Just a couple of weeks ago was April 25th. For Italy, my home country, April 25th represents the day of Liberation and the official end of World War II. Usually we have great celebrations; everyone gathers in city centers to celebrate or just reunite with family and friends to have a good time, remembering the day when Italy was freed from Fascists with the great help of the American Army.
Someone has likened the COVID-19 pandemic to a war. For the most part, I don’t agree with this comparison. I was brought up listening carefully to my grandparents and other elderly folks who lived through war’s troubling times. Their stories and memories seem different: fear, suffering, violence, chaos, confusion, hunger, the need to hide just to stay alive, witnessing your parents or children taken away, and so on.
Certainly we are experiencing a really difficult period: uncertainty both in terms of work opportunities and social interactions may give us that unpleasant feeling of living on the edge. Some of us may feel as we’ve never felt before, developing anxiety and stress related symptoms.
At the same time, I have felt that we must look at what’s happening from a different perspective. The vast majority of us have a nice house, with plenty of food and the chance to continue our jobs by working from home. There is no real enemy to fight against, no one is trying to rob, rape, or use violence against us. No one is forcing us to leave our homes. No explosion is heard and no enemy’s army is seen in the streets. My intention is not to minimize any loss of life, nor the challenges of the health epidemic, but to bring perspective.
At present, while I’m sitting here writing from my home office in Modena, Italy, I contemplate what my experience might have been like had I taken leave for Tucson, Arizona where I had been accepted as an observer in the Integrative Psychiatry Fellowship at the University of Arizona. Due to COVID-19, in-person training was no longer possible. Instead, and like many others in these pandemic times, I have been able to participate remotely – a wonder of modern technology.
This new and evolving experience has made me realize that there may be one point in which the current pandemic and war are comparable: they both can lead to trauma, individually and/or collectively. Trauma can arise in reaction to any overwhelming experience where our hardwired threat appraisal and response systems kick into overdrive.
Thinking back to the first few days when it seemed that Italy alone was affected by the virus, many of us felt overwhelmed by a sense of weakness — an unpleasant fear of being left out from the rest of the world. Those first days were terrible for us, as we felt we were somehow being punished for a sort of negligence in response to the situation. Being the only nation in the western world initially and disproportionately affected by the outbreak, we were overcome with a collective sense of guilt and shame.
Then, when the rest of the world began to live what we were living and feel what we were feeling, we started feeling less alone and secluded.
Sadly, during our lifetime all of us will likely be exposed to small or big traumas, each in our own ways. We need the support of our fellow humans. We need to experience non-judgmental acceptance. Sharing our stories, being compassionate, and connecting to others are vital building blocks of survival, healing, and resilience. That’s why group therapies and group support, such as found in mind-body skills groups, have growing recognition and evidence for promoting healing processes.
Such components and techniques are used in the growing field of Integrative Psychiatry, which is a holistic approach to mental health, encompassing personalized treatments to suit each person’s needs and preferences using both conventional and complementary approaches.
I’m getting familiar with this interesting field, realizing after several years of practice in my own clinic that conventional medicine is often not enough to treat every patient’s disease. I am an anesthesiologist, pain doctor and acupuncturist practicing medicine in Italy. My clinical experiences have helped me see how important psychosocial dimensions of illness and health are and why they should never be overlooked. A comprehensive, holistic approach is not only more effective in helping those suffering from illness; it is even more professionally satisfying for the physician.
My passion for medicine and profound desire to keep growing and improving as a professional and a human being have led me to consider moving to the U.S. to study integrative medicine, a field that piques my interest but that is currently uncommon in my country.
Most of modern conventional medicine principles come from the ancient Cartesian philosophy in which the mind and body were considered as separate entities. But long before this, dating back to the fifth century B.C., Hippocrates of Kos, who’s considered to be the real founder of medicine as a science, acknowledged that disease and health are influenced by certain human circumstances and experiences. In fact, he examined his patients’ dietary habits, climate and environmental factors, as well as psychological and social elements. The individual had to be evaluated in a global and holistic, rather than particular, context.
In these days of my online observership at the Integrative Psychiatry Clinic I am realizing the importance of mind-body medicine practices before starting the doctors’ work day. The practices, which include a variety of techniques such as guided imagery, mindful movement, meditations, or breathing exercises seem to offer a fascinating piece in addition to the many practical aspects related to the patient evaluation and treatment. Prior to each day’s work discussing clinical cases and meeting with patients, we spend 5-10 minutes where one of the physicians facilitates the rest of the group in a mind-body medicine experiential activity.
The first time I joined the session I vividly remember thinking, “Wow.. this is awesome! In Italy we aren’t even allowed to dream of such a practice at work! What a great opportunity!” Then came anxiety: “I’ve never done it! What if I can’t do it properly?”
When these meditations start, however, just after a few seconds one naturally understands how to go beyond prejudices, expectations, judgments, and fears and see the practice as a personal opportunity and experiment; an opportunity to be yourself; there is no right or wrong and no one is there to judge you.
After the meditation, if you want, you can share your experience with the group. You can share what you noticed, what you’re feeling, what is on your mind or what you are experiencing in your body in terms of tension, discomfort, pain, or even pleasant experiences, whatever.
Meditation may seem like a simple gesture, without sense, and at the beginning you can be confused or unable to see why it’s done or what effect it might have. But suddenly something happens. In my experience, after two weeks, I surprised myself by becoming more attentive towards my emotions and physical sensations during my daily activity and listening to the effects that different events have on me. This is so powerful! I feel stronger, more focused and grounded; the therapeutic effects of these practices should be taken into account.
It’s fascinating to share experiences and listen to others and realize how the same exercise can lead to different emotions and insights. You can recognize in others’ words and stories something familiar or relatable to you. It’s an opportunity to learn from diversity and accept oneself and others without judgment.
In this era of our lives when most of us are in lock down, it is particularly important to know the power of sharing, of listening, of being in the present moment and part of a community. Dealing with stress and trauma together, sharing thoughts and experiences, and learning how to be more mindful are gifts to ourselves and those around us.
I’m looking forward to starting my experience with an online mind-body skills group as taught and delivered by The Center for Mind-Body Medicine and starting a new and fascinating experience to try to reach a deeper level of connectedness and awareness. More will be revealed…
Special thanks to Noshene Ranjbar, MD, Assistant Professor at University of Arizona Department of Psychiatry for her support in writing this piece.