I have noticed a disturbing trend with my mental state since this pandemic began. I want to see if maybe you have felt it, too. It has to do with the social contact aspect of COVID-19, or lack thereof, I dare say. It has been six months, now, since I have had appropriate physical contact with my doctor, meaning traditional means of greeting, meeting, and parting. It was a progression. We have always (traditionally) used the handshake to secure the relationship at the end of a session and bid each other farewell and until next time. When one of us was sick, we would fist bump or wave farewell, and then use some hand sanitizer to make sure we did not spread anything to one another. That was before the pandemic really got a head of steam up. When it began to affect Seattle, where the Doc’s medical school rotation students came out of, the elbow bump was used. That lasted for a period of two weeks. Then the pandemic hit the U.S. full-on, and no contact was had. At least we still had eye contact and the physical presence of one another in his office together. Lasting for only one more week, physical in-person sessions were transferred at first to a FaceTime telemedicine format (with my permissions regarding HIPAA), and then to a secure Zoom telemedicine platform with passwords and such as protections. That has been the “new normal” for me in my dealings with the Doc on a weekly basis for a period of time going on a few months, now.
So how has this affected me? I have noticed some disturbing trends. First, in a telemedicine meeting, one is never really making eye contact because the screen that you are looking at the other person on is below the camera in most cases, and people do not look at the camera when they are speaking. They are looking at the screen. This triggers something disingenuous in my interpretation of what is being communicated on an unconscious level. It also makes me consciously question the genuineness of the person on the other end. Now, with the Doc, I fight these thought tendencies because I know him, and I know him very well. He really goes the extra mile for his patients and genuinely cares about their well-being, whether they have treated him well or not. I still fight those feelings, though. So, there is the eye-contact, or lack thereof, thing. Another thing is that you are not in the separate, safe environment of the doctor’s office. Now, knowing the Doc, I know that he does not have a bunch of people off-camera listening in on our session, but I cannot secure that kind of privacy on my end, no matter where I go. I do not have my own safe, secure space in which to have a session with my psychiatrist, and that, I surmise, is the case for many psych patients, much less patients in general. Third, I feel like the relationship is weakening. The therapeutic relationship is breaking down due to the impersonal way in which we even meet. Yes, it is great to see each other and talk to each other in real time, but it is too much like TV to me…and I do not watch TV. As far as the relationship goes, I get sent a code with a password by the office manager (whom I also miss seeing), sign on when it is “time”, and wait for the “host” — the Doc — to connect and have a chat on the computer. This may be something that he is used to, but it is not something I am used to. I am not sure, at this point, that I would feel like I could call him in case of an emergency, and that is not only dangerous, but an indication that this isolation and fake meeting media has taken a terrible toll on one of the most important relationships I have — the therapeutic relationship of a severely and chronically mentally ill patient with their therapist/doctor. My safety net is in jeopardy. This is NOT, and let me repeat NOT, the Doc’s fault. He is doing everything he can under the circumstances to keep his patients healthy and alive during this pandemic. Psychiatric patients, especially, though, need that physical, personal, interpersonal interaction with a real human being.
Now, as not to demonize our wonderful technology during this time of crisis, I want to say that my ability to take classes online and the advances that I am seeing in communications over the internet and such are great strides that should have been brought into advancement long ago. Better late than never, though, and we have taken a giant leap into the 21st century with our technology for the betterment of most of mankind in attempting to keep our humanity during the SARS-CoV-2 worldwide pandemic. That is both admirable and a good sign. That means that we, as human beings, are coming together and focusing on what matters instead of bickering over the finer points of whose political conduct is the most reprehensible on the golf course. For that, I am glad.
Let me make it clear that I am not slamming technology. It can be used for tremendous good in the world, and these views are only my personal opinions and feelings, which I am entitled to. If you disagree, that is fine. Perhaps your situation differs from mine. As a matter of fact, I am almost positive that it does in some ways, and probably very important ones. Take this as an endorsement of the continuing role that technological advancement can play in our daily lives to keep us safer and make us more intelligent. Take this, also, as a condemnation and a warning against allowing computers to be the end-all in socialization and communication once we are able to safely do so in person once again. Life is better lived in full color, with handshakes, eye contact, and real tears. We must keep technology a tool and not make it our way of life when it is safe to do so.