Beirut, with its civil strife volcano that sleeps too lightly and its cacophony of oppressions, is generally a good match for my specialty. But 2020 was a year of unprecedented financial, political, emotional, and bodily carnage. As a psychologist, it was a year of witnessing an endless slew of awful and unnecessary suffering from a dizzyingly intimate perspective, but nothing could have prepared me, as a psychologist or as a citizen, for the explosion of August 4th.

The year is nearly done, yet still, nothing feels normal about waking up in this city where the living survived by miracle and the departed died by nightmare; and everyone, therefore, suffers from the derealization of almost-existence.

Patients still feel like apparitions. They’ve tired of talking about their houses turned to shells, investments to rubble; about crushing silences where life used to be, and how that silence yells louder now that it’s the holidays. And yet their lives have rarely moved on. They mine randomness for inexistent patterns; try to wind back time to yank a loved one just a few inches back to safety.

So when patients ask, “How are you? What will you do?” the therapist-citizen attempts an answer: “I am grieving and I am angry, more deeply than I ever imagined possible. And I am staying, as long as it remains possible. To work with you is an antidote to the fragmentation of city and self that the explosion has wrought on us all, and I want to build a country with you.”

They talk about leaving. Some mean Lebanon; others, life. Even for those who have emigrated, their psyches are here, trapped in existential negotiations.

Patients ask: “Will you leave?” Meaning: Will the blast take you, too?

Professionals have left in droves. Doctors have left in droves. Friends and family members have left in droves. Every home is an empty nest. The human attrition following August 4th has created an endless second wave of mourning. “I don’t mean to ask personal questions, but…” How solid is this space we share? Must I add you to my grief?

The frameworks that guide therapist self-disclosure aren’t built for these circumstances. What’s more, the question is directed not only at the therapist, but also the co-citizen.

I think: I don’t know what to do. All the wrong people are leaving, and the scale of their retreat vacuums the air from my lungs. That sister, that neighbor, that colleague, they’re mine! I want to scream to the airplanes. Instead, I cry. Leaving won’t take away my pain, so I redecorate my office.

I nearly confess: I wonder, as we work through your plans: Will I add YOU to my grief? I, too, am afraid of loss.

But the work takes its toll. A common symptom of post-traumatic stress is re-experiencing: in the form of intrusive thoughts, images, feelings, sensations, or nightmares. Evidently, it can also take the form of doing therapy. On top of the way that I experienced the event myself, I relive it in as many different ways as there are patients who lived it too, in as many ways in which they themselves re-experience it. It is a house of mirrors of explosions.

“Ever shoot a person in the head? I did, on Tuesday night. A doctor slapped an industrial staple gun into my hand. They couldn’t keep up with the bodies, so I went around the ER literally stapling people’s skulls together. A woman peeled a blood-drenched patch off her eye. ‘How bad is it?’ she said. ‘Can you see with the other?’ I asked, and she said, ‘Yeah.’ ‘You’ll be okay,’ I said – it’s one way of telling someone that their eyeball exploded.”

“I go to sleep. Next thing I know, I’m near the door, fully dressed, phone in hand, full of adrenaline, ready to run. I don’t even remember waking up. I calm myself down, undress, get back in bed, go to sleep. Next thing I know I’m at the door again, fully dressed, ready to run. I calm myself down, undress, and get back in bed. Next thing I know I’m at the door again.”

“I was near the port when the pressure blasted through the car When I found my bearings, I realized that everyone around me was dead. That I was in traffic that would never move again.”

Professionals have left in droves. Doctors have left in droves. Friends and family members have left in droves. Every home is an empty nest. The human attrition following August 4th has created an endless second wave of mourning. 

It is a perverse honor to be the collective diary of an apocalypse. There is an emotion-headache that won’t leave my skull. So when patients ask: “How are you”? I wonder: how much mirror do I give, and how much rock?

The therapist-patient relationship is by nature asymmetrical, but nothing levels the playing field like an explosion that gutted swaths of the city that therapist and patient both share. There is a mutual and persistent existential concussion that aches to be acknowledged. Lean across the countertop, but don’t cross it. I am careful not to finish patients’ sentences: the space is co-constructed, but it is theirs. There are other places where the boundary will blur.

Indeed, the office is not the only shared space between therapist and patient, nor is the explosion the only shared traumatic reality. If the decades have taught us, as Lebanese, to tolerate a sense of catastrophe dulled only by chronicity, the past year has been chronically acute. Such strife has urged frequent communal protest. Here, therapist-citizen and patient-citizen often meet as co-citizens, hearts ablaze with the same desperation for hope.

I, too, am desperate for hope.

2020 leaves both psychologist and patient in need of healing, yet I am blessed. Nourishment has come, in this darkest of years, in the form of honest connection, and my profession affords me plenty of it. Working at the crossroads of so much pain also offers a vista onto the miraculous steadfastness of the human heart. My own heart is stronger and more optimistic for learning and loving the intimate wonders of my remarkable co-citizens.

So when patients ask, “How are you? What will you do?” the therapist-citizen attempts an answer: “I am grieving and I am angry, more deeply than I ever imagined possible. And I am staying, as long as it remains possible. To work with you is an antidote to the fragmentation of city and self that the explosion has wrought on us all, and I want to build a country with you.”