Covid Has Traumatized America.
A Doctor Explains What We Need to Heal.
March 22nd, 2021, David Marchese, Dr. Diane E. Meier interview
Serious illness and suffering. Fear and fresh awareness of death. The uncertainty they all bring and what, for each, would constitute humane and effective medical treatment. Those physical and emotional concerns, central to palliative care, have forced their way into so many of our lives during the pandemic, even as we edge toward some skewed version of normalcy.
They’re also the concerns that Dr. Diane E. Meier has been working on and thinking deeply about for decades. Meier, 68, is the longtime director of the Center to Advance Palliative Care, which is part of New York City’s Mount Sinai Hospital, and a 2008 recipient of a MacArthur Foundation “genius” fellowship.
She has been a uniquely qualified observer of the Covid-induced cataclysms — often existential — experienced by patients and physicians. “If ever we needed to be reminded of how important human connection and support is for people with serious illness,” Meier says, “this pandemic has made the point very, very clearly.”
At this stage of your career are there aspects of the human experience of chronic illness or pain that used to be mysterious to you that you now understand?
It has to do with trauma. Trauma is widespread. In wealthy families and poor families; individual and family trauma; community trauma and societal trauma. We have so much of that here — just start with racism and go on. It is repressed and treated with denial. That doesn’t make it go away.
It’s controlling how people respond to new trauma, whether it’s a diagnosis or a pandemic or a January 6th. So my perspective on trauma has a bigger scale than it used to — a species-level and tribal-level scale.
And as I read the news, I don’t know whether we’re going to evolve our way out of this. The need to hate and kill the other is a determinative human characteristic and it informs so many aspects of our society. I also don’t see a disconnect between what has happened to the practice of medicine and that reality, because what’s happened to medicine is being driven by a societal commitment to profit above all else. And what is that? It’s trauma.
You could imagine somebody rolling their eyes at you, saying “You’re saying capitalism is trauma?”
What has happened to the practice of medicine is that the public perception is that it has become totally transactional. That we do things either to make money or to avoid spending money. So, for example, many people of color fear that a conversation about whether or not they want cardiopulmonary resuscitation is not about what’s best for that patient; it’s about saving money for the hospital.
Those perceptions are not wrong. That’s the problem. And there’s more than a kernel of truth in the perceptions of people feeling as if they or their loved one is being put through a marketplace of M.R.I.s and P.E.T. scans and specialists and subspecialists, and everybody is billing. The visibility of the extraction mind-set of the practice of medicine — it’s not subtle, and the public knows it. I’m worried about blowing the hard-earned trust that our profession worked toward over hundreds of years through, essentially, the commercialization of health care delivery.
Can you tease out the link you suggested earlier between trauma and killing the other?
The analogy is post-traumatic stress disorder: an overreaction to new traumas because the prior traumas were never addressed, never expressed, never worked through. So everything that happens re-triggers it. There’s a book called The Body Keeps the Score, and that’s what it’s about: Things that happened to you years ago don’t ever go away. They are embedded in your mind and body and inform how you react to things that happen today. In my typical mechanistic doctor manner, I will tell you that there are things to do about it: It’s called trauma-informed care.
It’s literally as simple as asking people what happened to them. What happened during your childhood? Because people know. They’ve just never been asked. And until it is unearthed and respected for the power that it had in that person’s life, it is controlling. The only way to take back control is to bring it to consciousness and name it.
Have you found that there are common positive meanings people find in life when they’re seriously ill that are applicable to those who aren’t? Yes. You may have read people talking about how while they would not wish their diagnosis on anyone, they are grateful for it. Because it made them stop worrying about things that aren’t important and focus on the things that are. That might be putting the garden in or spending time with grandchildren.
Or my colleague — she’s 60 — said she’s going to become a bat mitzvah. She’s not sick, but the pandemic focused her on things she had put off. And she realized, What am I waiting for?
That process of reflection requires pausing the racing in circles that our normal life tends to be: Get up at 6, go to the gym, go to work, etc. Whether we’re pausing because it has been forced on us by the pandemic or because we have a new diagnosis that requires us to reorganize our days — the busy-ness that has characterized everyday life for most people gets in the way of reflection. But it is a very common phenomenon for people to take the time and reflect about what’s important. People are trying desperately to make room for one’s inner life.
