A Challenging Psychotherapeutic Journey

Psychiatric TimesVol 37, Issue 8
Volume 37
Issue 8

One can only hope today's challenges will become a “corrective emotional experience."



-Series Editor: H. Steven Moffic, MD

Early in 2020, when I first met “Rona” in my psychotherapeutic practice, I was struck by his contradictory impression. On the one hand, he was almost invisible with a timid appearance. On the other, he had an impressive crown-like outer shell with spikes that could explode if one bumped into them. But Rona, a master of disguise and transformation, was trying to evade any careful scrutiny. It was only when my patient presented himself as the silent killer responsible for the COVID-19 pandemic that he evoked my curiosity.

Accepting Rona as a patient was a difficult decision. I previously had worked with patients for whom I felt some amount of sympathy and for whom I wanted to help. Now, I was faced with an adversary I ultimately might want to eradicate.

When Rona entered my office, I immediately felt nauseated with breathing difficulties. I didn’t make much of it until I gradually became aware of the various symptoms he caused me—fatigue, sore throat, dry cough,nasal congestion, and fever. These were not the familiar countertransference reactions therapists have with their patients. They were warning signs of central importance to get a deeper understanding of who he actually was. Being suspicious of his intentions for coming to therapy in the first place, I decided to keep some distance from him to protect myself.

As it turned out, people keeping a distance from him was his main presenting problem. He felt chronically lonely. “Everyone relates to me as if I were some kind of pest,” Rona said, “as if I have no birthright.” While sobbing heavily, he added: “Nobody has ever told me they love me.”

Not being in close contact with others also made him feel detached from himself. As long as he could remember, he said he searched for his real identity and for his genuine “self.” There was no “core” within him, no nucleus that gave him a sense of grounding.

Sometimes, he even doubted if he was alive at all. He felt empty in his solitude and thrived only when gaining entry into another person’s cells through his spike protein. That is when he could obtain some sense of self-actualization and multiply. At that moment, he said, he got a kick from causing a kind of blast in himself and the other person. It took some time before I understood he was talking about the cytokine storm when the immune system starts to attack its own cells and tissues rather than just fighting off the virus. Every time this happened, he felt exhilarated and was willing to go to extreme lengths to repeat the experience.

Before embarking on treatment, I administered some tests to assess Rona’s physical and mental functioning. First Rona underwent a basic medical examination with the polymerase chain reaction test (PCR). It confirmed he was indeed made up of the SARS-CoV-2 virus. Then, I conducted a clinical interview to reveal his personal and childhood history, recent life experiences, and family background.

Rona told me he was a child of the animal kingdom. His ancestors had lived a comfortable life within bats and other creatures for centuries. Without explaining how, he said he jumped into the human environment. “It took some time for us to adapt to these new surroundings because they were very different from what we had been used to. These bodies were so much more susceptible to various illnesses, especially in their respiratory systems. Their immune systems didn’t recognize us at all and went haywire when we started to multiply. I wish we had stayed within animals because we had a good life there.”

Rona was the heir of a long lineage of imperial families who each had a history of causing pandemics. “Some of my predecessors from the SARS and MERS families have told me all about you people long before I came here,” he said in a scratchy voice. “I am a descendant of these prominent protein lines and carry their legacy with pride.”

To learn more about his unconscious, I tried a few projective tests. When asked to make up stories about the ambiguous pictures in the thematic apperception test, Rona expressed considerable emotional distress. An unfortunate serial killer being chased by corrupt police in white uniforms evoked anger and fear. A world without human beings was considered “heaven on earth.” The common themes typically exhibited some kind of paranoid fantasies.

Next, I administered a Rorschach test, which Rona seemed to enjoy tremendously. Watching the inkblots, he often responded with loud laughs. He saw a lot of animals, but also many details of inner organs. In Card 8, he was visibly thrilled when he recognized some bats. They were at the center of his most urgent longing. The responses revealed a complex personality structure with internal conflicts.

Much of Rona’s psychopathology was exposed during these intake sessions, and it helped me to suggest a tentative diagnosis. He was addicted to spreading his vibes, contaminating as many people as possible. Besides his psychopathic and sociopathic behavior, he was also suffering from a severe narcissistic personality disorder. To emphasize his superiority over others, he had taken the nickname Corona, which means crownand implies sovereignty. Apparently, Rona had an inflated sense of his own importance, a deep need for admiration, and a lack of empathy for others. All these traits created troubled relationships. In short, he was a genuine example of an insidious egotistical parasite, someone who clings to another for personal gain without giving anything in return.

Interestingly, Rona had higher than normal intelligence. He was so clever that he had been able to outsmart many known drugs and vaccines. He presented a completely new kind of psychopathology that nobody had come across before. Viral immunologists observed that he could harm all the major organs via blood vessel cells. Scientists were still trying to figure out what to do with him. Rona had already infected millions, and he had killed hundreds of thousands. The consequence of his activities also caused catastrophic worldwide economic damage. As a result, researchers from all over the world were searching for ways to eradicate Rona.

Despite the efforts of so many, being invisible to the naked eye gave Rona an upper hand, and he succeeded to escape being caught. As a result, there was an overwhelming sense of powerlessness among governments all over the world. I was well aware of the urgent need to find better ways to cope with the threat he posed.

Treatment options

I contemplated what to do with Rona. Exceptional measures were needed. Should I commit him to a closed ward and isolate him? Should I refer him to a medical specialist? Should I let him out among the people? Would I be able to cure him of his ailment with my psychotherapeutic arsenal? Would psychological techniques help him in his struggle? Did I want to help him? Or, as things developed, would I rather prefer to destroy him?

Despite all efforts to eradicate Rona, nobody had sat down to listen carefully to what he had to say. Nobody had tried to understand with an open mind what he was doing. That is what I wanted to do.

I had misgivings from the very beginning. I thought an individual approach would perhaps be insufficient in dealing with a global problem that demanded a worldwide concerted struggle. Even if I succeeded to “cure” Rona, the contamination would continue to be spread by his offspring. My hope was that if I could understand him better, I could perhaps help to end his lethal mission. If I could let him feel what he did to others, he might be able to gain some insight and change his ways.

Alternatively, I wanted to find the best strategy to destroy him.

Therapeutic process

Even though I tried to establish a therapeutic alliance with Rona, the sessions remained scary. When getting close to him, I was afraid he might infect me, and it was hard to build a sense of trust between us. Concurrently, I felt sad for the people who were dying and for their loved ones who could not be with them when they passed. Being empathic with Rona was especially difficult when I imagined a changing apocalyptic world without any future.

Numerous unanswered questions about him prevailed: How exactly did he infect people, and how long time did it take? Why was he affecting diverse people in different ways? Was it possible to become immune to him? Did he have a conscious or an unconscious agenda? These questions crossed my mind as I started to meet with him regularly.

Working with patients to develop themselveswithin a relationship of mutuality was something I had previously done. I knew if I could help them differentiate and integrate their self- and object-representations, their self-confidence would increase. However, I was not sure I wanted Rona to become more self-assured. Who knows what he could turn into at the end of such a process?

The last thing I wanted to do was to help Rona strengthen his self-esteem and to “find himself” within a relationship of “unconditional positive regard.” More importantly, I felt, was to cultivate some amount of reality-testing in him.

Therefore, I decided to focus on his identity by asking him, “Who do you think you are?”

Every time I asked Rona that question, he had a different answer. One day, he said, “I am the Angel of Death to some. To others, I just come and visit with a breeze. Most children don’t sit still long enough for me to get under their skin.”

Another day he bragged, “I am Corona! Nobody knew my name only a few months ago. Now, I am world famous, and everybody knows me. I am a celebrity, with pictures shown on all TV stations and everybody talks about me. Is there someone more recognized than I am? Should I not be proud of my achievements?” He had been quite offended when they called him a “normal flu” at the start of the pandemic. “There is nothing ‘normal’ about me,” he said. “I am more contagious and much more dangerous than the unsophisticated viral mutations for which people are vaccinated against every year.” I looked at him with bewilderment but had to agree.

That made him continue with renewed enthusiasm, and he exclaimed: “You still relate to me as if I was a person, like your next-door neighbor. You cannot accept the fact that I am something else. I am not a human being! I am much smaller than you and much less sophisticated in terms of my genetic setup. That doesn’t mean I am less intelligent than you, however. You still can’t stand this fact. With all your 20,000 or more genes and your big brains, you are still incapable of realizing the fact that I am more powerful than you. It blows your mind that I can kill you by a simple burp!”

Enraged, I repeated the same question again with a fiercer tone: “Who do you think you are? What gives you the right to spread your poison around and harm people? You are just a dangerous, cruel organism! What gives you the right to play God? You can’t do that! Don’t you have any sense of compassion?” He looked at me as if he was unable to understand.

I realized human beings are not so different from Rona. We are only infinitely more destructive. I stopped to wonder if the present pandemic will become a ‘corrective emotional experience' for those who survive it

It became more obvious to both of us that I began to relate to him more as a foe than a friend. But as I looked for the best strategy to eradicate him, it struck me that his existence was ultimately based on a very basic (and eternal) question of survival, adaptation, and evolution that had always found a battlefield within biochemistry. And it was now materializing in my treatment room. I had read somewhere that parasites are intrinsic to biological evolution and that they drive its complexity at multiple levels. All living things are trying to survive and multiply either through fight or through cooperation, and they change a little during this process. Taking this aspect into consideration made me a little more accepting of him.

As I had now expressed some of my anger, it became easier for me to continue to stay in contact with Rona. The next time I asked him, “Who do you think you are?” it was in a more friendly voice, and he was willing to open up more.

“I do not think who I am. I just exist. I am a chemical structure with a set of proteins that perform specific functions. It is not something I decide to do, neither is it something I have any conscious control over. In fact, I am not sure if I am conscious of anything at all. Consciousness is a privilege for humans and not for viral beings like me. You know you exist, while we just exist. At the end of the day, that’s why I came to you for treatment. I also want to think and know I have a self. I get so tired of just floating around and multiplying.”

To my surprise, Rona turned his head towards me and added an important piece of information: “Look at me, doctor . . .” I looked at Rona and saw he was choked up with emotion. “Self-replication is a central part of being me. I am, after all, just a virus.”

That was a smart thing to acknowledge, I thought, for such a primitive molecular creature. He began to recognize he felt bound by his body and had no conscience, no free will, and no self-control. Self-replication was apparently an expression of his libido; his fundamental life instinct. Gaining a sense of self in the form of an inner nucleus would perhaps help him to better control his previously destructive behavior.

It seemed as if we were making some progress in the therapeutic process.

Being there

From this point on, my respect for Rona gradually grew. Discovering new parts of his personality also helped me ask Rona more frankly about his motives for killing so many people. He assured me: “I don’t kill the people who die. I just enter their organs to multiply. When that happens, some of them can’t tolerate it. They can’t breathe and their lungs stop functioning. Or their cardiovascular systems go caput, and they develop blood clots. It is just a sad result of me being there. But it’s not my original purpose.”

“What I want is simply to multiply; to stay ‘virulent,’ and to be able to co-create. When people get too sick, and especially when they die, I cannot use them anymore, and I die with them. That is who I am. I have to find a suitable balance between the infection I spread, and the damage I cause to the body I enter. It’s an ongoing process I am still working on.”

My tentative diagnosis of Rona as a psychopathic killer was obviously incorrect. As therapy progressed, I gained more of his confidence. He started sharing some of the techniques he used to spread himself around the globe: “People are so easily infected, you can’t believe it! If I leave a small trace of myself on a doorknob, for example, when someone touches it and then touches his mouth, I am able to get in through the respiratory tract and start my journey. It’s so easy!” He was clearly pleased with himself.

I had never thought about contagion in this way.

He continued: “What makes infecting more difficult, however, is with people who are too scared. People who have obsessive-compulsive disorder, for example, are really difficult to infect. They clean everything they touch all the time, and often I am washed away with soap or some ugly disinfectant spray! That’s very cruel! Don’t you think so?”

I understood that contagion for Rona was equal to ego-building. He was literally strengthening his sense of self whenever he succeeded in multiplying. And in each such multiplication, he was trying to imitate and learn from the host cell and to change his ways accordingly. I wondered if this was also happening during our sessions but didn’t want to ask him directly. I was afraid of discovering that he was already floating around inside the cells of my body.

Instead, I asked Rona to describe how he was entering the cells of another body to perform his multiplication strategy: “You must understand,” he said, “I am just an assembly of malicious nucleic acid that infiltrates and burglarizes cells. I am, therefore, on a constant search for unsuspecting people with immune systems that are unable to detect me. I first disguise myself so the watchdogs can’t notice me. That is not so difficult, because they are both naïve and usually have no memory of having seen someone like me before. So, I am just let in without any problems.”

“Inside the cells, I must prevent being discovered by all kinds of informants in white T-shirts who are constantly looking for foreigners like me. But every time I enter a new cell, I am most terrified of the white T-shirts who want to get rid of me,” he exclaimed. He then added with an innocent grin: “When I manage to bribe them and persuade them to join me in my revolution, all hell breaks out.”

Envisaging the havoc Rona wrought inside cells made me feel dizzy. But my curiosity grew from his apparent understanding of what was happening in the immune system of human beings and how to manipulate its white blood cells. I, therefore, wondered if he was also aware of what was happening in the world. Had he noticed the chaos his pandemic rampage had done to the human population?

His answer to this question surprised me more than anything he had previously shared. Rona looked at me with distrust, as if he were unsure of how much to reveal. Hesitantly, he said: “While you are looking at me with your fancy electron microscope, you don’t realize I am also looking at you with my own viral magnifying glass.”

Our roles were suddenly reversed

Taken aback, I asked him suspiciously, “So what do you see in your magnifying glass?”

“I see you are scared of me and you try to keep a safe distance from me,” he replied.

Somewhat embarrassed, I nodded and asked in as offhand a way as I could, “And . . .?”

“I see the chaos I have created in your world—the social distancing, the lockdowns, and the panic all around . . . I see how you struggle with existential dilemmas, with protecting your health versus saving the economy.”

He smiled at me briefly, and added in a stammering low voice: “Well, what I see . . . what I also see when I look at you human beings . . .” He closed his eyes and opened them slowly. “I see what you are doing. I see what you do all the time, even behind your silly bandito face masques. I see what you are doing with everything around you, with nature, with the planet, with the earth. I see how you contaminate the air you breathe and poison the water you drink. I see how you destroy nature at a faster pace than it can restore itself. I see how you burglarize its resources, and how you fail to give it back.”

I kept silent, waiting for him to continue.

“I also see how you spread your kind all over at the expense of others—the mass extinction of other creatures, all the mammals, the birds, the reptiles, and the fish that have been killed by you people.” He paused again, and whispered with his eyes closed as if he doubted I would understand what he talked about, “You assume supremacy over all kinds of biological organisms you move around and annihilate.”

Then, he added with a more accusing tone: “Who do you think you are?” referring to humankind in general. “What do you think you are doing to the Earth where we all live?”

After that session, he suddenly disappeared in a droplet carried away by the wind.

I was left not only with a loss of smell but also with a new awareness. By trying to answer his question, “Who do we think we are?” I realized human beings are not so different from Rona. We are only infinitely more destructive. I stopped to wonder if the present pandemic will become a “corrective emotional experience” for those who survive it.

Dr Kellermann is a retired psychologist from Jerusalem, Israel. Website: http://peterfelix.weebly.com. For a continuation of the story, please see Dr Kellermann's book, Who Do You Think You Are?: COVID-19 in Psychotherapy.

This article was originally posted on June 9, 2020, with the title "A Difficult Psychotherapeutic Journey: COVID, Who Do You Think You Are?, and has since been updated. -Ed

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