate the experience of all my clients. In general, people want to talk the talk of being empathetic and understanding of other people’s experiences. But when it comes time, walking the walk is a very different situation.
If we can overcome our own justifiable anger and frustration with more patience, empathy, and a little education, the world might be a slightly better place for everyone. When I see these videos of people behaving in problematic ways, I first ask myself why this person would be motivated to act this way? While it doesn’t excuse their behavior, it adds context and tempers one’s own tendency to react.
Social media is another facet of this pandemic. I will see someone post photos of the kids giving Grandma “a quick hug” or spending unmasked time with other children who are not in their households or taking mini-vacations. Then they seem truly oblivious to the fact that we saw that content and adjust our plans to interact accordingly. It seems like a form of denial coupled with desperation. I’m glad I have the information because this is not a difference of opinion. But that disconnect between promoting magic memories on social media and making healthy choices is noticeable, perhaps increasingly so. And it fuels the divides. It is almost like people cheating on a diet only the impact has the potential to hurt more than your own health goals. If this pandemic has shown us anything, it has highlighted our tendencies to behave badly, break our own rules, to make exceptions, engage in denial, to be hypocritical, etc. We as human beings are rot with cognitive distortions, emotional thinking, and other problematic dynamics that you just identified. Under normal circumstances, the fallout from this is rather minor, most of the time.
Unfortunately, like you referenced, when applied to COVID-19 situation, the consequences are that much more severe. Our own emotional reaction might tell us to brow beat, shame, and capture the whole thing on video; I question whether or not this is the best approach. It only ends up alienating that person and more than likely solidifying their behaviors on principle. Like with anything, there is a learning curve and as a result, people who push back. This is an expected dynamic and we should have ways of approaching these situations that exhibit the same kind of patience that we would want if the roles were reversed.
Another trend I’ve noticed is this idea of people whom we “can trust to be careful” or are “clean” – smart, educated, science believers who still think they have a magic crystal ball based on their emotional relationship with the person to ignore the safety protocols. It is literally an asymptomatic disease so no one is clean in that sense. And this language is dangerous itself, creating a false sense of security and creating a class of “unclean” people” – never a good thing. How does dividing people in our lives but not our households into clean/safe categories impact our wellness as individuals and communities? Dividing people in any context is bound to have bad outcomes. And in this situation the distinct camps become far more entrenched than they would with a simple disagreement or argument with a stranger on the bus. This is a very slippery slope, where we will end up policing each other’s behaviors. Its difficult to find the dialectic here, where the opposing forces are using such vitriol like you referenced, i.e. “clean” vs “unclean” people. I believe it exacerbates an already problematic divide, and in this situation they seems to line up with political ideologies, the particular source of news/information that person utilizes, and at times their socio economic status. Looking at a given individual as more than their view point on this topic can help humanize that person, and in turn give some breathing room to talk on a more meaningful level.
I don’t trust anyone but my partner with whom I live and can confirm has been keeping to the protocols. I’m conscious that risks I might take will impact her. She has to assume a certain degree of risk through her work activities and she’s the primary responsible adult for her 80-something mother. So we have to make a lot of decisions based on what might happen not just to us but by extension to her coworkers and her mom, much less other other family, friends, neighbors. It is so hard. Sounds difficult for sure. Like with any life circumstances, we all have to develop some level of distress tolerance. One can retool this idea in relation to COVID-19; in other words, to make decisions to keep one’s self safe while not ruining your own life for the sake of safety. What makes this even more difficult is that we don’t know the full implications of this virus.
That’s rhetoric that reminds me of conversations around HIV which of course is not airborne nor transmittable by casual encounters. Still, are there public health lessons we can transfer from managing HIV to managing COVID-19? There is a lot to learn from those who have dealt with HIV. First off, in the early days (i.e. early 80s) when HIV wasn’t fully understood, people made very problematic assumptions about what HIV was, for example it was called the Gay Cancer, assumed to be transmitted via hugs/kisses, and people brought the religious angle into it, asserting that it was god’s punishment for something. All of these assumptions were based in nothing scientific.
People are doing the same thing when it comes to Covid, which is very problematic. For instance the disease does not look the same for every person, therefore treatment protocols will vary. Second, the other component of this is related to treatment outcomes. It has taken decades for HIV treatment to become what it is, going from it being a death sentence to a treatable medical issue. Obvious questions develop: Will COVID have a vaccine? Will there be better treatments for it? Will we reach herd immunity? All great questions, but our desire for expedience will not automatically provide an outcome to our liking.
There is undeniably a new level of community trauma that comes with living through a pandemic. We have lost so much, we are isolated, we are afraid, and we do not have a steady hand guiding the nation through this crisis. How does that trauma manifest itself in our daily lives? The first and most measurable way that trauma manifests itself is in our ability to maintain activities of daily living. These habits and behaviors, which most of the time we take for granted, are the first things to be effected by one’s mental health decompensating, i.e. poor hygiene, inability to maintain routine, decreased appetite, sleep disturbances, and a general difficulty in general functioning.
As trauma effects someone more severely, we see other symptoms develop, i.e. flashbacks, panic attacks, unexpected triggers, nightmares, among many others. Understanding and having insight into your trauma, for example: awareness of your triggers, the frequency and severity of the symptoms, etc; can be helpful in regards to gauging when to seek out more support, professional or otherwise.
Please briefly explain the distinctions and commonalities of PTSD, Chronic Trauma, and Community Trauma. PTSD is a diagnosis with a certain set for criteria that encapsulates a whole range of experiences related to trauma. Identifying trauma as chronic and related to the community is a more colloquial. Even thought these aren’t specific diagnoses outlined in the DSM, this verbal can be very helpful when unpacking and processing through said trauma. When any mental health issue is chronic, is implies a certain length and severity that under the best of circumstances is difficult to cope with.
When trauma effects an entire community, the implications can be vast. It may have an effect on the culture of a community, their resilience, and prompt intergenerational trauma. All of these issues intersect with one another. When fully grasping the scope of how trauma effects the lives of an individual and the society at large, it becomes clear how important it is to be trauma informed and competent both personally and professionally.
A particular form of trauma is the increasing clashes between folks who wear masks (or require them) and folks who do not. How do you suggest people cope with this? As I mentioned above, this is as very tricky dynamic to navigate for both parties. The policing that is going is very problematic. Even though we may view wearing masks as essential and common sense, the other side feels just as justified and confident in their behavior. Taking people to task, brow beating, and catching it all on camera is a recipe to escalate tensions and turn toxic very quickly, evidenced by the horrible behavior we’ve all seen online.
In most situations, one should ask themselves what their role is in this dynamic. Is it your place to correct this person? How do you approach this? How would you want to be spoken to if the roles were reversed? At what point should you walk away if the conversation isn’t going anywhere? These are basic social skills that we take for granted but are important when trying to cope and behave in a mature way during these difficult times. What frustrates me is the performative nature of some of these interactions that one sees in the media. It makes me ask: To what end?
Am I a coward for not confronting an anti-masker in public because I’m afraid of confrontation and being exposed to them? How can I constructively participate in resisting anti-maskers without increased harm? No, absolutely not. Not wanting to get into an all-out argument with a complete stranger does not make one a coward. There are plenty of reasons to steer clear of these confrontations all together. The exposure risk can be reason enough, aside from the trauma that could be inflicted from having a confrontation like this, The attention that it could draw from people in the surrounding area (like in a grocery store or on the bus), and perhaps even being motivated to avoid the annoyance of having to go down that road all together. If one wants to constructively participate but avoid harm, start at home and within your family/friend circle, set an example by doing the right thing and normalizing the behavior.
At the same time as we navigate this pandemic, we are also seeing a resurgence of efforts calling for racial justice and attention to how white supremacy shapes our institutional and individual lives. How can LGBTQIA+ folks navigate this critical need to address anti-Blackness while in a pandemic? This is a tough one. Under normal circumstances, I would encourage anyone and everyone to get out, put your energy to good use, i.e. canvasing, protesting, advocating, etc. But it is extremely difficult for anyone to do these things and feel safe, especially if you have a preexisting condition that prohibits you from exposing yourself to others unnecessarily.
It’s under these kinds of situations that we must be creative and original in our endeavors. Creating new means in which to express yourself, and help others may seem foreign but are essential. Given our dependence on social media and technology in order to socialize, something as simple as sharing a post about a protest or information about how/where to donate funds/materials/etc to a good cause can be a step in the right direction. Small acts of kindness and advocacy may seem innocuous; but if you can sway one person, it can lead to a butterfly effect that can create real change.
For our readers who may not have this information, what are some of the typical trauma symptoms we might see in our individual lives if we haven’t processed our traumatic experiences? As before, the first signs of one’s mental health decompensating (getting worse) is the decreased ability to engage in activities of daily living, i.e. hygiene, sleep (too much or too little), eating/drinking, and general functioning. More specific signs of trauma include but are not limited to ruminating about a specific events, being triggered by sensory input i.e. sounds ,smells, tastes, etc that elicit memories of a traumatic nature, flashbacks, nightmares, dissociation, racing thoughts, fight/flight response, physical symptoms like pain or tingling in areas associated with trauma, etc. If you are experiencing any of these symptoms, it may appropriate to reach out to professional help in order to reconcile these traumas that are causing you problems.
How might trauma impact our physical health? And how does our physical health impact processing (or not) our trauma? It completely depends on the individual in question and how their mind/body reacts to trauma. Studies are showing that we store the “data” of trauma in both our minds and our bodies. One might experience pain or discomfort in certain areas of their bodies, other are more cerebral when it comes to internalizing trauma experiencing more intrusive thoughts or other symptoms. It a case by case situation.
In all cases, our physical health definitely impacts our ability to process; in simply terms, if you feel sick to your stomach how able will you be to start unpacking and reconcile significant traumas? The likely hood isn’t very high, and given that any specific symptom could be a results of that said trauma, makes the processing work that much more difficult. It is important to point out that professional help is at times required to do this work.
What resources are available to regional LGBTQIA+ folks who need support with trauma related to COVID-19 or in general? The resources are out there, but it can take some searching and leg work to find what you need. The are countless therapist out there who are eager to see clients, both in private practice and at non-profit agencies. Under the current circumstances, I would not limit yourself to places that work primarily or exclusively with the LGBTQIA+ population. Many times, there can be long waiting lists at certain places like this, so keep an open mind. If you have insurance, and can afford a co-pay, working with a private therapist could be the best fit.
Go on PsychologyToday and search for a therapist who accepts your insurance and who states that they are competent working with members of our community. You can also call your insurance company and get a list, but sometimes this process makes it more laborious. If you are in a situation where you need to work within the bounds of public assistance, going through the larger mental health agencies likes Western Psych or Pittsburgh mercy’s outpatient programs might be a good fit. They have the most resources and can means in which to see a psychiatrist more quickly than the other non-profits. There are plenty of other agencies to work with as well, i.e. Persad Center, Central Outreach, among others, but the wait lists can be long.
If you could add one resource of any sort to that mix, what would it be? In my recent experience, those who are in recovery are really struggling to maintain supports and attendance at AA/NA meetings. There are many online and zoom-oriented meetings to attend. While they might not be the same as in-person meetings, they are an extremely helpful supplement. https://www.pghaa.org/online_mtgs.pdf
Is there anything you’d like to add? I’ve said a lot, but if anyone wants to reach out for more information or to ask questions about navigating the mental health services field, please feel free to call/email me.
Where can readers find ALLIES online and via social media?
Thank you, Matthew.
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