Where Should We Begin? with Esther Perel - A Hospital Divided

Episode Date: October 16, 2023

They're best friends and ER doctors at a small hospital. During the pandemic, they experienced a fracturing among their coworkers, who they once thought of as family. After one of them develops an autoimmune disease that renders her immunocompromised, she begins to wonder why her coworkers can't prioritize her safety. This episode was recorded after the Omicron wave in 2022 for Esther's podcast How's Work that explores conversations between colleagues, business partners, and peers. Learn more about your ad choices. Visit podcastchoices.com/adchoices

How's Work is an unscripted one-time counseling session focused on work. For the purposes of maintaining confidentiality, names, employers, and other identifiable characteristics have been removed. But their voices and their stories are real. Thank you. approach. Noom wants to help you stay focused on what's important to you with their psychology and biology-based approach. This program helps you understand the science behind your eating choices and helps you build new habits for a healthier lifestyle. Stay focused on what's important to you with Noom's psychology and biology-based approach. Sign up for your free trial today at Noom.com. Metrolinks and Crosslinks are reminding everyone to be careful as Eglinton Crosstown LRT train testing is in progress. Please be alert as trains can pass at any time on the tracks.

Remember to follow all traffic signals, be careful along our tracks, and only make left turns where it's safe to do so. Be alert, be aware, and stay safe. What makes the emergency department so beautiful and so unique, we are connected to each other on an incredibly, incredibly intimate level. I know more about my colleagues than probably their spouses do. There is no physical boundary that exists for us in the ER when we're in the middle of like a resuscitation. And then there's also not like an emotional boundary. We are, to say a family is an understatement. The town in which we work is an extremely conservative town. The day that the vaccine mandate came out, there was like a huge crowd of people with guns outside the hospital. Like maybe 30% of our hospital staff are vaccinated.

And then from there, it turned into people refusing to wear their masks, even in the emergency room at work, because it didn't align with their political beliefs. And that's kind of where the rift started. A crisis often creates polarization. Crisis fragments because it brings up such insecurity and such uncertainty that people kind of latch on

to certain sides with a kind of a false certainty. And in this ER unit, the team disintegrated. The doctors that we meet here lost their team and they could no longer be sure that they were all working together as one family as they say to save lives and that led them to feel that they were compromising their

moral compass. The nurses or the techs or the clerks will come to me and ask me my daughter my son who's this going on? And they trust me with all of these things. And yet when it came to this thing that was making us look at all of these Americans dying, making us put our neighbors in the ICU, yet they didn't trust me. At one point, we had 70 people out sick at one time. And the vast majority of those were unvaccinated to the point where we were unable to staff our hospital properly.

And we were so understaffed that people died. I mean, truly, people died because we didn't have enough staff to take care of them. That medical people would allow their political views to, like, have them completely ignore sort of... Epidemiology and science. Yes. Was really wounding for me to see that happen. And I'm just sort of angry at everybody. So I've kind of withdrawn quite a bit at work.

I feel your isolation. I feel the betrayal. I feel I'm trapped because I don't want to leave. So the only thing I can do is not talk to them. Small leaving, small departures. But if this is brought up, the response is what? The whole time through COVID, getting the nurses to wear their masks has been battle. Just like to wear their masks at work in the emergency department. I think you should share why that makes such a difference in terms of your personal story? So about a year into COVID, I ended up really sick.

And I have like a fairly rare autoimmune condition. And to live, I have to take medication that makes me immunocompromised. So it felt super personal on top of this sort of science denying in a medical setting for my own staff. OK, you don't want to get vaccinated. Like, I'm an American. I can understand that. But if you're going to be working in a medical facility, even just for me

person to person to not be willing to wear a mask felt um like a huge slap in the face I don't think cognitive dissonance is like a big enough word for what we witnessed happen and what would happen with the patients I mean we must have had patients who came in with COVID too. Oh yeah, we've had a ton. And died in the ER. Oh yeah. So when we watched this whole first wave of everything in New York, that was really painful.

And then we got like the second or third wave is what hit us hardest when it got really bad. And that's when we saw people die that didn't have to die. And it's like they don't care. I think they do care. I think they care deeply. And I think that their own fear comes out in a different avenue, right? Like their own fear and sense of control then comes out in a different narrative than ours. Politics got mixed up in it. And so then there was a political narrative that happened rather than just a science narrative that happened. And then we were at odds with ourselves. So like we went to work and rather than, and I think this is probably where the story really

starts, rather than showing up in the emergency department as a team, which is why you and I both chose to be emergency medicine physicians is because we inherently love being part of a true family and a true team. All of a sudden that was stripped from us because all of a sudden it was like a civil war inside of like right like it was a family divided yeah you know really what we I'll speak for myself what we seek to get out of like today's session is thoughts on how you heal and how you move past and how you continue to then thrive in this environment where for the last two years it was a family divided. A house divided here refers to an emergency room that is experiencing a major fracture where people who are colleagues and co-workers in this small town no longer talk to

each other, see each other as a threat, and they once used to play together, socialize, shop together. What's happened to this family? This leads me to think about the many other families where similar divides have taken place as well. Children who don't talk to their parents, siblings who no longer connect to each other, where there is a clash between the interpersonal and the political. How do I stay connected with people who see the world so completely different from me? Yes, that is one of my questions. Right?

And that is a question that happens in families all the time, regardless of politics. There's a lot of different aspects to the view of reality in which in a couple, two people have completely different ideas of what happened or what was said or who did what in a family. So in that sense, if we go digging in broader spaces of where people who fundamentally disagree or diverge still manage to stay closely connected, we can maybe draw something from there into the particular situation that you face in the hospital.

Yeah. Right? If we just keep it to politics, then we will have too narrow a frame to try to come up with something creative. Right? Why did you decide that you can't leave? Just so I know. Or that you won't leave. or at least maybe not now. My parents just left their home of 45 years and moved to be in the same place as us.

So that just happened. But also, I love it. I love my life there, except for this slice of when I go to work. The other part about why I think you won't leave is because we do live in a rural area, and so there's vast space and outdoors. Physically, there's not a lot of other options. And so you, but you love the outdoors. I love the outdoors.

What do you mean there's not a lot of others? Like, there's no other hospitals around. Uh-uh-uh. Do you feel like, can I, and maybe this is a question you should be asking about me but do you feel like equal opportunity here equal opportunity asking um do you feel like there's any circumstance with any of our staff like now that I mean we have gone through like the main wave and right now COVID has abated somewhat and now there are different mask rules and everything has sort of changed even scientifically right do you feel like in the last few months do you have any experience with any of

the staff where you have started to recreate trust and bonds and familial relationships again or do you feel like you're just emotionally in a place where I just can't access it and I can't trust it and I'm like can't go there? I feel like it's like sneaking back up on me without me trying to. Like I found myself sort of laughing and remembering about something with, like, someone who we had a particularly hard time during all of this. And I, like, got, like, mad. I felt, like, a flash of anger at myself for, like, letting myself sort of bond with this person again. Like, you hurt me so badly. I can't just laugh and have fun with you again.

But I did. But I did. And does that person know? I don't think so. That they hurt you so badly. That's why I'm going for the... Yeah. Because you described small town,

because you described the power of the connections, because you described the ubiqu of the connections yeah because you described the ubiquitousness of a small group of people in multiple parts of your life yeah I am actually asking if the personal connection overrides some of the beliefs not in changing the beliefs but in simply you know um responding to someone I care in the way that sometimes we just, I still think this, but for you. Yeah. So when you think, I think in my experience, I'll answer that for myself. I think that there are people who I hurt very, very deeply and they hurt me very, very deeply. And we know that. We know that we hurt each other very very very deeply and I can

name those people and I won't name them but like I have people in my mind's eye because I had the face-to-face conversation with them and we cried and we yes and it was about and it was about what did you say it was a what did they say what did we say I What did they say? What did we say? I think it was just... At that meeting where we all had to sit at that table? No, well, yes, there was the meeting where we all had to sit at the table and talk to each other. We had such a divide in our department that we actually voluntarily had a meeting where we allowed everybody to come who wanted to come, didn't matter position or whatever. And we had a mediator sort of like help us talk to each other out loud and say our experience. And I think that that meeting was very reflective of the fact that

people really, really, really knew and everybody was hurt. But I guess I'm talking personally, like because of who I am as a human and because of the personal relationships I had, I had face to face, like, Hey, do you mind coming into this room where no patient is? And it's slow and it's not, you know, like it wasn't inappropriate. I guess I'm saying, um, and like saying to them, I know you don't like me anymore. And I know that you have been disparaging of me as a human. Like, I feel like what you're saying is you're saying I am a bad person. And they said to me, I feel like you're saying I'm a bad person. And we understood that we both had wounded each other

in a way that made the other person feel like you don't exist as a human. That like your purpose as a human and your purpose of being here at work or like whatever your purpose that like we had taken away like a base, like you are not human to me anymore. You are so vile based on the way you've acted or your political beliefs or your whatever that like it had transpired to the point that like I don't even use human anymore. And here's where I'm going to call bullshit on that. Because the thing is, is that all we were asking them to do was wear a mask, which was a hospital policy to begin with. But that's your experience, buddy.

That's not my experience. But for them to have that crazy reaction. But it wasn't crazy because I had the same reaction. I know, but for them to say, you're taking away my humanity by asking me to wear a mask. But they took my humanity away too. And that's what I'm saying is when I sat down and looked in, like this happened three different times with three different staff members and we cried together and we yelled at each other. And we left the room literally, literally saying, one person literally looked me in the face and said, you will never be my friend again, but at least after this meeting, I can still take care of a

patient with you. And that wrecked me. That wrecked me, my soul, like my purpose for going to work and my why and my mission, those relationships and the ones that I was brave enough with to like have that face-to-face conversation, like they were my brother or sister or whatever, like it was incredibly palpably apparent that I had hurt them and they had hurt me and we had really hurt each other like deeply. Okay. But I got to bring it back to the, for me, when I hear that, I hear that you had that conversation. And I would be so angry in that moment in the context of saying like. Because you don't understand why, on what basis do they even think that you have hurt them? Right.

In that, I'm not the one who's asking them to wear the mask. I mean, I am personally for my own personal safety. But this is also the body of medicine, the body of science and our own hospital's policy. So for you to get that hurt and me take away your humanity by asking you to wear a piece of paper on your face, I think is a dramatic disproportionate response. But this is one place where the two of you differ. Yes. Right? Yeah.

Is that on some level you'd say they're willing to let me get sick for a principle. Yeah. That I don't even, that I believe in and they don't. Or they're willing to let patients. You think so too? I'm not the only immunocompromised person in the emergency department. I'm not the only immunocompromised staff member that they work with, let alone their patients.

So if they think their purpose is to be there for their patients, but they're not willing to do the bare minimum of wearing a mask, I question everything they have to say. Like, I don't have respect for you. If you honest to God are telling me that this, wearing this over your face, you're not going to do that for your own patients,

like, I have contempt for that. What you are highlighting between the two of you is that there is a certain kind of principled reasoning that you hold by that surrounds your anger, your hurt, your contempt, your disillusion, and the sense of betrayal and other things. And that you keep saying, maybe the depth of my connections allowed me to want to reach over and at least have a conversation with those people and find a way to still have some connection with them, even if I fundamentally disagree on this issue with them. And you say, not only don't I respect them, but I certainly will not love them.

That's what I hear. I mean, I think that what is fascinating is the difference. It's a subtle difference, but a very profound one in how each of you is experiencing the hurt because behind the anger is hurt. The disillusion, the breach, the complete breach of trust that that seems to be for you. But I'm less interested in the beliefs about the COVID itself than how you deal with the breach of trust, how you continue to work with these people. Because in an emergency room, as you see, the level of interdependence and unity in the moment

is at its highest. And if you do not trust them how does that influence the work this is just patient care now um and then what in your respective personalities and personal histories lends itself to the more rigid position that you are holding on to and a little bit trapped in, and the more flexible position that you are drawn to, but that may at times challenge your conscience. And it becomes a moral crisis as much as an emotional one.

That was... Do you want tissues? It's an incredibly articulate and profound way of, I think, articulating and putting into words. Thank you for that. What did I just say that felt... I have not had the insight until you said it in those words. I can't let people I love go. And I love them so much.

Even if I disagree with them, but then that brings with it this other writing emotion where I feel guilt or I feel like maybe I'm not abiding by like a higher moral standard and maybe I'm letting people, other people I love like you who's sitting next to me right now, maybe I'm letting you down. And so it does, the way you said it was the first time I think I had insight into my own psychology, honestly. And it's true. And that's why I'm crying. Faced with this moral and ethical dilemma, one of the physicians has chosen to stand her ground and to keep her conscience clear.

But the price she paid is the price of disconnection and isolation. While her partner, who is the medical director of the hospital, chose to emphasize the importance of the connections, even if it came at a price for her conscience. And this polarity is very important in understanding the case of moral injury that both of these

women are experiencing. It's not the PTSD, it's not the trauma reaction, it's the crisis of conscience. It's the gap between their values and their behaviors, between how I see what I am meant to do, and what I stand for, and what I end up doing, that gap became apparent for the medical professions during the pandemic. And this is what these two physicians are experiencing as well. With SmartWater's pure, crisp taste, there's nothing to overthink. So while you may be spiraling over double-texting your crush, whether your skincare routine is working because you look the same

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and the perfect pairing for your game time. When Miller Lite set out to brew a light beer, they had to choose great taste or 90 calories per can. They chose both because they knew the best part of beer is the beer. Your game time tastes like Miller time. Learn more at MillerLite.ca. Must be legal drinking age. I heard you say that we are two examples of a continuum of everyone bringing their relationship patterns to how they process an event. And this was a universal event and that we all went through it. But our experiences are different and the way we're going to process it is very different and we bring our patterns to this as much as we do anything else

and I very much in my personal life have a very low tolerance for people treating me poorly or feeling like I'm getting stepped on and you kind of got to earn my trust and love first. I don't just give it right away. And that's me and the difference between me and you. Where does that come from for you? Just from, yeah, being injured along the way. I just don't think people show you their true self right at first. You've got to get to know them a little while first,

and I'm happy to have a more, like a congenial, nice relationship, but I'm not going to call you a friend until I feel like I know you well. Is that like childhood? It just takes time. Gosh, I've been like that for a very long time. Yeah, I'm sure childhood. Yeah. It takes time. Gosh, I've been like that for a very long time. Yeah, I'm sure childhood. Yeah. That's where you developed the lack of tolerance?

Yeah. That's like school bus learning. There was a kid on the school bus that would bully me and I had to learn how to deal with it. And I don't think I even ever told my parents about it. There's just a certain amount of like, yeah, you can't let people walk all over you. I won't let people walk all over me. Do you run the ER? When I'm there, I'm the only one there. I'm like the only doctor in the hospital at night. I work at night now. So I am the authority in the hospital for when I'm there. And there's

no other doctors even with me. By choice? By choice and partially because of my illness, it's a way for me to manage my schedule better. But it was also a way to pull back away from the heat of the divide. Sometimes it's easier not to try to convince someone to change their mind, but simply to say, you know, this is dangerous for me, do you mind? Yeah. And they do it for you, not because they think it's important, but because they care about you. I guess I reached a level of exhaustion of doing that because it's almost every person, every single time. That's okay. I'll tell you why.

I mean, not that I know, but because I hear that if there's a mountain to die on, it's this one. And I hear the anger that accompanies the, you know, I'll have to die for you to finally get the message. The thing is, is this has gone on for so long now that there was a period of time where I did that and it was useful for a period of time. But it's just gone on long enough that people, they don't care. I don't think they care. As a therapist, my job is not to enter into the ideological conversation,

but to understand how each of them dealt with this moral crisis. And to help them understand the nature of the choices that they made and what in their own personal histories contributed to those particular choices. And also the limitations that some of these choices sometimes carry. What I have experienced, when I go down like that, and I start to feel like I'm hitting my head, and I'm a little bit on repeat, I always think, I've got to try something

completely different that has nothing to do with this particular situation to see how it plays out. Imagine we're in this room and you're cold and you ask me to close the window. We don't go into a discussion about, is it really cold? Though some couples do that, right? So now it's the couples therapist in me talking, the family therapist in me talk, right? Sometimes you just say, it doesn't matter if it's cold or not cold

or if you don't think it is cold. Your partner is cold. Close the window just because you care about them. What do you care? You know, we're not having a discussion about temperature. We're having a discussion about, you know, can I make you more comfortable? Often people get stuck because they first want to, you know, I don't want you to do this for me. I want you to do this because you think it's important to call my mother, to write a thank you note, to, you know,

what is the thing you really want? You want the other person to agree with you so that you don't have to experience a sense of differentiation or you want the other person just to care enough about you that you feel entitled to say can you do this for me and entitled in the good sense of the word and they'll do it simply out of not even love not even care sometimes just simply courtesy and sometimes you have to ask a thousand times because you may be the person in the classroom, in the hospital, in the office, who's always hot or who's always cold.

And at most, you just say, hey, I know that you don't give a fuck about this. So I really appreciate that you do it just because I ask. I'm sure it's annoying. Oh, that makes me feel resentful. I was like, what comes up? But it doesn't make you feel resentful if you leave this situation. This situation at this point is too charged.

So we've got to go derivative for a moment. We have to go tangential because there's so much hurt, so much fear, so much heat that is wrapped here that you can't detach yourself enough to even just try it on for size. So I'm taking you to another department. And by the way, you're not telling your parents about the bus. It's actually very important for what we're discussing right now. Yeah. I don't know, that's life, right?

No, that's your life. That's my life. That is not life. Sorry. You learned something long ago that is following you right through the emergency room. And I just feel it. I don't know you, I just met met you so I don't want to imply

but I have a sense that there's a convergence here of a few things yeah I don't know like when we were growing up it was like there was just stuff you had to deal with on your own. There's going to be mean kids on the bus. Like, that's a pretty universal experience, I think. Maybe not. Maybe not everybody rides the bus, but, like, yeah, I guess I got, like, picked on at school for being smart. Like, I had to go to this special school where you leave one day a week.

I had a teacher who was pretty mean about it and other kids and stuff. It was things we talked about very openly in my family. We talked about it with my mom. She definitely helped me through a lot of that. I didn't do it alone. But when you're at school, when you're in the ER, you are by yourself. And I'm not going to let anybody fuck with me. At work or at school.

Because nobody gets to treat you like that. Nobody gets to treat me like that. I'm not going to treat someone else like that. When she says, I won't let anyone fuck with me, and she says it again, and I sense the pain that sits underneath this. I feel like we're on top of a vault. But I know that we're not going to have the chance in this session to open this.

So I can choose something a little more easily accessible, which is that we're not talking about letting other people do you harm. We're actually talking about what it's like for you to ask for help. I'm asking you something a little different. It's less that I won't let you fuck with me and it's more the I ask you sometimes something I need even if it's inconvenient. Yeah I'm not good at asking for what I need. And sometimes it's hard for me to know. Like, it takes me a while to get to figuring out what I need. That's exactly what happens in an emergency room. They don't know what they need.

Yeah. And you're the all-knowing. And so it puts you in a position where you never have to feel the thing that is hardest for you. Sometimes. Professionally, that makes sense, right? Your job is you knowing. My job is also knowing what I don't know and when to ask for help for the things I don't know. And that is a big part of our job, especially in a rural place, is knowing what you know and knowing what you don't know.

But knowing what you don't know intellectually and medically is different than knowing what you don't know emotionally and what you need emotionally yeah totally so it's less about the what you don't do to me and more can you close the window can you walk slower can you put on a mask yeah that makes me uncomfortable to have to ask numerous times but because but yes it's uncomfortable and I'll finish my thought for some reason I still think it's more worth it to be uncomfortable and ask multiple times than to die on that hill yeah I just hope we can agree on that. Yes. Yes. That's really good. I love you.

I love you too. Getting sick has been good for me in a lot of ways because I have had to. I had to learn to ask. And it like hurts that much more to ask. And it doesn't happen. To work up the nerve to be clear and ask

and then to have it disregarded hurts so much, especially in the context like god I can't get away from the context because it just is like that that extra knife for me it's like it is actually torrential downpouring and you're like can you close the window and they're like, well, it's not even raining. It is raining. I like our metaphors. We're getting more and more. What's it like for you to ask for help is one of my favorite questions because it says a lot about a person. And in her case, the notion of being self-reliant and not needing anybody was so central to her identity, that when she says, getting sick was good for me, it implies, it taught me to be more vulnerable.

It led me to feel that I need other people, that other people can take care of me, that I can be in the hands of others. All these other layers that were not part of the experience of I can stand on my own two feet. So the question of what's it like for you to ask for help? I suggest as you listen to this that you ask it for yourself and try to answer. What's your experience with asking for help? And you're not good at asking for help. I will call you out on that. That's why I was laughing because I think it's totally true. You're terrible at asking for help. I will call you out on that. That's why I was laughing because I think it's totally true.

You're terrible at asking for help. I'm getting better. I have to like intervene and ask you what you need or give you suggestions of what you need. What would you do if it's cold? What would I do if it's cold? I would ask you for help right away. I'd say, hey, it's really breezy. Can we close the window?

Yeah. My life, my lived experience on this earth is, I will cry now. My first memories as a child are very, very, very, very traumatic. I've had trauma in my life, deep trauma. And then there's been other traumas on top of it. And every single time I think I'm by myself, I'm not. Every single time this earth has showed me that it's like connection and it's love and that is what conquers and that's what perseveres. And that even when I, in my life, have gone through XYZ experience or I've done something where I think I'm unlovable, the people in my life rally around me and show me that I'm incredibly lovable. And so the way I've learned through my experience to navigate the world is to very different than you is to like obligatorily ask people to carry you when you need carried that's how I've navigated the world through

connection and so I have this faith and I have this knowledge that I can ask. I don't think I'm that different from you in that regard. Yeah. I just think I'm going to do what I can first. Finish your question. We're not that different. Like, we are. We have some fundamental differences but like I guess what I'm hearing when we're saying all this is like

you are more invested in making personal relationships with them and that's what's helping you pull through this difficult time with them is is that you still want to be their friends and personally involved with them to an extent that that allows you to connect outside of what's not connecting. I guess what I'll say about that is that that part of me allows me to soften now. Now when people that we, you and I fundamentally disagreed with and had conflict with, and we were not on the same page with these people at work, you know, house divided. Like I said, now when that person gives me an olive branch and says, I was at Walmart and I saw this card and it made I thought of you, I opened because it's who I am, because I am like, oh my God, you were at the store. You thought of me when I wasn't present. You cared enough to take a picture and now you're showing it to me and I can't help but

fall back in love. May I? And what would be your interpretation in a situation like this? So I think the thing is that why I can't soften yet is that I still feel personal fear. And then secondarily, the third part of this, the third layer to all this for me is like, there's no acknowledgement at all about how your actions contributed to people dying. So when she brings you the card, or when this person brings you the card... They're not bringing me cards.

No, if they were bringing you the card, your reaction internally would be? It just feels inauthentic. It feels inauthentic to me in my heart. No, but give it to me in the soliloquy inside. The soliloquy says, oh, that's nice. I'm glad your feelings aren't hurt anymore. You still have not scratched the surface of what's actually going on here. Like you still don't get it.

And I can be congenial. I will absolutely say, thank you. This is lovely. I appreciate the thought. And I can mean that sincerely. I can have that. But I have this whole other underlying thing happening inside of me that I'm not going to share with them.

So I guess I would challenge that and say that I think that they do get it because they had people who they've known forever die. A lot of our staff had first degree relatives die. And so I think, I think they live with the pain deeply. I actually do think they do. Then how do I, how do you look at people who put what's the right words I don't know the right words their family at risk they did it to themselves they brought it home from work and gave it to their grandma because they wouldn't wear a mask and they wouldn't isolate and they wouldn't do the things that needed to be done they They should feel bad. I gave it to my family too. They should feel good.

Let's be very like- Right. But you made sure your family got vaccinated and therefore they didn't have severe illness and they didn't die. That's the point of the vaccines. That's what we know the vaccines do. I gave it to my family before there were vaccines. We all had it before there were vaccines. That's true. The easy way is to silo yourself and the easy way is to say my way is the right way and you're wrong. But then when I look at my own actions, I did the same thing.

I literally brought COVID home literally to my family. I did it too. Sure, I wore a mask. Sure, I washed my hands, but I did it. I know that it's not black and white, and I know that it's not simple. I know all of that. Yeah. I literally brought it home to my sister who has underlying pulmonary disease. Like literally, I called her twice a day, every day, wanting to know if I needed to bring her to the hospital so I don't know ideology or not we all suffered like there's not a human on this earth who was not touched and does not have an emotional reaction to COVID.

It's a world, it was a global pandemic. We all suffered. And suffering is not a unique emotion. No, I know that. And I can completely acknowledge that. But there's this part of me that wants to call bullshit on people who didn't... What's the right words here? I don't know. So the image of asking somebody to close a window

is about asking for help instead of talking about asking them to wear a mask. But the other analogy I had was around the work that I have done around intimate betrayal. When people that you are close to violate your trust, or you feel have let you down, or you feel have put their interests ahead of you, and basically you experience it as a betrayal. And I have a sense that some of what she feels with her colleagues and former friends is that sense of betrayal. And so I borrow from the work that I have done in the area of infidelity to give her different frameworks

that hopefully will enable her to open up possibilities as she tries to understand her predicament. The asking for the mask is one piece. The second piece is what you were highlighting. It's how do I receive the card and see it as a true expression of care rather than, and that's how you want to show me you care? Do the freaking thing that really matters. I don't need your fucking card.

I mean, I'm never going to say that out loud, but that is what's happening. Of course. I got it. I knew it. I felt it. I felt it. And you're very polite professional people you know but it is the underlying layer that is interesting because

internally you feel like if you say thank you to the court you're letting them get away with something yes I do feel that you know which is exactly the politics of betrayal somebody betrayed you somebody cheated on you.

Somebody acted egregiously and then says in whatever version, you know, I still care about you. I'm sorry. And sometimes people feel like if I allow myself to come close to you, it's as if I'm telling you that what you did to me

wasn't really serious. That big of a deal. Yeah. They're completely different frames that you have, relational frames in terms of translating the experience of this Walmart cart. And whereas you're saying, ah, and you're calling it an olive branch. Ah, they came and they reached out to me with something. Oof, so nice.

I've got something I can actually help to, you know, allow me to rebuild, you know. And allowing me to reestablish the trust or to rebuild the connection is very different from this is a ruse to... Well, it feels more like it's not real. It's hollow if all that underlying stuff is there so like I'm I don't know if I'm going to be able to have a real relationship in the way that in my mind a real relationship

so how do people get past betrayal that's the right like in family psychology and in couples therapy how do people get past betrayal? It's a very good question. When somebody says, you know, if I say, yes, I want to go out with you, or yes, I still want to make love to you after you betrayed me, Oh yes, you know, I too want the closeness. And you experience the yes as a relinquishing of your righteousness or as a relinquishing of the acknowledgement that you were severely, you know, hurt. One of the ways you overcome it is because the other person actually is able to tell you, I'm really sorry I hurt you. And that is the piece you feel you haven't gotten. It's not, they're still not wearing the mask, it's that there is

no acknowledgement. That's what you keep wanting. And you answer and you say, but I, you know, I need to acknowledge them. And she keeps saying to you, why shall I acknowledge them? They still haven't acknowledged me. And as long as I don't get that recognition, this is, you know, what happens in trauma. One of the things that helps us heal the most is the acknowledgement on the part of the person who hurt us for the guilt, for the remorse, for the recognition of what they did, even if they had reasons for doing what they did. So if you really want to use the metaphor around family, is that sometimes people say,

I still believe that what I did was the right thing to do, but I know it hurt you. And that's the piece you don't feel you got and are getting, because everybody's righteous. In that sense, you have the same sense of righteousness i have that same sense of stubbornness and that like they're not going to change their mind like i've accepted but you're not going to change yours no right i'm not talking

about the content of the political and the ideological beliefs I'm not talking about the content of the political and ideological beliefs. I'm just talking about the structure. Right, right. And in the structure, you are set to. Whereas you're into, I want to understand them. They have a point, too. Whatever the point is. I have respect for their ability to have their opinion.

I don't respect their opinion. Right. I feel like I can't forgive them because they don't even have the slightest clue about what happened. Like, their perspective and their life experience is such that they can't see it. I mean, what is the nature of the relationship with someone that you feel has not reckoned and has no remorse because they basically disagree with how you define their actions? What they do to you. As unimaginable as it is to you, they may think you did something to them.

Oh, I'm sure of it. As well. I'm sure. Not you, you personally. Yeah. But you and what you represent. I am 100% sure of that. And you kind of say, what did I do to you? I'm trying to save you.

But you get an incentive. Because that means you have something they want from you too. And that means that you have something to give. And that means that you have agency. And that's a different narrative than the narrative of you betrayed me. And you have zero remorse about it and you actually justify it. And you don't even see why you think, why I would think that you betrayed me. And I don't know that one is more, you know, that this is not about which one is true. I am intensely pragmatic in a moment like this and just thinking, where is there an opening?

It's like you bang on the wall and you listen for where it's hollow. Where is there an end? Especially if you choose to stay. So if you want to get out of your rut, you need to pick one or two people. To repair with. You want repair or you may say, I want, you know. Start new with. Retributive justice or restitutive justice.

But yes, to get out of your stuckness. Not because it's going to eat you up alive or this or that, but because there's no end, there's no way out to this one. It just gets more of itself. It becomes more and more rigid and more and more entrenched and you will be more and more angry

and more and more bitter and more and more isolated and you will try to make it as possible for it not to upset you, but it will and you will be more sick. So I see this as healthcare. So you find two people, either because you like them, either because you think they could get it, either because you think they're more fenced people, they're more nuanced and you

think you could get through with them either because you think you know you you miss them yeah that feels like an actionable step that i can do with some support yes um it feels very vulnerable a little dangerous and i have like someone in mind right away. I thought you I was gonna ask you help somebody immediately. Like how do I even start? I mean I've heard you give people little scripts and I kind of want a little script. That's my uh how do you call this the little prescription paper? Yeah yeah. Like casually on a shift do I like ask to meet for coffee yeah you say hey it's been a long time since we had a you start you start casually on the shift because you don't know if she wants to go have a coffee with you and if she's a concern that you may be ambushing her you don't go to the

topic you go to the relationship. I missed you and I missed our hanging out and I missed our hiking, biking, yoga, whatever you did with this person. I'd love to do one again. And I promise I will not be talking

about the vaccine. And you put that with a laugh to like, you know, no COVID talk, you know. We only talk about our favorite coffee or whatever it is, the other things that you share and you make a light of it. You don't need to go into a confession booth. I'm worried I would like, leave the societal analysis.

Leave it out. You're just going to reconnect with someone that you enjoy very much, that you like, and that you haven't seen in a long time, really seen. And that you want to know, you know, I hope you've missed me on occasion too. So this is intentional compartmentalization in a way. Yes. It means it, yes, there is something strategic in, if you want to reconnect, create the warmth first to lay the ground for the difficult conversation that needs to happen rather than go into a difficult conversation cold. Yeah. Yeah. You need to create invitation. You need to create excitement. You need to create desire for this conversation. All of that. Because once

you get unstuck, new things will come to you. Yeah. But you are trapped in the anger and the hurt. And so you can't think and you can't see possibilities and you have more despair and no hope. So all I'm thinking of is hopeful steps or steps that may breed some hope and possibility and regeneration. That's a really good idea. You're like a relationship ER doctor. I never thought of myself as an emergency doctor, but I have on occasion thought I'm doing emergency therapy. Thank you. show notes, go to howswork.esterperel.com. Hows Work is produced by Magnificent Noise. We're part of the Vox Media Podcast Network in partnership with New York Magazine and The Cut. Our production staff includes Eric Newsom, Eva Walchover, Destry Sibley, Sabrina Farhi,

Eleanor Kagan, Kristen Muller, and Julian Hatt. Original music and additional production by Paul Schneider. And the executive producers of Howe's work are Esther Perel and Jesse Baker. We'd also like to thank Courtney Hamilton, Mary Alice Miller, Jen Marler, and Jack Saul. Thank you.