Issue 6: Meet the Team: Reflections from Amiad

The Lookout for Hope: Long Covid Reflections

Music of Hope 

A tune has recently been playing in my mind: a piece by Bill Frisell called “Lookout for Hope”. There are several versions. The earliest, from 1988, is rather grim, as if the “lookout” involves ploughing through the mud, which is actually how one client was describing their Long Covid experience to me recently. As the years have gone by, later versions of the same tune have cropped up, as if softening into that journey: one with energy and movement (1998); another echoing with warmth, with wider acoustic, and contemplative timber (2022). Each version keeps that “blue note” though: some bits of the tune don’t sit quite right, continually moving through different keys which keeps the harmony and the melody imperfect. I find the gentle shifts between that strange tone, to the warm melody, which opens up every so often, to be very life-like. The beauty in it is derived from this tension: landing back in our comfort zone brings a sense of ease and delight that could have been neglected if it was just sweet all along.  

I suppose that if it was out of tune throughout, it could have been rather draining. It’s very likely that I would never want to hear that tune again. We can only tolerate dissonance for so long- a lesson painfully learned when facing a long-term condition. Before I attend to our ability to bear dissonance (as well as our brain’s tendency to get used to a dissonance) I should note that I am not writing as a musician, but as a health psychologist – a clinician working with people with Post Covid symptoms and Long Covid since December 2020. I am the deputy lead in a specialised psychology service for people with Long Covid and have been involved in the ENO Breathe programme since February 2021, consulting the team with the emotional aspects of working on the programme. 

Ploughing Through the Mud

So, Covid. The first national lockdown was announced on March 23rd, 2020. A year after, March 23rd was announced as a National Day of Reflection for people who were lost to Covid, and later on, a day of wider remembrance for loved ones who’ve died, and supporting people who are grieving. I would also hold in mind other Covid related losses.  

Dates can sometimes matter; we remember days, hours, moments – some echo strongly in our minds, our bodies, and between us. Listening to people who share their Covid experiences when visiting our clinics, we have learned important lessons about the meaning of these days and hours – moments of shifts and transitions. Moments in which time changed its pace: slowing down to grey dullness, or suddenly being sent into fierce white waters, and at times flowing both ways at once. 

This piece will focus on the way our brains and bodies work with memories: about our relationships with memories, with people around us, and the lookout for hope. 

Memories can carry a range of meanings. When the original event was strong and significant, memories may stay with us in a strong and particular form. This is just how our minds work. Keeping the image, as well as the emotional and sensual memory. This may happen when the initial event was out of context. So, on top of being hard, it also took us by surprise and made no sense to start with. In these cases, when it’s harder to have a relatable storyline, the memory is stored in clusters. Our minds are trying to make sense of these memory clusters by repeating it again and again. The more severe form will be experienced as flashbacks. More often, these repetitions are quite subtle and less distressing.  

These clusters can become clearer when at any point in time thereafter, we are given the opportunity to reflect, untangle, and change our relations with the memory of what had happened. This may involve professional help, but with the presence of other supporting factors, not necessarily so. Considering that, days of remembrance may not necessarily entail repeating a memory as it was: when we commemorate past events or losses, we are bound to observe it from our current perspective. Hence it can’t just be repetition. Hopefully as life gains more saturation, with further processing and perspective, these memories don’t lose importance, but gain new meaning and depth.  

Clarifying Embodied Memories

While the cognitive and emotional experience is now under the spotlight, it works quite the same with other parts of our body. Sometimes it is not an explicit memory, but a felt sense of threat and unease. Sometimes it is experienced in parts of the body that respond strongly to the sense of threat. Or actually stored in other parts of the body that resonate with stress, or have just been affected due to a physiological condition, with an accumulating effect that may lead to a sense of felt threat. Having a disrupted breathing pattern, as you well know, can be emotionally distressing. 

Participants of ENO Breathe are familiar with the way the body may adopt via memory, a disrupted breathing pattern, and its potential correction and reversibility. This means that despite the body’s tendency to maintain patterns that were helpful in the past (and no longer are), patterns that the body got used to, we can gently absorb the conviction that it is safe now – we can breathe in deeply. Well, it takes practice. And support. 

Similarly, the initial felt sense of threat and emergency can remain regardless of the time that has passed. So, the much-needed alertness that had initially kept people safe, can remain as a basic physical and emotional stance; a sense of embodied threat, sometimes an undercurrent emphasised by other Long Covid symptoms, resonating in the way our hearts beat and our breath works. In the context of these rather common clusters – a felt sense of danger and threat – I keep wondering what the effects were of the general tone during earlier pandemic days. It is not the psychological distress that causes long term symptoms, rather it is the embodied sense of threat that responds strongly to existing symptoms, burdening people’s emotional and cognitive resources. The term “earlier pandemic days” relates both to one’s harsh encounter with having Covid, as well as to the wider context. 

Bearing Dissonance

Fighting this embodied sense of threat by ignoring it, moving forward too soon, or without sufficient practice, can demand significant energy, and rarely brings relief. 

This also may sound familiar. Being aware of the many readers’ journeys so far, and what Long Covid journeys may look like – when gradually recovering, rarely in a linear fashion – you will, by now, have met these notions of how minds and bodies work.  Also, how hard it may get when medical symptoms are stretching the emotional resilience; how hard it may get when that disruption to the breathing pattern may lead to extreme anxiousness and concern. And, how when it happens, being worried and sad does not make it easier to “breathe right”. While sometimes we are just worried and sad, because it is just hard. 

Now, if you find yourself sinking in your chair, sighing with despair, it’s the time to remind you that it is hope that we look for, or perhaps hope that is suggested here. If we can track back, or speculate what has fed into the saturated distress, it also means that we can target it. Bringing human care and compassion, in the form of evidence-based treatments. As it happens, ENO Breathe is an example of this – it is now one of quite a few pathways that offer care and hope; the proactive sort of hope. And isn’t it that hope is always proactive? By nature? It is not just the act of setting one’s compass, but also walking towards the desired direction, or just turning towards it. 

If you are wondering about the length in which I was describing the dissonance so far, my rationale is: when having an unpleasant tone, especially one that we can’t get rid of, we might as well listen carefully, looking into its subtle shades. Listening long enough with curiosity makes it more likely for us to notice that it is no longer disharmony. Things are starting to make sense.  

Seeking Harmony

Have you ever tried to untangle a rope or a cord? Tracking back to what went wrong is one way of doing it. We can also try to follow our tracks towards what was right. Or what was simply ok. When untangling a rope, it is very unlikely that pulling harder will lead to resolve… With breathing, being reminded means being softly guided into what it feels like to breathe “as usual”, or gently follow some familiar motions. A similar process is involved in regaining a sense of safety: being gently invited to experience the sense of safety. It is only possible when it is indeed safe enough. As if we gently jiggle that entanglement, loosening up the knots. You might know from your experience that it cannot be forced.  

The same applies to how it feels to be together (rather than isolated in a concrete or a relational form), with a group of people which one can resonate with – sharing, listening. Not necessarily the advice-giving kind of dynamic, so not forcing the “getting better”, and also not the “coming to terms with”. That’s not the point. Fundamentally, the action of “being with” is an effective way of moving forward. The opposite is “running away from”, that usually brings along a sense of struggle. On top of consuming precious energy, it may also further agitate the felt sense of alertness and threat. 

Being well aware that a sole reading is unlikely to solve your Long Covid challenges, it is not a list of tips, nor a recovery manual that is offered here. These Long Covid reflections are intended to resonate with what you already know, potentially providing a framework to common experiences. By March 2023, I imagine that you have already tried many pathways towards recovery or ease. Some hopefully have proven to help. Since you are reading this now, it must be that you are still looking for something.  

If you (the reader) are not having Long Covid symptoms, being a family member, a friend, or a professional, these reflections may have helped you to gain further perspective into what it might feel like, and how intricate it is. The brighter side is that having many threads involved actually means that there is more than one pathway to relief. 

Sounds Like Hope 

Moving forwards is a commitment that takes nourishment. When a dissonance is present, it means to further listen. The brain will eventually make sense of it, not necessarily making it pleasant, but finding some sort of order and familiarity. Or rather, allow an emphasis of current discontent. Our right of protest. That’s another way of calibrating the compass. Having the needle pointing towards the desirable. Walking along this course will get you closer, as it may revive the memory of the desired emotion.  

Similar to what was experienced in the body by intentionally breathing in a specific way, the practice allows the body and mind to find comfort and peace in what was “out of order” for some time – the potential satisfaction of gently gaining control, even for a moment, counts. The brain keeps a record of that, further feeding the sense of safety and stability. While the dissonance still echoes in the background, the mind is much more aware of the emerging harmony, potentially being able to absorb it fully, as it is now well practiced in moving towards all that may arrive, with openness. Surely, doing that in a group, a congregation, helps? Being together to gain validation, but more so, to join forces, to synchronise together. I encourage you to learn more about the functions of synchronicity and co-regulation. 

Music of Hope Revisited

Turning back to music is inevitable with ENO Breathe in mind. Rhythm, melody, tone, and harmony (togetherness) stand as a constant reference point, as all our hearts are literally beating in time. Also, having in mind (and body), breathing, which you all are so familiar with. This intimate acquaintance that most people don’t have (perhaps blissfully so at times…), but there you go; now you know. It’s not a blessing, nor a compliment. Naturally many would prefer to avoid this lesson altogether. Just pointing out a fact: having gone through the ENO Breathe programme, you know more about your breathing. About your voice. Hopefully more about your heart (the metaphorical one this time).  

So, turning back to the music of “Lookout for Hope”. What had started with a stronger emphasis on the lookout – almost grim in tone, reappears later in its warmer form, as if acknowledging that the lookout for hope is hope itself. 

Amiad Abrahams