Daily Archives: April 27, 2022

While maladaptive daydreaming (MD) is not currently recognized as a psychiatric disorder, a new study suggests that the condition deserves more clinical attention. The researchers found that only about 20% of an ADHD sample met criteria for MD, suggesting that maladaptive daydreaming involves a unique form of inattention that makes it distinct from ADHD. The findings were published in theJournal of Clinical Psychology.

Maladaptive daydreaming is the act of immersing oneself in detailed, imaginative fantasies that consume ones attention at the expense of everyday functioning. This type of daydreaming shares some overlap with symptoms of attention deficit hyperactivity disorder (ADHD), a condition involving difficulty maintaining attention.

However, the authors of the current study proposed a distinction between MD and ADHD. The researchers suggest that the daydreaming associated with ADHD is better described as mind wandering the spontaneous shifting of attention to task-unrelated thoughts. Maladaptive daydreaming, on the other hand, is defined by daydreaming that is intentional, complex, and vivid. These distinctions are important because the two forms of daydreaming may have different underlying mechanisms and call for different treatment.

In a previous study, we recruited about 40 people with MD and did a full clinical interview with each of them to identify if they meet criteria for any DSM-5 disorders, and if so, which. The most striking finding in that study was that they had overwhelming levels of clinical-level psychopathology: all participants met criteria for DSM-5 disorders, with most of them meeting criteria for more than one, often even three or four, said study author Nirit Soffer-Dudek, a senior lecturer and head of The Consciousness and Psychopathology Laboratory at Ben-Gurion University of the Negev.

In addition, we found that 77% of the sample met criteria for ADHD, most of them to the inattention only type (without hyperactivity). Spontaneously in the interview they explained that their difficulty concentrating on tasks was a result of their addiction to fantastical daydreaming. Thus, we began to view meeting criteria for ADHD as a secondary result of MD.

Moreover, we came to view this supposed comorbidity not as a true comorbidity but rather as inaccurate labeling. Specifically, it seemed that if MD were a formal diagnostic syndrome, the label of ADHD would be superfluous for these people (because the symptoms seemed to be better explained by MD in their cases). We assumed that having MD leads to meeting criteria for ADHD, but not necessarily vice versa.

For their new study, Soffer-Dudek and her colleagues aimed to investigate whether MD is a distinct mental phenomenon from ADHD by examining rates of MD among people with ADHD. While studies have found high rates of ADHD among people with MD, if the two constructs are independent, people with ADHD will not have similarly high rates of MD.

A group of 98 people with ADHD completed online questionnaires that assessed ADHD symptoms, several measures of psychological distress, and maladaptive daydreaming. Of these participants, 59 had elevated MD scores and were contacted to undergo a clinical interview to assess MD. After 44 of these participants responded and were interviewed, 17 met criteria for MD. Accounting for selective dropout, this means that roughly 20-23% of the full sample of ADHD participants also met criteria for MD.

Notably, this rate of MD in an ADHD sample is far smaller than the previously reported incidence of ADHD in an MD sample, which was around 77%. This suggests that the two constructs are distinct, with MD involving unique characteristics that are not explained by ADHD.

The study authors suggest that maladaptive daydreaming is better described as a dissociative disorder or behavioral addiction, rather than an issue of attention. They suggest that MD is an independent mental phenomenon, which often creates a deficit in attention as a side effect, causing MDers in some cases to also meet criteria for ADHD, but not necessarily vice versa.

Participants who met criteria for both ADHD and MD had higher depression and loneliness, and worse self-esteem. These heightened symptoms of distress were not explained by ADHD symptom severity, suggesting a unique contribution of MD.

The researchers note the importance of distinguishing between the two conditions. There are many reasons why people may find it hard to focus, Soffer-Dudek told PsyPost. The ADHD diagnosis is a bit broad in that it looks mainly at the end result, and not on the inner dynamic of thought leading to that result. We suggest that different thought dynamics should be treated differently.

If your ADHD stems from general mind-wandering with ever-changing distractions (which is characteristic of typical ADHD), you may need different treatment than if you find yourself compulsively drawn to engage in elaborate, narrative, vivid and highly emotional fantasies (characteristic of MD). If it is the latter, we suggest seeking psychological help, and introducing to the clinician the concept of MD, which has been researched extensively in the past years, but is still quite unknown.

Along similar lines, many people with MD have called for better recognition of the construct of maladaptive daydreaming, expressing that the existing psychological definitions do not adequately capture the depth of their experiences. While further study is needed to confirm whether MD should be considered a psychiatric disorder, it could be that some people with an ADHD diagnosis would be better served by a diagnosis of MD.

If someone has fanciful immersive daydreams but does not experience them as a problem, then that would not count as MD, and is not a problem, Soffer-Dudek noted. Our aim is not to pathologize normal daydreaming. MD describes a situation where the person feels that their addiction to daydreaming is impairing their lives (e.g., loneliness, difficulties concentrating due to daydreaming, or difficulty creating or maintaining relationships because it is easier and more rewarding in the short run to daydream them).

Many MD communities exist online (e.g., Facebook, Reddit) offering peer support, Soffer-Dudek added. Also, we have a website dedicated to the research of MD, where people who see themselves as suffering from MD can register to get news updates on the topic and be offered to participate in research.

The researchers are currently seeking participants for a new study. We are looking for people who have been diagnosed as suffering from ADHD (they dont have to be maladaptive daydreamers), Soffer-Dudek said. Information about the new study can be found here: https://bgupsych.eu.qualtrics.com/jfe/form/SV_2lQVt6a2JKLFzD0

The study, Could immersive daydreaming underlie a deficit in attention? The prevalence and characteristics of maladaptive daydreaming in individuals with attentiondeficit/hyperactivity disorder, was authored by Nitzan TheodorKatz, Eli Somer, Rinatya M. Hesseg, and Nirit SofferDudek.

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Study suggests maladaptive daydreaming should be classified as a unique mental disorder, distinct from ADHD - PsyPost

Museums participating in the Measurement of Museum Social Impact study have had to go above and beyond to find large numbers of committed community members. Find out what tactics have and haven't worked for them.

Despite the ongoing effect of COVID-19 on museums daily operations, the national Measurement of Museum Social Impact (MOMSI) project has been forging ahead with thirty-eight museum participants since January 2021. The perseverance of the host museums and their staff goes to show the importance of this social science research project. Meant not only to measure their museums social impact but also help validate a social impact survey and inform a social impact toolkit (to be published 2023), the project will help raise the whole museum field thanks to their participation.

Each MOMSI host museum was responsible for recruiting study participants. The project team provided the institutions with recruitment language (including translations into other languages as needed), images and flyers, and recommendations on how and where to recruit participants, but in the end it was up to each of them to recruit a minimum of one hundred visitors for the study. Reaching this number for any study is a heavy lift for most institutions, particularly smaller museums and those located in rural areas. Add to that the uncertainties brought on by a pandemic, waves of infections, mask and vaccine requirements, potentially reduced operating hours and staff, and the general fatigue and angst of much of the American public. Furthermore, the ask of participants was greater than in many studies, with each one required to visit three times to be eligible for the study. In other words, each of the thirty-eight museums had to find one hundred visitors who would agree to visit three times in just four to eight months and then complete the instrument! Anyone who has spent time asking people to participate in a study can understand the magnitude of this effort.

While the final data and toolkit for the MOMSI project are still months away, we thought we would share an update on these recruiting efforts from a few of the participating institutions, to provide consolation and inspiration for everyone engaged in community recruiting, whether for social science projects or for other endeavors like advisory committees.

The process has been different for each institution, owing to their individual character and situations. For the Carter County Museum, a museum heavily visited by tourists, it has prompted them to take a new look at their immediate community. For the Plains Art Museum, it has left them reflecting on how they can cast an even broader net in future community work. For the Florence Griswold Museum, current relationships with community members have helped get the word out to those less familiar with the museum. For the Fresno Chaffee Zoo, the community has responded in a big way to calls to help with the study, revealing the depth of feeling for the institution. Finally, the Minneapolis Institute of Art (Mia) has discovered the limitations of using targeted online campaigns to bring in first-time visitors. Read on to hear about these findings in each of their own words.

We participated in MOMSI with the hope that we could provide representation for rural communities and demonstrate the social impact and relevance of small museums. What we didnt expect was that this study would lead to a resurgence of interest in our museum from local audiences, who made up only 31 percent of our visitors prior to the pandemic.

So far, we have recruited sixty-three individuals for the studyno mean feat for an institution in a town of only four hundred people. To start out, we posted the usual flyer in our lobby, but we knew that we needed to dig much deeper to reach our full goal. Our board and staff were instrumental in this effort, inviting neighbors during backyard conversations and going off-site to the local holiday bazaar. We created a sign-up link that staff could easily share, which worked well and created a seamless process for people. And, to increase accessibility for our older members, we provided help with filling out the application. We are delighted to share that we have a very high registration/survey completion ratio.

As a result of MOMSI, community members are discovering that the Carter County Museum is a dynamic institution that changes often. Many participants are long-time residents of the area but do not often visit the museum, and this study has served as a spark to bring them back through the doors, and with them their grandchildren or visiting relatives. They leave with stories to share with friends and family about new dinosaurs and archaeological collections on display.

For other participants who are regular visitors to the museum, this study has given them a new lens, where the attention to detail necessary to complete the survey has resulted in new discoveries of items they had overlooked or changes since their last trip. Above all we are seeing a renewed appreciation for and pride in this hidden gem of a museum, as some are now calling it. As the months shift to summer, our recruitment will finish with our annual visitors to the Dino Shindig, and it will be interesting to see how their perspectives add other colors to the tapestry.

At the Plains Art Museum, we used a combination of digital marketing via email and social media platforms, flyers available for pickup in high-traffic areas of the museum, and a press release to local and regional media contacts. Within weeks of opening recruitment, we had over one hundred study participants.

Having very little trouble recruiting participants was both surprising and affirming, confirming for us that people in our region value and are interested in supporting our museum.

However, looking back, we should have extended our recruitment by a few more weeks, allowing us to be even more intentional with our efforts and secure an even larger sample for MOMSI. Yes, we met the basic requirements, but we believe that with more time we would have been able to cast a broader net for participants. While we will never know if the overall demographic makeup of our sample would have changed with more participants, having more participants would have furthered both Plains Art Museum and MOMSIs goals: to better understand our social impact and help validate the instrument.

When we learned about MOMSI, we realized it was the perfect fit for us, as we had planned to reach out to our community in the broadest terms possible as part of an ongoing capital campaign, major expansion, and new five-year strategic plan. We had pledged to leverage our resources to incorporate our community stakeholders into each and every goal and to be responsive to their needs. We felt that, along with another audience research project we will likely undertake this summer, our participation in MOMSI could help us learn about those not familiar with the museum.

To recruit participants, we used social media and our e-newsletter (reaching more than twenty-four thousand people) and sent emails to local chambers, social service organizations, affinity groups, and others. The recruitment text stressed the importance and national significance of the project while keeping the language light and fun. As a bonus, we added the carrot of free admission to our special event, Wee Faerie Village, and a special gift.

Asking for our constituents help was also key. We have such loyal and proactive members and friends, who we know would look for any opportunity to promote us! So we asked our members to appeal to their friends. Through all of our efforts, we sought participants who are not familiar with the museum. It seemed to work. About half of those participating in MOMSI at Florence Griswold Museum have never visited the museum before, and the other half only visit one or two times a year.

Fresno is unique in that its a large metropolitan area by population but lacks other large cultural institutions. As a result, the zoo has an opportunity and obligation to impact our communities and visitors in ways that might be different than other zoos and aquariums, and MOMSI is helping us meet this challenge. Our communities have consistently shown tremendous support for the zoo, most directly by passing a county sales tax measure that provides both capital and operational funds for the zoo each year. We also saw this goodwill and support in our recruitment for MOMSI.

We were able to activate an already engaged audience through our social media channels, a major component of our recruitment efforts. We paired this with leveraging existing mailing lists and other groups that we had partnerships with in our community. By working through these community partners, we were able to amplify our reach while also diversifying our audience. Through these efforts, more than seventeen hundred people applied to participate, and we ultimately accepted four hundred into the project. MOMSI recruitment also helped us identify mission overlap with other wonderful organizations in the Fresno area, leading not only to more interest in MOMSI, but also other meaningful relationships for the zoo moving forward.

At the Minneapolis Institute of Art (Mia), we have two staff members responsible for conducting audience research and evaluation of our programs, exhibits, and interpretive material. We have been deeply reflecting on the questions of social impact (like social cohesion, social bridging, belonging, and welcoming), as well as the means to achieve this impact (like multigenerational dialogue, fostering empathy, and challenging dominant narratives). We believe that as a field we are entering a new phase of measuring the museum visitor experience, one that addresses the communal and interconnected way that a museum visit fosters connection between peopleboth past and present, known and unknown.

To explore these ideas, we know we need to hear from visitors beyond who we typically hear from. If we are interested in understanding to what extent visitors feel they have a positive social experience at the museum, we need to hear from a diverse set of visitors to know that that impact is consistent across demographics. Therefore, we made it a goal to recruit 50 percent new-to-Mia visitors and 50 percent returning Mia visitors for the MOMSI study.

We worked closely with our Engagement Strategy team, who recommended a recruitment strategy that included geo-located Facebook ads to the seven-county metro area, emails to a subset of our mailing list (including participants to virtual events who indicated they had never visited the museum), and a post on Nextdoor. We also advertised a fifty-dollar VISA gift card incentive once participants completed their three visits and the survey. One thing we werent able to do was engage in a more grassroots approach throughout the neighborhood and through partnerships. While we think this would have been the most effective strategy, we didnt have the staffing capacity to take it on.

Unfortunately, we fell short of our goal: only 10 percent of our MOMSI participants are new-to-Mia visitors. We suspect that Mia already has a large brand recognition in the region, and so people who saw our advertisements were likely to click on them because they were already familiar with Mia. Also, our museum has free entry, so money is not the main barrier for visitation, meaning people who have not visited before are likely to have other reasons for not visiting. Fall 2022 also meant many changes to mask and vaccination requirements for visitation, which may have deterred prospective participants. While were disappointed, we are hopeful that the validation of this tool means that we can use it in future studies with more visitorsboth new and returning.

The experiences shared above show just some of the challenges and opportunities museums face when recruiting community members to participate in projects. MOMSIs project team is grateful to the host museums for the unique strategies each of them took in recruitment efforts. The insights theyve gleaned will not only inform the social impact toolkit but also help museum professionals recruiting visitors for their own studies. Summarizing their findings, here are some general recommendations for recruiting strategies:

Sabre Moore, Executive Director, Carter County Museum

Sarah Anstett, Development & Marketing Manager, Plains Art Museum

Tammi Flynn, Director of Marketing, and Emily Clark, Marketing Associate, Florence Griswold Museum

Dean Watanabe, Chief Mission Officer, Fresno Chaffee Zoo

Alice Anderson, Manager of Audience Research & Impact, Minneapolis Institute of Art

Dr. Michelle A. Mileham is the Program Manager for Measurement of Museum Social Impact (MOMSI) through the Utah Division of Arts and Museums. Michelles museum career includes previous work in evaluation and education, and she currently serves as Chair of AAMs Committee on Audience Research and Evaluation.

Laureen Trainer is the Principal and Founder of Trainer Evaluation and was co-curator of the Essential Evaluators blog series. She has been involved with museum education and evaluation for over twenty years and currently serves with Michelle on CARE.

Continue reading here:

Recruiting Strategies: How to Find Community Members for Research Studies and More - aam-us.org

Portlands 14-month old crisis response program that sends mental health workers instead of police to most low-level mental health crisis calls received high ratings from people it served, according to a year-end progress report released Tuesday.

In the first year, the Portland Street Response team responded to more than 900 calls. Most individuals received assistance on site and many were connected to additional follow-up support, the report said. That led nine formerly unhoused individuals to receive help finding an apartment. No one was harmed during any incidents the team responded to and no one was arrested, the report said.

The program aims to reduce the number of behavioral health calls that police or fire officials respond to and instead send first responders who are better trained to deescalate mental health episodes and care for clients during those moments of crisis.

Championed by Commissioner Jo Ann Hardesty, the city-funded program launched in mid-February of 2021 in the Lents neighborhood, expanded to a broader area in east Portland in November and then went citywide on March 28.

Even though it is an expansion of our first responder system, it is not the traditional first responder, said Hardesty, who oversees Portland Fire & Rescue, which houses Portland Street Response. The program has also been able to host de-escalation training for neighborhood associations and businesses and host resource fairs in underserved communities, she said.

The creation of the team led to an overall 4% reduction in total emergency calls traditionally dispatched to police and a 27% reduction in welfare checks and unwanted person calls that police would typically have responded to, according to the one-year evaluation was conducted by Portland State Universitys Homelessness Research and Action Collaborative. The report was presented to the City Council Tuesday.

On average, unhoused community members served by Portland Street Response rated their satisfaction level with the program as a 4.6 on a 5-point scale.

The team responded to 903 incidents during its first year. In one-third of those cases, team members could not find the person theyd been summoned to check on. Most calls are made by onlookers and not the individual in need.

In 26% of cases, a person was evaluated but workers concluded no additional extensive treatment was needed. In 17% of cases, the person workers were summoned to check on refused evaluation or treatment. In 9% of cases, the person was located and deemed in need of treatment, two-thirds of whom were treated by the team while the other one-third were treated and then transferred by ambulance for additional care.

While the team is designed to serve an emergency response function, clients have the option of being connected to ongoing support. They can either get connected to one of the teams community health workers or peer support specialists or else be referred to another homelessness organization. This networking system led to nine people who were experiencing homelessness moving into a permanent home in the past year, the report said.

Portland Mayor Ted Wheeler said he would like the program to provide more intentional wrap-around services to individuals it interacts with over and over. That could reduce the number of emergency calls to both Portland Street Response and police, he said.

Of the total calls, 65% involved clients experiencing homelessness and 52% involved someone with suspected mental health needs.

The fact that none of the calls led to an arrest is significant, as 51% of unhoused people that Portland State interviewed said they did not feel safe calling 911 if they or someone else needed help. This percent was even higher for Black, Native American and multiracial individuals surveyed.

One homeless person interviewed by Portland State researchers said they didnt feel safe calling police for help during mental health emergencies because in the past they had difficulty communicating with them because (the police) just assumed it was drug related because Im houseless. Theyre supposed to be saving a life, not judging a life.

Another unhoused person said they would only call police if they were dying because when they previously called 911 for help, they ended up getting arrested.

While Portland Street Response workers have continued to build trust with community members and spoke well about their experiences serving the community, they told researchers that they faced barriers connecting clients to long-term mental health care, because there arent enough mental health services available. They also expressed interested in being allowed to respond to suicide calls in place of police.

Robyn Burek, Portland Street Response program manager, said she hopes to add additional team members in the coming years and to work with the Portland Police Bureau and its union to expand the type of calls her team members are allowed to respond to. Burek said city council will receive recommendations on expansion by June 30.

Nicole Hayden reports on homelessness for The Oregonian/OregonLive. She can be reached at nhayden@oregonian.com or on Twitter @Nicole_A_Hayden.

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Portland Street Response led to 9 housing successes, no arrests in first year - OregonLive

Visionaries is a limited series that looks at figures who are trying to transform the way we live.

Dr. Rachel Hardemans journey to understanding community health care began in Cuba, where she studied medicine and public health at the Latin American School of Medicine from 2002 to 2004. Thats really where I learned not just what public health was, but how powerful it could be, she said. I saw that theres a different model for caring for people than what we know and what Id been exposed to in the United States.

In February 2021, Dr. Hardeman, who is now a reproductive health equity researcher and associate professor at the University of Minnesota, founded the Center for Anti-Racism Research for Health Equity, which seeks health care solutions to the effects of policies and attitudes that work against people of color. Dr. Hardeman is the first to acknowledge that balancing her academic work and the center can be a challenge. I feel like Im building a plane while also flying the plane, she said. The work cant stop while I build the infrastructure for the center.

While the subjects and data-driven results of her research survival rates of Black infants who are cared for by Black doctors versus white doctors after difficult deliveries, for example sometimes garner controversy, Dr. Hardeman believes they are necessary for understanding the Black experience in the United States.

She has also partnered with the Roots Community Birth Center in Minneapolis, one of the first Black birthing centers in the United States. Her work has shown the difference that Roots and similar centers can make for both mothers and their babies, revealing more positive outcomes than many hospital systems.

Government involvement, Dr. Hardeman said, is also key. While she tries to get congressional support, she is leading up a work group with the Centers for Disease Control and Prevention as well as the American College of Obstetricians and Gynecologists, where we are tasked with developing a tool to help maternal mortality review committees identify racism as a contributing factor in maternal deaths, she said.

Dr. Hardeman hopes to inspire others to think bigger about policies that hamstring women of color, and in turn, to think of solutions that protect mothers and babies: We have to be thinking about the complexities of how this all shows up right to be able to have the impact. (The following interview has been condensed and edited.)

When and how did you determine where you wanted to focus?

At Xavier University of Louisiana, a historically Black college in New Orleans. I was actually on the pre-med path. I talked a lot about health disparities, but I didnt have the language for what I was seeing, right within my family and my community and certainly in New Orleans. Xavier is surrounded by some really poor and underresourced neighborhoods and a lot of marginalized folks, and so I knew even in undergrad I knew that I was really interested in asking: How do we change this reality?

And your path to that was through academia?

I went into my Ph.D. program with the intention of getting the training I needed to go work for a policy institute to use evidence to inform policy. And somewhere along the way, I started looking around at who I learned from and who taught me as a doctoral student, who was saying the words that I wanted and needed to hear about racial inequities and health and who wasnt.

What did you learn from that assessment?

I realized that as a doctoral student or in the School of Public Health that Id never taken a class from someone who was Black. So I thought to myself, If not me, then who? What could my place be in academia? What would that look like? Can I occupy space in academia and still be true to who I am?

And it seems that youve found quite a few roles that accomplish that. Do you feel as if you have to do it all?

I feel like you have to be working at multiple places along the spectrum to actually get the work done. Its all related, and Im a big thinker. I like to think big and bold and broadly about this work and the ways that it can be connected. So everything I do is very intentional. I deeply feel the urgency. Its a matter of life and death.

Do you have any free time?

[Laughs] I dont. Work has been really interesting and important because weve sounded the alarm on the impact of racism on maternal health outcomes. Now were trying to sort of see how we collect these data and identify whats happening and these maternal deaths, so both of the maternal deaths mother and child arent in vain. Also, statistically, we need to be able to, either from a quantitative or a research perspective, name whats happening, and also map out how we intervene.

Does your identity as a Black woman play into your feeling as if you need to do everything in this space?

Youre familiar with the narrative of Black women taking on the caregiver role. My daughter and I both have shirts that say Black girls save the world. I think that phenomenon is hard to move away from, especially when I think about the Black role models that came before me who did incredible things: my mom and both my grandmothers, who were just incredible people who cared for their families and their communities and did what they could to affect change in the spaces that they were in. I come from a family where it was very clear to me from a young age that to whom much is given, much is required. Ive always had this sense of responsibility, in addition to just caring deeply about people my people and caring deeply about liberation.

With all of that in mind, how do you care for yourself to prevent burnout?

In the past couple of years, Ive become more intentional about self-care. I found an amazing Black female therapist who helps me a great deal. I intentionally take time off to go away with my family. Recently, my husband and I booked airfare and we went someplace warm for a few days to relax and get some vitamin D, some sunshine. Im also trying to shift my thinking. I cant show up if Im not taking care of myself.

I think it was [the sociologist and New York Times contributing opinion writer] Tressie McMillan Cottom who said: These institutions do not love you or they will not love you back. Theyre still there to generate knowledge and generate capital, and you have to recognize that you are someone whos helping to make that happen. But you dont owe them anything. This is advice I need to take personally. Were all replaceable.

What would you tell another Black woman whos maybe starting out in her career and feels like she needs to do it all?

I always want to encourage them to be clear about why theyre there and what they want to do. They also have to make sure thats whats driving them. I always say my purpose in being here is to manifest racial justice so that Black women and girls can live their full greatness and glory that they can achieve and have the opportunities for health equity. I think you have to know that and be clear about that to be able to be in the space of spaces that I am in and thrive.

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Pulling Back the Curtain on Race and Health Care - The New York Times

Historically, outdoor recreationhas predominantly been a white, wealthy, able-bodied and male dominated space. While there have been shifts to change that, there is still plenty of work to be done. Since research shows that nature can be extremely healing, marginalized communities deserve to feel safe and welcome in outdoor spaces as well.

As of 2019, the U.S. Census Bureau estimates that the total population of Minnesota is about 5,639,632. Of that number, 20% of Minnesotans are BIPOC and make up only 5% of state park visitors, according to a 2019 Department of Natural Resources visitor study. 10% of Minnesotans report any disability, with ambulatory disabilitiesdifficulty walking, climbing stairsbeing most common, according to the Minnesota State Demographic Center, which has alsofound wide disparities in disabilities by race and cultural groups. And disabilityrates are highest among people of color (and 19% of people with disabilities livebelow the poverty line).

Minnesotans with disabilities may face a wide range of barriers to enjoying outdoor spaces. Too often, environments are not structured to allow them full participation and enjoyable experiences.

Every child has challenges, some you see and some you cant see,Michele St. Martin, PACER Center director of communications said. Some people have what can be considered an invisible disability, and while they might not be physically prevented from going outside, there can be a lot of issues around inclusion, and like any sort of prejudice, it takes getting to know someone on an individual level.

Jamie McBride, program consultant for the DNR Parks and Trails division says that though there are trails that meet ADA laws, someone might not feel comfortable traversing a trail because of uneven ground. We can build trails that meet the definition of accessible but that doesnt help everybody, he said.What were trying to do is make sure people have as much information as possible so that they can make their own decisions, more information is better. McBride acknowledges that its an ongoing process. The facilities at newer parks like Split Rock Lighthouse and White Water state parks are built with accessibility in mind, but construction and rehabilitation of older parks might end up with a new accessible feature with surrounding infrastructure that mayneed work.

In the last month, the DNR launched the latest program in the fight for accessibility. Paid forby the Minnesota Parks & Trails General Fund, the program will see all-terrain wheelchairs in select Minnesota state parks by the summer. The Action Trackchair is a wheelchair designed to travel through rough terrain and provide extra mobility and independence to people with disabilities. The wheelchairs will be found in Camden, Crow Wing, Maplewood, and Myre-Big Island state parks, with a fifth location to be chosen soon. There's a long list of qualifications that a park hasto fill to get a trackchair according to McBride. Among the most important was the ability to provide a high quality experience. For example, the Maplewood State Park trail ends at a vista with 360 degreeviews. Its a beautiful feature of the trail, McBride says.

In 2021, the Twin Cities Metropolitan Council Youth and Parks Report identified racism as an obstacle preventing young people from connecting to the outdoors, manifesting as in-park racism and unwelcoming park culture. Safety concerns, lack of opportunity to learn necessary skills, low or lack of awareness of parks and amenities, time and transportation and economic constraints, were also mentioned as obstacles which can affect marginalized communities disproportionately.

Asha Shoffner, the founder of the BIPOC Outdoors Twin Cities group, prefers not to focus on the barriers. Id rather just offer a program or an opportunity to folks and be like, let's do this. Rather than talking about it, lets just go do it." Shoffner says the group was created out of necessity, were doing all we can to create a space that we can be in the outdoors not only safely but to just fully be because we havent felt welcome in other traditional outdoor spaces. It was important for Shoffner to find ways that folks can be outdoors in a way that feels comfortable to them and engage in whatever they are able to and choose to.

When Monica Bryand founded the Urban Bird Collective, she had the same thing in mind. She has been birding for over 20 years and when her BIPOC friends became interested, many told her they didnt feel comfortable. She gathered a group of friends, and what started as a simple gathering with the hopes of increasing their birding skills quickly became an intentional establishment of a safe space for queer BIPOC folks who are passionate about birding to find community. I quickly knew that I wasn't going to try to diversify the mainstream birding community, I was going to create my own community. In the third year of Urban Bird Collectives birdwatching gathering, it is the only bird festival in the country that is majority BIPOC. Out of over 100 people there, about 80-85 are going to be BIPOC.

When the Facebook group first started, 80% of members were BIPOC. Bryand explains that now out of around 400, the majority are not BIPOC. And thats okay, we need allies in this to create safe space, she said. But this is where you have to be intentional about how you do outreach.The BIPOC Outdoors Twin Cities Facebook group is open to people who identify as BIPOC, live or work in the Twin Cities, and enjoy spending time outdoors.

Sometimes, helping at an individual level is letting marginalized communities have their spaces. Instead of taking the perspective of exclusion, they are making a space that feels safe and welcome for them. Shoffner explains it as, if there were a womens hiking group and a guy wanted to join because he has a daughter or a wife, would you let the guy into the group? Probably not, because its a womens group. Shoffner acknowledges that gender and race are not the same but it can be understood as women in male-dominated sport, had to make their own space, its the same thing.

Access to resources can halt outdoor recreation in marginalized communities, institutions can facilitate and fill those gaps. One of the things they could do more of is actually partnering with organizations like BIPOC Outdoors or the Urban Bird Collective and provide resources to us, Bryand says. In addition to that, they need to do their work internally. How do they hire folks that look like us? We trust you to do your work, and then help provide us with some resources.

The Met Councils Youth and Parks Report stated that youth had concerns about park inclusivity citing lack of representative staffing, omission of their own cultural history, non-inclusive promotional materials, lack of multilingual materials, and going to the park and no one like me is there. These features sent the message that parks are for white people. Growing up in Minnesota, I never had teachers that looked like me, I never had anybody that looked like me to look up to doing outdoor things, Shoffner said. Ive been really intentional about that and its made a difference.

BIPOC Outdoors has connections to St. Paul Parks and Recreation which helps supply equipment and resources for the 1.6k members in their group. Urban Bird Collective runs on a number of grants and has a partnership with the Minnesota Valley Wildlife Refuge, which is able to provide space and equipment for the group. This is where I turn to mainstream organizations, Bryand says. Be it nature centers or whatever, I say, can you share your resources with us for free?

Shoffner thinks its important to normalize not being an athletewith all the fancy equipment to consider yourself outdoorsy. When its nice outside, I sit on my front porch and work. To me that counts as somebody who likes to spend time outdoors, she says. We dont have to run ultra marathonsits taking your lunch break outside or going for a walk around the block, those things count too.

Visit link:

Making the Outdoors Inclusive for Everyone - Mpls.St.Paul Magazine

We are at war at home and abroad. Constitutional scholar Laurence Tribe stated, We face an existential threat from a movement openly contemptuous of democracy and willing to use violence to achieve its ends. No self-governing society can survive such a threat by denying that it exists. It requires Americans to work together to ensure its success and our future. It means amplifying truth over lies, courage over fear, and country over party. We need to stop treating our fellow Americans and neighbors as the enemy. As former Republican Stuart Stevens says, legitimizing hate is like a war: it is easier to begin than stop. We can disagree about policy issues because thats what vibrant democracies do. But the threats are apparent.

Several threats have metastasized from the Big Lie through misinformation and propaganda. Based on this misguided voter fraud talking point, Republican-controlled states, like Montana, are passing laws to suppress voter turnout. For example, college students can no longer use their student IDs to vote. This law will substantially reduce these young adults ability to vote. And to what end? According to David Pepper in the Laboratories of Autocracy, this doesnt improve the voting process; it is an intentional effort to reduce young voter turnout because younger educated people dont vote Republican. Other threats include gerrymandering congressional districts, restrictive voter IDs, vast amounts of dark money, and burgeoning propaganda that has become a cottage industry. Montana Republicans are trying to diminish the independence of our state Supreme Court, which is a constitutional check upon the Legislature. Combined with an unwillingness to seek a compromise on matters vital to Americans, extremists in Congress like our very own Rep. Matt Rosendale supported the insurrectionists by voting against certifying the election after MAGA forces stormed the U.S. Capitol building to overturn a free and fair election.

Part of the war at home comes from media personalities such as Tucker Carlson, featured on Russian State News for repeating Russian disinformation. And like Donald Trump, many Republicans have nothing but praise for autocrats like Putin. The Conservative Political Action Conference (CPAC) event is sponsoring an official conference in Hungary to support Viktor Orban, the strongman ruler who has destroyed democracy in his country.

To Putin, truth is the enemy. State media constantly floods Russians with propaganda and disinformation with each imperialistic action he takes. First was Georgia, then Crimea, then east Ukraine and Belarus, and now war crimes in Bucha. According to Russian propaganda, these areas wanted Russia to liberate them from the Nazis.: As history teaches us, the atrocities we see in Ukraine are a typical result of corrupt autocracies. It is a brutal lesson of whats at stake in our world and our own country. Helping Ukraine defend itself from autocratic Putin is one way to fight. But many Republicans, such as our own Matt Rosendale and Sen. Steve Daines, voted against sending aid to Ukraine. The lies and performative antics of Republicans like Tom Cotton, Josh Hawley, and Ted Cruz are becoming the mainstream of their party. For them, truth is irrelevant. Getting Twitter clicks and spots on Fox News is the aim. America, under President Joe Biden, has resumed a leadership role to strengthen and support democracies worldwide since WWII; yet many in the GOP support Putin and Orban.

The hate and lies are alive and well in our world and communities. To survive as a democracy, we need to elect people who believe in democracy and truth. When Republicans defend the January 6th insurrection as a legitimate political discourse or punish those who seek the truth in their party, it should give any party member reason to reconsider their loyalty to a leader and party who thrives on hate.

David R. James has a PhD in history and spent 40 years teaching in Eureka and Melbourne, Australia.

Read the original:

The Threats to Our Democracy - Flathead Beacon

(IN ALL CASE EXAMPLES from my clinical practice, clients identities and details are changed significantly to disguise and protect them. The issues and dilemmas raised are questions arising in my clinical practice.)

I hold my hand up to the image of her face. My fingers stumble against the phone screen.

Sweetie, weve survived the plague and who knows what else. Well see you. Soon.

I heard the unnamed catch in her voice. That pause before she said soon. She almost said again. None of us say it out loud.

Soon, I repeat. Promise? I ask.

We promise, says her wife leaning over her shoulder. She comes closer to the phones camera and holds her fingers to mine through the glass and the miles between us.

Im FaceTiming with a dyke couple whom Ive loved and considered family since we met in ACT UP 30 years ago. One of them has been HIV positive since before we met. The other has very fragile lungs. We all have gray hair now.

The next day, I have a telehealth session with a psychotherapy client who is a medical first responder. Theyve looked more and more exhausted every session since the pandemic began. I worry about them. And I worry that Im not able to take good enough care of them from a distance. Through my computer screen, I can see that they have lines embedded in their face from masks and goggles and fatigue. They rub their face between their chapped fingers during our session.

You cant possibly be thinking about reopening your office anytime soon. Its a statement, not a question.

This is working for you? Meeting this way? I ask.

Yeah. I wouldnt have thought so. But I feel contaminated. Im more anxious when Im around people. I cant imagine going to your office. But I feel safe, contained here at home, being with as few people as possible outside of work, seeing you but knowing Im not putting you or anyone else at risk right now.

For many years, Ive had clients who Ive worked with via phone or video those who live too far to commute to my office or who travel often for work and come in when theyre in town, or who struggle with chronic illness or pain and are sometimes housebound. All of those arrangements have been at the request of clients. This is the first time I am shutting the doors to my office, hoping it will be temporary, feeling like I am changing the terms of our relationship and taking something away.

I started working from home a few weeks before the mandatory shelter-in-place order. I love my office, in an old Berkeley craftsman apartment building converted into many suites of psychotherapy offices surrounding a courtyard with an ornamental plum tree that coats the ground in pink petals all spring. Ive had my practice there for a decade. But the quirky building conversion means the suite I work in has a tiny waiting room, a narrow hallway, one bathroom, and three other offices. I cant figure out how to keep everyone safe. I cant figure out how to keep anyone safe.

At the end of a day of telehealth sessions with my clients, I have a video session with my therapist. Because hes a gay man who lived through the early years of the AIDS pandemic, I know he understands the shorthand and subtext when I tell him I lost almost everyone I loved once, and I dont think I can do it again. I tell him my deep brewing anxiety, both familiar and amplified, knowing he must have his own. Usually were sitting across from each other in his office. Looking out the same window when we hear the same wind, the same rain. The same sirens heading to the hospital less than a mile away. Hes in his office, sitting in the chair where he always sits, his computer screen angled so I feel almost like Im, as usual, sitting on the couch facing him. Almost.

After my session with him, I wonder why I didnt choose to work from my office, conducting phone and video sessions so that clients would see the familiar backdrop the Robert Mapplethorpe print, the Japanese textiles of cranes and cherry blossoms, and the crowded bookcase. Instead, Im at home, and though with the door closed my wife Lisa and I cant hear each other, I know shes working in another part of the house.

I dont do well with separation. Separation panic predates my entrance into my family and consumes the story of my birth. I was born two months premature followed by several weeks in an incubator in the NICU. A generation earlier, my family was pulled apart and incarcerated during World War II. My mother was born in the Manzanar Internment Camp hospital, and her uncle was sent back to Okinawa and unable to return until she was in high school. His children grew up not knowing him. I feel the gut-punch of separation trauma as I watch and read reports of families separated along the Southern border of the United States. Kids in cages, parents sent away, neither knowing what has happened to the other.

Some of my clients are undocumented. When they get sick, they weigh the need for medical assessment against the possibilities of incarceration, viral exposure, and sexual abuse in detention, deportation, and permanent separation. This is familiar from the HIV pandemic: immigration status is a barrier to testing and treatment as it flags people and enters them into a tracking system designed to isolate and criminalize. The double bind is weight on their chests: stay at home and remain untested, and possibly risk spreading infection through their families; or seek care and risk incarceration and deportation. In March 2020, 75 percent of asylum seekers who were deported to Guatemala from ICE detention in the US tested positive for COVID-19.

How do we protect our communities and families now? What does it look like if care is organized around questions of distance as much as around questions of closeness? How can we enact a materially and emotionally useful and healing contact while still holding enough physical distance to make conscious decisions about risk? Who has the privileges to be able to access and choose distance? What do contact, proximity, and separation mean in the histories of all of our communities? Touch and distance are both symbolic and deeply, concretely, epidemiologically literal.

A dyke friend from ACT UP who works in public health policy is entrenched in the wreck of constantly changing COVID-19 public health advisement. Her texts are an archive of the strange lexicon of the pandemic, the way ordinary language has come to symbolize incomprehensible equations of safety and risk. In the first days of the pandemic, her texts were one quick word sent between urgent meetings and said things like bleach. And the next day masks. Thirty years ago, she used to distract riot police at demonstrations, putting herself in harms way to capture their attention, creating the chance for some of our more vulnerable friends and comrades to pivot away from another arrest or the rise and fall of a police baton. Now, she texts early in the morning, saying Just. Stay. In. We are, I text back, Im worried about you. And when I text How are you? she doesnt answer.

I have my first COVID-19 panic attack when I read about people dying alone, loved ones seeing each other for the last time at the entrance to emergency rooms or ambulance loading doors. Doors closing.

A few months into the pandemic, I was on a webinar panel about harm reduction as community care, and how the lessons learned from HIV/AIDS might be employed in surviving COVID-19. In harm reduction, we focus less on the action or behavior causing harm than on the need the behavior is attempting to meet, and how those needs might otherwise be met. In the early plague years of HIV, before any hope of successful treatment and longevity, we were told that our desires for queer touch were toxic. We fought hard to claim the bodies of our desires. And now? What does it mean when the reduction of possible risk is the loss of contact? One of the traumas of those first plague years was the pressure to move away from the risk of embodied intimacies. Some of us were paralyzed by our fear, wanting survival more than we wanted our loved ones. Some of us responded by moving toward contact and intimacy, choosing viral risk, and the psychological risk of loss as an inevitability of attachment, a counterphobic move of insistence on embodied, social, sexual queerness as its own form of survival. Choosing a mediated viral risk over the suffering and harm of isolation. And now? Of course, COVID-19 is not transmitted just through queer contact. But we queers know something about the projection of toxicity and harm onto all bodies categorized as dangerous.

During the week which would have been an annual gay mens gathering, a client tells me hes frustrated and depressed by lack of physical intimacy and sexual partnership. If I had known it was going to go on this long, I would have found a fuck buddy for the duration of this. After he says it, we both pause, thinking about it. I know, he says, it isnt even that its a bad idea. But it feels like too much work.

What part of it is too much work?

Im tired. Work is nonstop. And I feel weirdly more connected to my family, even though we havent lived in the same time zone even in years. Now they think Im always available on Zoom. Maybe I am. And my friends, too. I miss being in the same place with them even more than I miss having a partner. It isnt that I want a domestic partner. I want a sex partner. That used to be easy to find. But now the amount of safety negotiations seems impossible.

This client has been a sex educator and taught queer men of color how to navigate openly about sex and desire and safety and consent since before the cocktail in the mid-90s. I wouldnt even know what to teach people now, he says.

Neither of us knows. Were sharing information in real time, even as I am holding space for his feelings about it.

We know what isnt safe. But we dont know what is. Its like the early days of HIV.

Hes right, it is.

Glory holes, he says. Is that the answer?

I cant help it, I start laughing. And were laughing about it together, until we both have tears in our eyes, from the sheer queer camp of it, and then from the highlighted fatigue and loss. He stops laughing, and through the screen of my computer I can see the tears in his eyes slip down his cheeks and he shakes his head.

I mean, I love a good glory hole, and it is kind of the perfect barrier for an airborne virus. But I want intimacy, even if only for a few minutes. Sex parties, gatherings, that was more intimacy, more possible connections, not less. To have disembodiment, or less contact be the only way to fuck feels like the shame weve been trying to shake off.

Now there are articles in queer media outlets against cruising and hook-up culture. We fought hard to reclaim queer sex as a form of vitality and queer sociality and rebelled against the idea that it was a certain death. In psychoanalytic terms, we might think about the death drive, and the ways queerness was assumed for years in medical and psychological disciplines to be an enactment of an unconscious desire for annihilation. Now is all sociability a form of death drive?

Clients who dont have histories of extensive trauma, or who dont come from communities and families at risk and explicitly targeted by dominant systems of political power, white supremacy, and heteronormativity are surprised at how traumatized they feel by the way COVID-19 has changed dailiness and separated communities. I explain that in times of trauma or great stress, its hard for our brains to focus the way we normally would. Instead, were focused on survival and scanning for immediate danger. And right now, almost everything feels like a potential source of danger.

But what becomes clear to me is that they expect this to be a shock trauma. Meaning, they expect this to be something from which they recover and go back to life and embodiment and sociality as before. For those of us who live in conditions of precarity, we know that while we might still fantasize about recovering to a before, this is a developmental trauma. Meaning that it will change the course of our development. As individual bodies and as communities. And developmental traumas echo and tug at each other. Thats part of why this feels, for many of us, like AIDS what I have for years referred to as plague time, until now, when we are in another plague time. And this one has both the echoes of that first one, and proximity to the political and social systems which have perpetuated it for decades.

Let me say it this way the way we feel this moment as a traumatic rupture to social attachment is in our bodies. Is embodied. And were searching for new ways to be bodies together, to keep track of and experience each others bodies.

As I meet with my clients via video, I track their bodily expressions the way I always track their bodily expressions, but the technology creates a sort of wrinkle in time. Did they really pause before they said that, or did the connection lag? Are those tears, or a reflection? Are they holding their breath? It seems as though they are making eye contact, but there is a lens, a filter, and many miles between us.

What is the embodiment of co-regulation in a digital relational moment? Usually Im experiencing our bodies in real time, simultaneously. I take a slow breath and settle more deeply into my chair as a client is experiencing a painful feeling and they slow their breathing and settle. Its a form of regulatory embodiment, not unlike the ways a parents embodiment is mirrored by a child as the child learns affective expression, or the way, over time, we attach to and mirror the embodiment patterns of anyone with whom we have deeply intimate contact. And by deeply intimate I dont mean sexual, or I dont only mean sexual. I mean intentional, where we attune to and track each other. We experience our bodies in relationship to each others bodies. And now? How does that work with a screen between us? In that split second of delay, or the glance outside of the screen at whatever is happening in our separate spaces, we feel more separation, aware of the different frames of reference of our immediate experiences. And in that separation, the possibilities of misattunements or projections arise.

One day the computer freezes and connection drops just as a client is telling me about a fight they had with their partner. They kept talking for a moment before they realized the connection dropped and when we got the connection back, they felt unmet by me, just as they had felt unmet by their partner, even though they knew it was a failure of technology. But thats the bind for the therapist, isnt it? To be able to follow our clients, no matter what. The presence of technology and technological glitches makes us aware of the ways in which we interpret each other and assign meaning to somatic cues, whether we are correct or not.

Another client pauses and stares at me through the screen, wide-eyed, when I sneeze. They had just lost a colleague to COVID-19. Im fine. I tell them. They dont believe me. Really, I say again, allergies. Its spring. I promise.

And later that evening, when Im in session with my therapist, and he sneezes, I have the same wide-eyed worry. And before I can ask, he says, Allergies. Really.

A friend texts that she and her partner are both sick, as are their young children. Fever, coughing, unbearable fatigue. An hour later when Lisa and I drop off bags of food on the porch, our friend comes to the door, one squirming child in her arms. Her red-rimmed and dark-circled eyes are the only part of her face I can see above her mask. Lisa and I want to go into the house, heat up dinner, rock the children, let our friends nap. But we have also agreed that for now we wont theyre tired but stable. So we do this: drop off dinner, groceries. Ask every day what they need. We feel both useful and useless.

How will we decide when we need to put ourselves at increased risk? And for whom?

These are the questions Im asking, and the questions my clients are asking. We find ourselves talking through assessments of risk and community care: there are no equations of risk reduction that leave anyone feeling safe or protected. What does it mean to be permeable? This has always been an emotional question. An affective one. Now it is also an epidemiological question.

A few days after the murder of George Floyd by police in Minneapolis, one of my clients was a few minutes late to our session.

I bet you thought I got arrested last night, she said, smiling. She looked tired.

Well, the thought had crossed my mind, I said. It sounds like it crossed yours, too.

Yeah, I went out there. There were the Black Lives Matter demonstrations through Oakland and San Francisco to protest yet another murder of a Black person by police. This client was a longtime organizer and had been part of many demonstrations prior to the COVID-19 lockdown. But she also lived with and took care of her grandmother, whose health was fragile.

You know Nana has been telling me to go. And I wouldnt because I didnt want to risk her.

I nodded. Wed been talking about this off and on for months, how her grandmother years ago had been a supporter of the Black Panthers in Oakland, part of an earlier generation organizing against police violence and state surveillance.

Right, you didnt want to risk harming her, even though she was telling you that it was all just different forms of violence, and you could stay home and be passive in the face of it or go out there and be at a different kind of risk, but not passive.

Yeah. Passive resistance just isnt her thing. You can imagine the role she played back in the day.

So, she convinced you?

We compromised. A change of pod, for now. My sister came home to stay with her, since she can work from home. And Im staying with my girlfriend, since were both organizing. And now we can be together. Its also sort of a trial run of living together. And now I can also do the grocery shopping for my sister and Nana, and they can be safe.

You look happy about it. Are you?

I think so. I havent been away from Nana during the pandemic, so I worry about her, even though my sister is there. But I also havent been with my girlfriend, and I want that too. I just thought, once I came out and once my Nana accepted my queerness, which she has, and she even loves my girlfriend, then I wouldnt have to choose.

And now it feels like choosing between your Nana and your girlfriend?

Yeah. But really its between my Nana and the movement. Which is even weirder. She pauses and looks at me through the screen and it feels like were making eye contact, as much as we can. Were you out there, last night, at the demonstration?

This is a complicated question to answer. It isnt only one question. Shes asking about my relationship to risk in this moment, what I will take a risk for. She knows Ive been out in the streets for demonstrations before, knows Ive been arrested. Thats how she was originally referred to me. But this is different. Shes asking how I situate myself right now. What I will put myself at risk for. A colleague argued that it is our role in queer mutual aid right now to stay as well as possible for as long as possible so we can care for other responders in the community, that were the only category of care provider and first responders able to stay virally sequestered and still do our job. That radical mutual aid doesnt just look like being in the streets. And I agree with my colleague even as Im deeply uncomfortable, and unfamiliar, with the privilege of relative safety.

I wasnt there last night. I answer simply, truthfully, not crowding the space with my ambivalence, or my worry about her. We may get to those things. But for the moment, I watch as she nods, thinking about what my answer means to her.

A therapist colleague starts a conversation on a clinical email list about making sure we have our professional wills intact. Which colleagues will we ask to care for our clients if we die? Who will notify our clients? This isnt like times of private crisis, when we can take a week away from our practices, cover for each other in case of emergencies. This is all an emergency. We dont know which one of us will be the emergency. Which ones.

Who are we prepared not to see again? That question brings a new intentionality to desires for connection where we had once been casual. We know steps toward contact will be slow, and this new caution may be permanent. The idea of restricting access to loved ones makes us want to be with them even more.

Some clients are getting restless within their sheltering. They fantasize about what they will do when its over, who they will see. Those of us who work with a harm reduction model of clinical practice are used to talking about full information and informed consent and clear choices and boundaries. What is an informed choice, or consent, in the absence of epidemiological certainty? How many people in our webs of human contact, from the grocery store clerks, to our family members we might need to care for or to visit, to the people we live with, to the doctors we need if we get sick with COVID-19, or anything else which requires medical care, get to consent to our choices?

Some of my clients, in their frustrations, say they know this has happened before and it ended. I know what theyre referring to, when they say it happened before and people survived and still chose pleasure.

People are writing about having lived through the AIDS epidemic as though it is over. And I know what they mean they mean the panic of constant unpredictable loss, the panic of tracking possible exposure, the days before the cocktail, before PEP and PrEP, and before undetectable viral loads made it possible for people who are seropositive to live as normal a lifespan as though they were not seropositive.

Let me say that again: as normal a lifespan as though they were not seropositive. That means they must have access to appropriate health care and medication. And it means they dont escape all of the issues of equity and health disparity that are now affecting mortality rates in the COVID-19 pandemic the wildly disproportionate number of communities of color that are being gutted by the virus because systemic racism has set them up to be more vulnerable lack of health care, food apartheid, school-to-prison-pipelines and post-incarceration discrimination limiting peoples options to low-wage, high-risk jobs they cant not go to now because the systems that depend on their labor are not shut down, and health complexities related to stress and inequity. So Ill say it again: people who are writing about having lived through the AIDS epidemic as though it is over are the ones who have had the health care and the economic access and maybe a little luck to have survived this far. As though the seroconversion rates arent now at a 50 percent chance of seropositivity in the US for Black men who have sex with men, and a 26 percent chance for transgender Latinas.

As though we are not right now and daily still living both in it and in the aftermath.

And it has stayed with us, it has stayed with me, shaping how we love, attach, desire. Obsessing over the question of whether we can save each other.

It is not just the ways COVID-19 is similar to HIV, but the ways it is different that are breaking my heart. The intersection of our political, moral, and embodied politic was an insistence that quarantine and distance were not acceptable universal precautions. The ways we defied anxiety and isolation have become our ways of being, have become our identities, and are now forbidden. We rebelled against the story that our embodied queerness was a death drive by insisting on touch. Insisting on embodied expressions of love as proximity and care. We insisted on sex. We insisted on holding each other, holding our hands to each others faces, breathing in and out together. Feeling that connection. We asked ourselves what risks were worth taking and we took them.

Heres what does feel the same: the way grief swirls up for those of us who have already lived through massive waves of loss. It isnt that this is exactly the same. But it doesnt have to be the same to be provocative. It just has to press against the same wounds. Body. Touch. Distance. Barrier. Quarantine. Separation. Death.

Remnants from the AIDS quilt are being used to make facemasks. Maybe this isnt the grieving of the dead. Maybe this is the incorporation of our grieving into our hope for survival.

The insomnia that has taken over my nights is familiar. The words that fill my head at 3:00 a.m. are some of the same keywords and questions from 30 years of grappling with the HIV pandemic:

SurveillanceStigmaPathogenesisViral countAntibodiesDetectabilityQuarantineCriminalization

Slowly, my colleagues and I are talking about what to do. We know that people are struggling to adapt to all of the new frames in their lives, from shelter-in-place to telehealth, and we wonder what it will take for us to sit in rooms with clients again. In most professional clinical associations, there are conversations about whether we need to request frequent testing and contact tracing from our clients as conditions of reopening our offices. But for decades Ive worked on campaigns opposing the surveillance and criminalization of HIV-positive bodies. Contact tracing has been debated in HIV public health for years. Epidemiologically it makes sense. But there is no epidemiology exempt from the current political power structures.

In other professional associations, psychotherapists want to require vaccines and frequent testing of their clients in order to resume in-person therapy. But to require expensive at-home rapid testing, or any guarantee of COVID seronegativity, will create a privileged class of clients who can come in to see us, and a virally and economically disenfranchised class of clients who cant because their essential public labor means that they are never entirely sure they arent exposed to and carrying an airborne virus, even if they are vaccinated and regularly tested, especially as new variants continue to be identified.

Are we left with the option to invite people who work from home into our offices, but not teachers, nurses, grocery store staff, and sex workers? What about immunocompromised folks whose sessions might be scheduled right after those childcare center staff, ER doctors, or farm workers? Every new advance in treatment or prevention highlights the racial and economic discrepancies of access and shelter. To resume in-person psychotherapy on a rolling basis as people gain individual access to resources and viral safety feels like enacting the systems that our clients are injured by. That my clients are injured by.

There are now frequent articles about resource scarcity, which is an intentional condition of capitalism now manifesting as ethical choices for caregivers instead of as failures of responsibility of politicians and corporations and the state. In the absence of universal health care, this has always been a choice for many people; and still, those with more economic access have better chances of being treated. With shortages of oral medication and limited ventilators, doctors and nurses are being asked to choose who will be denied treatment. It isnt just that they cant save everyone. They cant even try.

The field of psychotherapy isnt exempt from moral dilemmas, and they are amplified in the discussions about sitting in rooms with clients during this pandemic. For many years, there have been those of us who question the accepted practices and lenses of our field, making explicit the necessity of understanding identities and cultural experience as part of understanding our clients psyches and embodiments. We interrogate with our clients the ways in which their identities locate them within political and social categories of power and precarity, and how those frame their mental and emotional well-being. And we have been willing to bring our embodied subjectivity into the room explicitly, to unmask some of the frameworks of our experiences which shape how we see, hear, and understand what they tell us, and what they omit.

And there are some things I dont think should change: we dont ask our clients to take care of us. We make space in our relationships with our clients so they can explore the full complexity of their desires, fears, and impulses. Including, now, their desires to expand their circles of contact, to reestablish a life and social world they recognize, their need for bodily connection. This is a strange time for psychotherapy. We are all living through this together in real time, deeply impacted by the experiences and choices of one anothers bodies in the world. If we sit in a room together, there is no way not to be affected. There is no blank slate. None of us. And yet therapy should be the place where we can bring our whole experiences away from the anxiety of impact. Or where it is symbolic and not virological. Im pretty sure in the past Ive gotten the flu from clients who have come in to see me when they were sick, because my office is a place where they feel safe and cared for when they are unwell. And now? Do I ask them to only come see me if they are well? And will that set them up to feel like they cant tell the truth of their experience without jeopardizing our relationship? And what if I were the one to, unwittingly, expose them?

Some of my clients worry about me. They ask me if Im being careful. If Im safe. None of my clients have died of COVID-19. At least not yet. Many of my colleagues have lost clients. And more than half of my clients have lost loved ones. Yes, I tell them, taking a deep breath to slow myself down to make sure Im hearing them, taking them in, and they hear me and see me slowing down to respond thoughtfully, taking their concern seriously, Im being safe. Its the same way my therapist responds when I tell him I worry about him. If only we knew what it means to be safe. As though it is only an epidemiological question, and not an emotional one as well. Were all figuring this out in real time unfolding, together. But I understand the reassurance that my clients need when they ask, that we will get through this together. The same reassurance I need from my therapist. Even as we understand that we have no idea when we might be bodies in a shared room again, any of us.

Also, in reopening our offices, we would be bringing all of our clients into viral relationship with each other through the shared air. Other suggestions from professional organizations, in addition to increased liability insurance and liability waivers, should any of our clients get sick and feel certain that they were exposed while in our offices, waiting rooms, or bathrooms are consent to contact tracing, disclosure, and notification.

I just dont want to. The worlds we live in always enter into psychotherapy because we bring them with us. How can I continue to structure my clinical practice, which has always been in service of vulnerable clients, so that it doesnt contribute to their precarity?

This is not hypothetical.

What is my responsibility as a light-skinned femme-presenting person of mixed Asian ancestry? And as an HIV-seronegative person? The state tries to weaponize bodies through hierarchies of worth and checklists of respectability to earn the right to care and survival. The argument of sacrificing people to solve one crisis before the others has never worked. This is a moment when we need to insist that psychotherapy not become a weapon of anti-Blackness and anti-Indigeneity through collusion with state surveillance. Because yes, contact tracing is potentially an important part of bringing COVID-19 under containment, but what bodies are sacrificed along the way? I dont know the answer. It might not be knowable yet. But what I do know from 20 years of practicing psychotherapy is that when we dont know, we should slow down and make more space, not less.

Is a shift, at least for now, to solely telehealth a part of reimagining therapy as a form of queer mutual aid which actually allows for the continuity of a queer and protected therapeutic space, instead of following the parameters suggested by current health-care systems of oppression? I grieve for my office time with clients and colleagues, and the things we give up by not sharing physical space. But grieving is a necessary part of this moment, too. Even as we make choices toward survival, we lose things.

After a long day of telehealth sessions, I check on my beloved ACT UP dyke couple again. Theyre being as cautious as they can. And I miss them. Lisa and I start making calculations about how long we would have to quarantine for us to safely see them.

Am I falling into my own fantasies of COVID-19 as a shock trauma and holding the fantasy that things will return to a before? Even though none of us were safe or secure in the before. But we were, at least, together. Maybe the difference between what makes something a shock trauma or a developmental trauma is the proximity to privileges that allow one to recover to a before.

One of my clients sends me a note asking to check in for a few minutes on video several days before our next scheduled psychotherapy session. She joins our Zoom session with an unusually crackly connection, and when the image stabilizes, I dont recognize where she is. Shes a painter in her first year of an MFA program, having returned to art school, her dream, after years as a nurse. Since weve been meeting on Zoom, Ive been watching her work on new paintings, canvases lining the walls behind her.

Where are you? I ask.

Go here to see the original:

Refusing the Death Drive Story: A Psychotherapist Reflects on HIV, COVID-19, Trauma, and Queer Attachments in a Time of Plague(s) - lareviewofbooks