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Field Notes From Newtown: Reflections on What Constitutes Good Care in a Time of Crisis

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On Saturday morning, the feelings along the streets of Newtown, Conn. were conflicted -- there was sadness and love, fear and pride, uncertainty and pride. It was a testament to the complicated emotions of being human. There to help, to witness and report, I was quickly moved myself. As I made my way in from the outskirts of town, I spotted the Sandy Hook signpost and a bouquet of flowers someone had placed at its bottom. I thought: "Nice touch."

But then again, they looked awfully lonely -- at once sweet, lovely and sad. I suddenly felt a sense of fear: fear of the emotions that I sensed would soon envelop me. Moments later, joining up with the larger community of people all working together to try to make quick sense of what had happened to this picture-perfect town just the day before, I was struck by what a phenomenal sense of community really means in action. It was immediately and viscerally evident, powerful, and had a life force all its own -- all in the face of the media glare and the invisible eye of the world tuning in. There was a pulse, a vitality, a strength, and a will to endure. There was a sense that no one need feel alone in Newtown on Saturday. As President Obama said to the nation and the world from Newtown last night: "You are not alone." I imagine he felt that in the fabric of the Newtown spirit. And he was right about that.

When a shockingly-unfathomable loss of still unimaginable proportion strikes, our natural response can be to say or think: "This is too much. I cannot comprehend this. I'm going to fall apart. I'm going to die." This reaction -- that we all have to some extent -- may be initially lessened by the adaptive use of denial and minimization. "This can't be," we tell ourselves. Inevitably, as we have come to expect, the greater outcry, the greater noise we are subjected to is intense and difficult to avoid. It is a very big tent under which we need to identify the strong emotions that ultimately help us navigate human experience. We went to bed devastated Friday night and woke up on Saturday angry and afraid. We want answers and solutions, and we want to believe that somehow there is a way to move forward. But how? The start is by avoiding the urge to isolate, focusing on reestablishing a sense of safety.

Over the course of last Saturday in Newtown, I was over by two houses of worship, inside a diner, in the lobby of the middle school, where disaster relief counseling was underway, and alongside a park. I saw the familiar smiling and extraordinary comforting way everyone treated one another. It was with such grace, such courtesy and respect, with a genuine effort to understand and with a deep desire to help.

Being open to receive this form of loving kindness is the first step of the healing process. Continuing to remain open is the next step, the ongoing challenge. Whatever helps us is the right way to go. Be it the connection with family or friends, religion or counseling, what matters most is to continue to return to being present and open to what is a very natural process that -- make no mistake about this -- is built in to our very essence. We have a gift: We are capable of recovering from overwhelming loss. We are capable of grieving. It is sometimes a very long process, but it does lead to a healing, a resolution. We mourn, we grieve and in the end, we are able to carry on and find meaning in our lives -- we are able to experience the full range of human emotions without feeling dominated by a single horrific and once overwhelming atrocity, though, of course, nothing will ever be the same as it once was.

In my psychiatry practice, I see and treat suffering of this order all too often. It is a great privilege, and it can take a great deal out of me personally. I have to be mindful to take good care of myself as well -- to remain open to receiving loving kindness, to maintain a healthy routine, and to stay in contact with sources of support and understanding. Returning home early Sunday morning after such a long and draining day, I made time to stay up and talk with my wife and a few friends, despite the very late hour. I was very moved by what I had seen and heard and experienced: I needed to share. Then, I took to bed and surprised myself by really sleeping in -- for more than 12 hours. Everybody must take good care.

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