By Lillien Waller
Now in its third year, the COVID-19 pandemic has given rise to mental health crises worldwide—an astounding 25% increase in the global prevalence of depression and anxiety in the first year alone, according to the World Health Organization (March 2022). But when we say pandemic, we inevitably signal a number of crises that parallel, and have been intensified by, this unprecedented public health emergency. Cries of "getting back to normal" often fail to fully articulate the histories and lived experiences of people of color, people within the LGBTQ+ communities, the very poor, and those already living with, or at risk for, mental-health challenges.
CM spoke with three alumni/ae who work in mental health and adjacent spaces to talk about their various practices in psychotherapy, nutrition, and clinical social work. If a common theme emerges, it is that we cannot examine the pandemic and its effects on American life without acknowledging both contemporary and historical contexts, the client and the practitioner, the individual and the collective. Seeking to heal the one, we must consider the many.
Justice Forward: Anastasia Taketomo Fujii ’02
"I want a world where every person can exist, empowered in their wholeness. And that can look like a lot of different things: to be able to live free from fear of harm or persecution; to be seen, heard, and felt—holistically respected and equitably valued," says Anastasia Taketomo Fujii ’02, psychotherapist in private practice and Co-Director of the Kintsugi Therapist Collective (KTC).
Anastasia's vision for liberation informs their work as a licensed psychotherapist, which began more than a decade ago after doing criminal justice and reproductive justice work with the ACLU and Legal Aid in New York City. They founded KTC with longtime friend and colleague Asher Pandjiris in November 2021 during what should have been, but wasn't, the final months of the pandemic.
But Anastasia realized their connection to psychotherapy while still a student at Commonwealth, a personal need they described as a need "to be seen in my wholeness"—to find care and support that could help them understand, navigate, and deepen their identity as a queer person of color living with a chronic illness.
By the time they entered college, Anastasia was seeking a career that would enable them to be a resource for people within these various communities. It was a realization that would not only lead to their profession as a psychotherapist but also lay an early foundation for KTC, a virtual community of therapists that offers "embodied and liberatory visions of care and resources" to trans and non-binary, BIPOC, chronically ill, and disabled mental-health providers.
KTC exists to address an ongoing problem in clinical environments: that therapists often lack the critical resources and support they need to be well and sustain themselves as care providers. Many current models of therapy rely on a false dichotomy of the so-called well practitioner who bestows guidance on the sick patient. "So many people are called to do this work," Anastasia notes, "because of our own experiences of trauma, our own experiences of oppression, of grief, and of loss."
The collective seeks to create a model of therapy that is queer- and trans-affirming, anti-racism aligned, and disability justice-forward—and, most of all, a model that is radically relational in its ability to center the well-being and wholeness of both client and clinician. "Many of us [care providers] are now confronted by the need to include ourselves in the equity equation—thinking about capacity limits, realistic expectations, achievable goals, and necessary support and affirmation during a time that is so devastating."
That devastating time, of course, refers to two years (and counting) of COVID. The pandemic is an ongoing traumatic event that all of us experience but that, for queer and trans folks and folks of color, compounds the existing traumas of violence, oppression, and racism. It's an evolving and complex dynamic that makes plain an even greater need for help that too often can't be found. "COVID is a layer of trauma on top of all the other layers we all were already living with. There's just such a need and the resources available are not enough."
Anastasia observes that it is impossible to fully examine or heal from a trauma that is still happening—at once acknowledging their own capacity limits as well as our need to slow down and be more compassionate to ourselves and others. "The way that I practice as a therapist is to lead with gentleness and with acceptance in a more radical sense of those words and to become more patient—to pause and give pause to moments—to be embodied and in solidarity before taking action."
The Kintsugi Therapist Collective operates a yearlong program, the Embodied Private Practice Cohort, for discrete cohorts of therapists, offering consultation on each practitioner's business practices and clinical casework. The long-term plan is programming that can increase access to support and connection for therapists, while providing referrals for prospective clients nationwide. The current cohort, which began the virtual program in April 2022, includes care providers in six states. The next cohort is currently enrolling and expected to begin in September.
Body Positive: Naima Sullivan ’98
According to the Centers for Disease Control and Prevention (CDC), pediatric emergency-room visits skyrocketed during the pandemic, with a significant number of these visits related to eating disorders. In particular, adolescent female (12–17) ER visits have doubled since 2019. Increased by stress, anxiety, and depression brought on by the pandemic, such numbers point to a broader crisis in mental health rather than a crisis in diet.
Registered dietitian and culinary instructor Naima Sullivan ’98 is dedicated to addressing the challenges around behavior, body image, and eating habits in her practice at Karuna: Nutrition + Movement, a wellness studio in Norwood, Massachusetts, serving individuals and families. Karuna offers nutrition counseling, cooking instruction, and movement classes, and Naima helps her clients develop sustainable behaviors around nutrition in a way that is inclusive and body positive yet supportive of individual goals and lifestyles. "I think of it as a collaboration," Naima says. "I try to meet people where they are to help set goals that they direct so that we're achieving what they want to achieve. Ultimately, I don't want nutrition to seem scary and confusing. I hope to help people tune in to their bodies and be able to eat intuitively. When I think of having a healthy relationship with food, I think about internal regulation and being at peace with your body and with food."
Finding that sense of peace can vary widely from client to client, particularly among children, Naima's specialty. Issues range from pickiness and stress eating to more complex interference from their parents' own lifetime relationships with food. "Kids can start to move away from the internal regulation they had as infants—then they're eating not for themselves but for other people. That's especially true for kids who are bigger," she notes. "There tends to be a lot of interference that gets them to eat less, and that can in turn lead to more food preoccupation and, interestingly, more weight gain. There's a through line with a lot of the adults that I work with who have had traumatic histories with food, whether they were put on diets at a young age or struggled in another way."
Naima is a former dancer who made a career change to nutrition, spending years in community nutrition settings in New York, including Food Bank for New York City, Cornell Cooperative Extension, and as an HIV nutritionist with Gay Men's Health Crisis (GMHC). It is a background that continues to serve her as she navigates the more intimate challenges that arise within families. One of six dietitians at Karuna, Naima and her colleagues were not spared the explosion of eating disorders during the pandemic, and their clients included people of all genders, races, and ethnicities, as well as both children and adults—the result of a trauma response that made people more hypervigilant about their food and more stressed about "pandemic body," or unexpected weight gain.
"We tend to think about these things in terms of how quickly we can get to our goal, whatever that might be," Naima says. "My advice generally is to start with the behaviors. What are things that you can do that feel sustainable and that feel good? I don't think that nutrition or fitness should be a punishment or grueling or painful."
And emphasizing health at any size, she says, can be crucial to navigating sustainable behaviors for the long haul. "There's a growing size acceptance movement, and I think being gentler with each other around our body shapes and sizes becomes an important part of the cultural conversation. We survived a pandemic. If we're a little bigger for it, we could almost celebrate it, in a way. But it's really hard for people to think that way. So I think just being kinder to ourselves about what we've done to survive is really important."
Collective Solutions: Kate Gilbert ’78
Not long before the pandemic hit, Kate Gilbert ’78 threw herself into the "deep end." An anthropologist who had returned to graduate school to earn an M.S.W., Kate launched a second career as a clinical social worker and landed her first job at North Suffolk Mental Health Association's Freedom Trail Clinic, providing outpatient mental-health services to individuals and families. "My end of the clinic dealt with people with schizophrenia and serious psychotic disorders who were also homeless," Kate says. "I knew that I wanted to be in clinical social work. I knew I wanted to do therapy, and I knew I wanted to work with trauma."
It was during her first year at the clinic that Kate began to deepen her understanding of permanent and intergenerational trauma—the function of one's personal history of instability as well as social context. But when perpetual lockdowns ended in-person service, Kate began pulling ten-hour workdays conducting teletherapy from her home, which revealed how precarious mental health can be within high-risk groups.
"I worked with a lot of people who were either coming out of prison or going back into prison," she says. "The clinic had been the place of last resort when people were getting released from the hospital because there were very few permanent beds for people with major psychiatric illness. So I was aware that I was constantly working with people for whom there was not going to be any good old normal to return to."
Many patients with severe mental health disorders require ongoing, wraparound care. In teletherapy, "there's no one covering for you," Kate says. "So I couldn't take my more borderline clients with me because they were just too high risk. We saw the people that therapists wouldn't see in private practice." The move to teletherapy helped her clients lead more independent lives. But Kate saw that these clients were also dealing with multiple traumas that the pandemic had only intensified.
Now in the early stages of building her own practice, Kate notes that her personal experience of the pandemic, as well as world-historical events—like the storming of the Capitol on January 6, Black Lives Matter protests, and the Russian invasion of Ukraine—have opened her eyes to different aspects of her own race and class privilege and to the realities of intergenerational trauma of "populations that have been oppressed or subjugated."
The mental health professions typically view the individual as the locus of both the disease and the cure. As a clinical social worker for the most challenging populations, and as an anthropologist who has studied global cultures, Kate pushes back against this approach—which belies the significance and impact of collective experience.
"If you look at Ukraine, for example, they're still dealing with the after-effects of Holodomor [famine in Soviet Ukraine from 1932–1933]. And that is evident down to the physicality of the descendants of people who lived through a famine. A collective trauma once endured becomes a collective history that calls us to collective solutions and can be an enormous source of identity and strength for the individual who finds some security and meaning in shared suffering and shared action," Kate says.
"So when my clients are spinning out of control and suffering within their own particular hell, I always advocate community action, service, volunteerism, and protest because action counteracts the stasis of pain and community engagement counteracts the pain of isolation."
Lillien Waller is a poet, essayist, and editor. Her poems have been nominated for the Pushcart Prize and Best New Poets, and she is editor of the anthology American Ghost: Poets on Life after Industry (Stockport Flats). Lillien is a Cave Canem Fellow and a Kresge Artist Fellow in the Literary Arts. She lives in Detroit. This article was originally published in the Summer 2022 issue of Commonwealth Magazine.