Psychotherapy with Coronavirus: A Novel Experience

• A Very Strange Referral
• The Assessment Phase
• Treatment Options
• Therapeutic Process
• In the Here and Now
• A Sudden Role Reversal

A Very Strange Referral

When I first met Corona (“©”) in my psychotherapeutic practice early in 2020, I was struck by a contradictory impression. On the one hand, he was almost invisible, with a timid appearance. He was so small that I seemingly had to look at him through a transmission electron microscope. On the other, he had an impressive, crown-like outer shell. It resembled a round naval contact mine with spikes that could explode if one bumped into them. But ©, a master of disguise and transformation, was trying to evade any scrutiny. It was only when he presented himself as the silent killer responsible for the COVID-19 pandemic that he evoked my curiosity.

Despite being retired for years, I decided to accept © for immediate treatment. It was not an easy decision. In the past, I had worked with clients for whom I felt some amount of sympathy and whom I wanted to help. Now I was faced with an adversary I might ultimately want to eradicate.

When © entered my office, I immediately felt nausea and had difficulty breathing. I didn’t make much of it until I gradually became aware of the various symptoms he caused me — fatigue, sore throat, dry cough, and fever. These were not the common countertransference responses all therapists have with their patients. They were warning signs that I might need to develop a deeper appreciation and understanding of who he actually was. Being suspicious of his motivation for coming to therapy in the first place, I decided to keep some distance from him to safeguard my own health, both physical and emotional.

It turned out that people keeping a distance from him was his main “presenting problem.” As a result, he felt chronically lonesome. “Everyone relates to me as if I were some kind of pest,” © said, “as if I have no birthright.” 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. He said that as long as he could remember, he had 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. He was merely a string of RNA with 29 proteins that had to hijack living cells to replicate. “Sometimes, I even doubt if I am alive at all,” he said. “I feel so empty by myself and thrive only when I can merge with another person’s cells through my spike protein. That is when I obtain some sense of self-actualization. At that moment, I get a kick out of causing a kind of blast in myself 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 happens, I feel euphoric and am willing to do anything to feel it again.”

The Assessment Phase

Before starting treatment, I sent © for a few confirmatory medical tests to assess his physical functioning. First, he underwent a basic medical examination with the PCR test which confirmed he was indeed made up of the SARS-CoV-2 virus. Then I conducted a psychosocial evaluation to learn more about his childhood history, recent life experiences, and family background.

© told me he was a child of the animal kingdom. His ancestors had lived a comfortable life within bats and other creatures for centuries. “When stray dogs had bats for lunch, we lived in them for a while. Then, some hungry dudes made raw hamburgers of the dogs and consumed them with sauce,” he said. “We suddenly found ourselves within the cells of human beings. It took some time for us to adapt to these new surroundings, because they were very different from what we had been used to. The bodies of human beings were so much more vulnerable to illnesses, especially in their respiratory systems. I wish we had stayed within animals, because we had a good life there.”

© 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.” Clearly, there was more than just a slight hint of narcissism at work.

To learn more about his unconscious, I tried a few projective tests. When asked to make up stories about the ambiguous pictures in the T.A.T. test, © expressed considerable emotional agony. An unlucky serial killer being hunted by crooked police in white uniforms evoked anger and fear. A wonderful world without human beings was presented as “heaven on earth.” The common themes typically displayed some kind of paranoid fantasies.

Next, I administered a Rorschach test, which © seemed to enjoy tremendously, as if identifying with and recognizing each picture. 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 burning desires. Overall, his responses revealed a complex personality structure with a multitude of internal conflicts.

Much of ©’s psychopathology was exposed during these intake sessions, and it helped me to suggest a tentative diagnosis. Being a virus, he was addicted to spreading his vibes around, 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 name “Corona,” which means “crown” and implies sovereignty. He even liked to label himself as © so that he could not be illegally reproduced in any form. Apparently, © 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.

In addition to these personality characteristics, © had higher than normal intelligence. He was so clever that he had been able to outsmart the most known drugs and vaccines. He presented a completely new kind of psychopathology that nobody had previously encountered. What was most obvious was that he appeared to be more contagious and more deadly than others of his kind. © had already infected millions, and he had killed hundreds of thousands. The consequence of his activities had also caused catastrophic worldwide economic damage.

Researchers from all over the world were searching for ways to crush ©. They sought to understand how to block his proteins from trapping, overpowering and invading the cellular machinery of human beings. Hundreds of experimental antiviral drugs and vaccine candidates were investigated. These would either prevent © from entering a cell or stop the human immune system from going wild when © was inside. Alternatively, doctors would take the blood from recuperated survivors and give it to those who were ill to utilize the antibodies that had developed.

On a molecular level, some of the researchers targeted one of ©’s most precious spike protein receptors — the ACE-2 — but with little success. Epidemiologists had no clue as to when (or if) societies could reach sufficient population immunity to prevent further spread of the pandemic.

Being invisible evidently gave © an upper hand, and he succeeded in escaping being caught. As a result, there was an overwhelming sense of powerlessness among governments worldwide. 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 ©. Exceptional measures were called for. 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 eliminate ©, 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 actually up to. 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 in curing ©, contamination would continue to be spread by his offspring.

©, the silent serial killer I was reading about in the media, was now in my clinic, and I felt something needed to be done. 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 plan to wipe him out.

Therapeutic Process

Even though I tried to establish a therapeutic alliance with ©, 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 away. Being empathic with © was especially difficult when I imagined an apocalyptic world without a future.

Numerous unanswered questions about him remained: How exactly did he infect people and how long did it take for him to do it? Why was he affecting various people in distinctive 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 regularly with him.

Working with clients to help them develop a relationship of mutuality was something I had done before. 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 © 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 © strengthen his self-esteem and to “find himself” within a relationship of “unconditional positive regard.” I felt it was more important to promote some amount of reality-testing in him. I therefore decided to focus on his identity by asking him, “Who do you think you are?”

Every time I asked © 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 at the moment? 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 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 genes or more, 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 with a simple burp!” He was truly frightening in his sense of omnipotence and clearly was off the charts when it came to lethality.

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, for God’s sake! 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 what I was talking about.

It became more obvious to both of us that I now related to him more as a foe than a friend. But as I looked for the best strategy to get rid of 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 ©. The next time I asked him, “Who do you think you are?” it was in a more friendly voice, and he became 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, and 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, © turned his head towards me and added an important piece of information. “Look at me, doctor...” I looked at © and saw that 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.

In the Here and Now

From this point on, my respect for © gradually grew. Discovering new parts of his personality also helped me ask © 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 my 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 © as a psychopathic killer was obviously incorrect. As therapy progressed, I gained more of his trust. 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, and someone touches it and also touches his mouth, I will be able to get in through the respiratory tract and start my journey to the lungs. It’s so easy!” He was clearly pleased with himself. Then he added, “You should try it once yourself! You will be surprised at how easy it is.”

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 OCD, 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 © 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 © 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 acids 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 - into ®, so the watch dogs can’t notice me. That is not so difficult, because they are 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 who are constantly looking for foreigners like me. But every time I enter a new cell, I am most terrified of the executioners in white T-shirts who want to get rid of me,” he howled. But then he added with an innocent grin, “When I manage to bribe them and encourage them to join me in my revolution, all hell breaks out.”

Envisaging the havoc © wrought inside cells made me feel uncomfortable. 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 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. © 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.”

A Sudden Role Reversal

Taken aback, I asked him disbelievingly, “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 casual 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, or 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 as if trying to recollect something. “I see what you are doing. I see what you do all the time, even when you try to hide behind your silly face masks. 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 we breathe and poison the water we 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 relocate 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?”

With those words, 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 the Coronavirus. We are only considerably more destructive. I wonder if the present pandemic will become a “corrective emotional experience” for those who survive it.
 

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