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IN THE SHADOW OF THE EPIDEMIC
By Walt Odets

THE EPILOGUE

    There are, in history, three kinds of event: (1) "it never happened," (2) "it shouldn't have happened," (3) "it won't happen again" - and you are afraid your memory might fail.

          Keith Waldrop
          from The Quest For Mount Misery
           

The Idea of Bearing Witness

If I end this book without discussing Primo Levi, my friend and cohort in the investigation of the meaning of human life, Linda Zaretsky, will never speak to me again.  In 1989, shortly after San Francisco's second "big" earthquake and the downtown construction crane accident, I related to Linda the following dream about myself and Dan, who was then my lover:

    Dan and I were walking down the street and there was a very beautiful old-fashioned truck with a crane on it.  Just as we came along, some men were demonstrating it, and it quickly extended itself for miles through the city, weaving around buildings and other obstructions.  But, just as it was completely extended, the tip - now several miles away and into the Marina [district of San Francisco] - began to quiver, and then swing more and more wildly side-to-side.  As it did this, it began to destroy building after building with a terrible rumbling noise, and shortly the city was engulfed in fire, a cloud of smoke and dust billowing higher and higher above it.

    Dan and I were suddenly sitting in wooden bleachers next to a playing field in Napa [North across the San Francisco Bay from the city] watching a football game, which is something neither of us has ever done.  The playing field was located in a huge, absolutely flat plain that ran down to the edge of the bay.  The wife of one football player scurried along behind him as he executed each of the plays, an infant strapped to her back in a carrier.  The others in the bleachers, eating and drinking from picnic coolers, were very involved in the game, and cheered and carried on wildly as each play was made.

"Sounds like a very heterosexual, sports-minded, suburban crowd," commented Linda.

    Absolutely.  And in the dream that was very comforting, because these were ordinary people who were completely untroubled by the disaster going on in San Francisco.  But we also felt peculiar about being there.  The most amazing part was that right behind the game you could see San Francisco in the distance, and though the destruction was absolutely silent, this incredible cloud of smoke rose above the city for miles, and flames flickered up above the tallest buildings.  No one noticed this except me.  Dan and I, sitting in the bleachers, felt very safe in this ordinary, heterosexual environment, but I said to him, "Dan, look over there, because you can see the city burning.  It looks like it's burning right to the ground."  We were feeling very ambivalent about whether we should stay at the game and be safe, or go back to town.  It was very disturbing to be watching the city burn while sitting among those who neither knew of the disaster, nor cared.

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Primo Levi was an Italian Jew imprisoned by the Nazis during the war, and he wrote about the importance of bearing witness.  Bearing witness to what happened, he said, was the only way the event of the Holocaust might be kept real.  It would only be in a continuing affirmation of its reality that it could remain meaningful, and thus bearable.  Denied or forgotten, said Levi, the Holocaust would be unbearable.  Indeed, in the faded memories of April, 1987, Levi finally found his life after the Holocaust unbearable, and he killed himself.

I find Levi's thought - and his final act - intelligible, though I think Linda understands him better than I.  Having talked recently about Levi with Linda, and sitting by a pool, I finally understood more completely the idea of bearing witness.  A small boy standing at the edge of the water shouted repeatedly to his father.

"Daddy, watch me!  Watch me!  I'm going to jump in the water."  His father waved back at him.  The boy jumped, and the act accomplished, he climbed out of the pool and ran to his father and demanded, "Did you see me?  Did you see me jump!?"  His father, talking with another adult, nodded distractedly in the affirmative, and the boy seemed immensely pleased:  "I have jumped in the water!", he shouted, and, dancing off towards the pool for more fun, he seemed immensely satisfied.  The reality of the jump - affirmed by his father's recognition - was established, and it was thus also meaningful.

In the Shadow of the Epidemic: Being HIV negative in the Age of AIDS, by gay Berkeley therapist Walt Odets.Watching this exchange, I thought about how many ways we bear witness to each other's lives in adulthood too, and how important that is.  As with the boy at the pool, events become real and meaningful at the moment they are acknowledged and understood by others who are important to us.  Bearing witness is not only an acknowledgment of the event, it is an acknowledgment and understanding of the experience of those who have lived it.  In my dream of escape from the huge phallus destroying San Francisco, it was not enough for Dan and I to merely watch the event, sitting in the bleachers among those who knew nothing about it.  The experience of those still in the city was one of being watched - not witnessed - and our experience was not being witnessed by those around us.  Although Dan and I might have born witness to each other's experience, the shared witness of only two is usually not enough for big, enduring social events.  It is broad social recognition - particularly of painful, isolating, and seemingly meaningless experience - that transforms the subjective experience from a personal delusion or folié a deux into a witnessed, real, meaningful, and therefore bearable one.  

It is a remarkable fact of life in the cerebral cortex that simply sharing an experience makes it meaningful.  Certainly we never get over the infantile shock of finding out that we are not our mothers.  Perhaps it is because of this early, painful discovery that human life seems so often about being trapped in separate bodies, which is also to say in separate minds that never actually knows another's experience.  We thus devote our lives to trying to feel that we have separated, are autonomous, and have our own identities - or that we have finally bridged the seemingly inescapable, painful experience of essential isolation.  The effort to share consciousness - of social events, literary ideas, or simultaneous orgasm - is a universal pursuit of the human cortex, if not always a successful one.

The importance of the meaning derived from shared consciousness is demonstrated in the significance we attach to social rituals, which are a partly a conventionalized expression of shared consciousness.  That the convention does not always induce similar consciousness in all participants is another matter, and one confirmed by the number of family Thanksgiving dinners that have ended in conflict, accusation, and despair.  When social ritual is not too conventionalized - which is to say that it remains connected in some way to the subjective experience of participants - it can be immensely important in helping to confirm individual happiness, or assisting survival of what might otherwise be unendurable, private misery.

In the epidemic, a memorial service for a dead friend or viewing of the Names Project quilt, not only creates a tangible event in remembrance of the dead.  It also allows us to assemble, experience feelings about the losses, see that others experience apparently similar feelings, and (perhaps) understand our own.  In this shared event, the losses become real and important, instead of just a fleeting figment of subjective experience.  It is in this sense that bearing witness is most powerful and important:  that we recognize and share each other's internal experience of the public event, and thus supply the event with public meaning that can be reinternalized by the grieving mind.  Thus shared and formed by social recognition, the subjective grief somehow becomes more bearable.

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Psychotherapists bear witness to the feelings and insights of patients, and this is the reason that so much good psychotherapy is conducted with the therapist's silence, or with his or her spare reflections or clarifications that the patient can reinternalize.  In bearing silent, or nearly silent, witness to our patients, we allow them to exist in a way that they have not previously found possible or allowed themselves; and we validate the reality and importance of that subjective existence with - sometimes only implicit - recognition and understanding.  I am always surprised by how much psychotherapy is accomplished by simply allowing patients to exist as themselves in front of me.

The importance of bearing witness to the AIDS epidemic, in the psychotherapy patient or the friend, cannot be overestimated.  With HIV medically uncontrolled and spreading rapidly, it often seems that bearing witness is all we can do to keep the epidemic bearable.  This is apparent in the complex feelings that are often evoked by the thought of the epidemic ending .  In fleeting moments of fantasy about a cure for AIDS, many gay men experience an explosion of grief about what would seem a joyous event.  Woody Castrodale spoke to me about this subject on the phone.

    Last night in group, Tom said, "I'm beginning to be aware that if there were a cure, I would feel an enormous amount of resentment."  Well, there was a stunned silence in the group, and I realized that I felt that way - way, way down - but I had never been able to verbalize it.  Others said they had the same feelings too.  Tom is one of those people who has lost two lovers, and this puts him in a certain place, like me.  He said, "I have lived through all this, and I recognize that I have suffered through all this stuff in my center, that I have taken a stance towards it, that it's been my destiny to live with this, that my two lovers have died and I have suffered through all of that.  It has meaning .  If a cure came along, the whole balance would be changed.  All of this meaning would be gone because suddenly people would be living on, and the whole thing would be old history.  My God, when there's a cure, I'm going to have an enormous problem."

When it is over, Tom's apprehension predicts, the epidemic will vanish into meaninglessness, and with it, all of the feelings that have become part of who we now are.  It is thus we who will vanish into meaninglessness.  At the moment of a cure, we fear, the deaths will be trivialized, seemingly a twist of timing and fate.  The enemy will no longer seem indomitable, but petty and unworthy of those it took from us.  The environment of emergency and intensity, of camaraderie and shared experience that now makes some sense of our adrenalin-driven lives, will be gone.  We will be left, the morning after, with nothing but loss and grief pounding in our heads and hearts.  Our denial, no longer needed to make the fight seem possible, will suddenly be gone too, and in its place, an indelible emptiness that will haunt us from the shadows for the rest of our lives.

Ways We Can Bear Witness

After the epidemic, should there be such an age for us, life will be difficult regardless of how we conduct ourselves.  The worst possibilities, however, will be realized by meaninglessness rooted in our inability to adequately bear witness to the epidemic now , while it is conducting its fiendish work.  There is so much going against the effort to bear witness and sustain meaning in our lives:  a profound predisposition of denial within the gay communities enlisted to protect us from what often seem unmanageable feelings, and to contain shame and guilt that we so often harbor within ourselves for being homosexual and having AIDS; and the extraordinary denial of a profoundly homophobic society troubled by seemingly more important problems, and acknowledging the epidemic only sporadically and with cynical and covert hopes that HIV and AIDS will remain within excommunicated populations.

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Bearing witness arises from a state of mind - a willingness and capacity to acknowledge and understand the truth.  But it is also an act that can be facilitated by society rather than hindered, and we have within gay communities at least the rudiments of means to do that.  I have, within the main body of this work, implicitly offered some social forms that may help us bear witness, but I would like to offer a more pragmatic inventory of some other possibilities to help us both as whole communities, and as HIV-negative communities.  These include our writing, our AIDS education, and, importantly, psychological groups.

My writing and the writing of many others are acts of bearing witness.  The AIDS epidemic that has spawned so much horror and loss, has also spawned some writing of insight, eloquence, and truth.  To name only a few, the works of George Whitmore, Robert Ferro, George Stambolian, David B. Feinberg, Paul Monette, Andrew Holleran, and J. W. Money have contributed immensely to our capacity to bear witness to the epidemic.  This writing describes our experience and feelings, understands them, and bears witness to their truth and importance.  I conceive of the Names Project Quilt as being among these works of fiction and nonfiction, for it is both of those - as well as a monument that is at once so personal and so public, so particular and so universal, and conveys, unlike anything else, the enormity of the epidemic.

AIDS education, because it is such a pervasive, prominent cultural force and public reminder of the epidemic within gay communities, might help us bear witness, despite its primary pragmatic mission of reducing HIV transmission.  In fact, helping provide gay men a sense of meaning about the epidemic - the very foundation of lives worth living and therefore worth protecting - would help accomplish that primary mission.  AIDS educators, on the whole, do not perceive this obvious truth, for they are heirs to an approach to public health "education" that is as narrowly conceived as that which purports to teach children appreciation of human culture by having them memorize dates of important events.   In the United States, at least, AIDS education has so rarely been informed by psychological insight or the truth of gay men's experience in the epidemic, that it has been unable to either help bear witness or more directly motivate changes in sexual behavior.  Educational approaches that enlist and assist denial, and that promote half-truths and untruths, cannot change the way a person experiences and thinks about his life, and therefore cannot ultimately change behavior.  While such approaches may enforce short term behavioral compliance by exploiting fear or social compliance, shame, and guilt, the internal sources of behavior remain untouched, and the individual finally, perhaps in secrecy, returns to the dictates of his feelings.  The internal sources of truth remain untouched and unsupported by the public voice. 

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To be effective in any sense, our education is going to have to really acknowledge the broad human realities of life in the epidemic.  This means affirming gay men's complex and difficult experience rather than attempting to normalize life - or simply feign normality–in these most abnormal of circumstances.  In the San Francisco AIDS Foundation's "Outliving Forecasts of Doom" campaign, the advice offered for living in the epidemic is to "play it safe, make a plan, see it through."   The validating truth is that the epidemic is far from being merely a forecast.  It  has already exceeded our wildest and cruelest imaginations.   The campaign's glib advice to "make a plan and see it through" is a ridiculous prescription for a lifetime , is unvalidating of real experience, and is an effort to enlist denial against the substantial difficulty of creating a viable life in the circumstances many gay men find themselves in.  AIDS Foundation educators would apparently like to simply wish away the realities of life in the epidemic.  This is an encouragement to not know the truth, tell the truth, or bear witness, and like all buried truths, the epidemic thus misrepresented will surely become unendurable.  Helping to bear witness - and thus doing good prevention work in the bargain - will require that our education realistically acknowledge the complexity and depth of feeling of many men, even when that acknowledgment does not appear to immediately support the goal of reduced HIV transmission.  Our education must account for the nature of life in one of the longest-enduring disasters in twentieth century history, and the fact that HIV is communicable by ordinary, desirable, and necessary human behaviors.  AIDS education - a pervasive and potentially potent and constructive force in gay communities - is truly in need of a renaissance.

Psychological interventions are another important means to bearing witness to AIDS, finding meaning in it, and perhaps surviving it.  Much of the material in this book is taken from individual and group psychotherapy work, and those processes allow complex feelings to be clarified and understood, and are thus supportive of both survival and the perception of human truths.  But individual psychotherapy is a costly, resource-limited, and time consuming process, and is unavailable to the majority of those in the gay communities.  Psychological groups , however, have much broader potential, and it is thus important to pragmatically discuss their possibilities and workings.

The idea of "groups" has become something of a cliché.  They are now widely available to address problems spanning the spectrum from overeating to death.  They are organized in any number of ways, and "facilitated" or lead by people of every range of insight, training, and experience.  Initially within the province of psychology, groups were born in their modern form after World War II, and gained appeal at that time for many reasons.  They offered economy, requiring the services of only one or two psychotherapists for eight to ten therapy patients; they helped accommodate the huge population of returning veterans and others who appeared to require psychological help after their experiences with the global disaster of war and racial annihilation; and they were something psychiatrists did not mind letting clinical psychologists do, since there were not enough of the former to do all the work, and the latter seemed intent on clinical work from which they had theretofore been largely excluded.  In more recent times, groups have come to be lead or facilitated by mental health professionals other than psychiatrists and psychologists, by nonprofessional peer-group leaders, and by no one, which is to say self-facilitated

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Today we also generally make a distinction between therapy groups per se, support groups, drop-in groups, and one-time group workshops .  The single most critical issue with any group is the quality of the facilitation, regardless of the credentials of the facilitator.  Although groups professionally conducted as therapy groups seem to me to offer the most potential for change, other forms of groups, depending on the quality of facilitation, can be extremely useful.  Therapy groups are directed at the clarification of psychological conflict and its resolution in the group - which is to say, interpersonal - setting.  Support groups, properly speaking, are concerned with "emotional support" that involves the development or strengthening of existing psychological defenses against conflict, rather than clarification and resolution of the conflict.  This more limited objective is sometimes appropriate because of the nature of the problem being addressed, the unavailability of experienced facilitation for a true therapy group, or because of the objectives and goals of group members.  Drop-in groups are generally conducted as support groups rather than therapy groups.  Finally, one-time workshops, which offer a very wide range of forms and approaches, may function as limited therapy or support groups, depending on the aims of the group and the availability of facilitation that would allow true therapeutic exploration.

With regard to professionally facilitated therapy groups, we have come to recognize in the last two or three decades that they offer much more than economy and efficiency, and that in many ways they are neither substitutes for, nor substituted for by individual psychotherapy.  Groups offer a unique interpersonal milieu in which the interpersonal consequences of intrapsychic conflict is expressed and worked through.  Just as the transference relationships (between therapist and patient, in both "directions") of individual psychotherapy is the vehicle for resolution in that modality, the social environment of the group - really, a "society" of eight or ten - is a vehicle of a different sort that can provide insight and resolution that is not as available in an individual psychotherapy.  The experience of meaning achieved through bearing witness cannot, by its very nature, be a solely individual matter.  The process requires a social and cultural context out of which meaning is created by the act of mutual recognition and understanding.  Therefore, just as groups for HIV-positive men allow bearing witness to the experience of having HIV, groups for HIV-negative men are a natural choice for the problems about potential survival these people are experiencing.  A group for HIV-negative men allows a man to come-out to his peers and consolidate an identity as an uninfected gay man within a community of shared experience.

In San Francisco we now have at least some experience with all kinds of groups for HIV-negative gay men, and they have proved immensely productive.  Regardless of how they are conceived and conducted, all these groups have had to meet certain requirements to usefully assist negative men in meeting their psychological objectives, and provide an environment that allows bearing witness to their experience of the epidemic.  The fundamental requirement of all groups is that they provide a "safe" venue in which HIV-negative issues may be discussed openly, honestly, and confidentially without fear of directly  neglecting, offending, or hurting HIV-positive men, or incurring their resentment or anger.  Thus they must be limited, in their initial selection, to those who believe themselves to be uninfected.  Feelings about neglect, offense, hurt, resentment, and anger will be an important part of what many negative men have to deal with in the group.  But the group is not the place to have those things actually occur or be repeated, any more than an individual therapy is the place to have conflict with parents reenacted by a careless therapist.  The group, like the individual therapy, is the place to explore the feelings about the problems.

This fundamental, uncompromisable requirement is, of course, precisely the one that makes groups for HIV-negative men so personally and politically controversial within gay communities, and so difficult to fund.  In fact, in most gay communities, the idea of groups for HIV-negative men is still unspeakable .  In addition to the discussion of the complex relations of positives and negatives in Chapters 7 and 8, a simple statement about the purposes of  groups should be added here.  The idea that HIV-positive men might need groups for themselves is self-evident to anyone, because it is obvious that they have important, common issues that can only be shared and discussed among themselves.  Feelings that HIV-negative groups are more about excluding positive men, than about including only the issues of HIV-negative men, is rooted in the failure to perceive the special problems of being gay and uninfected in many gay communities.  If some positive men, having acknowledged that there are special issues for HIV-negative men, still feel there is an exclusionary or isolationist intent to HIV-negative groups not implicit in positive groups, then they must look at their own feelings about being positive.  To some extent, positive men who are unable to experience HIV-negative issues as something other than "viral apartheid," are projecting onto uninfected men their feelings about themselves - feelings that make them feel undesirable or excludable.   

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While the idea of safety in any kind of psychological intervention is of paramount importance, it is also among the most abused and misused concepts in the conduct of groups, especially support or drop-in groups.  In any well-run group, safety can mean only one thing:  Any honest expression of feelings or thoughts will be received and tolerated by the group,  and an attempt will be made to honestly respond to it.  This will be done without physical violence or undue emotional hurt to other members, and without abandonment of the group.  This essential objective is mostly easily accomplished with a professionally facilitated therapy group, because the group leader will have the necessary skills to mediate and limit conflict to a safe and constructive level.  When the idea of safety comes to mean, as it often does in poorly conducted therapy groups and many support groups, that members be polite and "non-judgmental" towards each other, then the prime therapeutic objectives are undermined.  Interpersonal interaction - as opposed to social form - necessarily involves feelings and judgments about others, and unless they can be expressed and discussed truthfully, the group can provide neither insight nor the meaning that comes of bearing witness.  Unfortunately, this may be a limitation of many support groups by nature, although with talented facilitation this is not necessarily so.  It is the quality of facilitation that will ultimately limit the group's accomplishment.

Denial is the opposite of both bearing witness and psychological insight.  When therapy or support groups take the idea of "support" literally, little genuine work can be accomplished.  The function of a group is not to make its members "feel better when they leave than when they came in," as one poorly supervised peer facilitator has routinely billed his weekly support group for San Francisco gay men.  It is the function of a therapy group, like individual psychotherapy, to help people attain the insight that allows them to make themselves feel better.  Although that is a more complex and difficult task than soothing hurts through mutual, collusive support and the bolstering of defenses, it is an effort that produces authentic and lasting results.  The precarious situation of uninfected gay men demands that we aim for authentic results.  At this point in the epidemic, we should settle for merely supportive efforts as nothing more than stopgap efforts until we are able to muster appropriate services.  Survivors of the epidemic are not going to be simply "supported" through it., and the attempt is an invalidating denial of the real difficulty many men are understandably having.

Support must be focused on the pursuit of insight and not on collusive, group denial of what people are really feeling about themselves, their lives, and others.  When the background of group members includes life in a profoundly painful, enduring, and insoluble event like the AIDS epidemic, such cosmetic - if kindly - collusion in denial can be very tempting.  A support group like that offered by the U.C.S.F. AIDS Health Project for HIV-negative gay men - Negatives Being Positive - implies by its very name that its purpose is a collusion with denial in the hope that men will feel better in the most superficial sense of the idea.  The group's name dictates how men are to feel while in attendance - positive, not to be confused with positive - and thus forecloses on all the other things that one might feel while living in a plague.  Were the title Uninfected men Ultimately Feeling Better Pending an Exploration of Why We're Feeling So Bad That We Need a Group , one might have more confidence in the purposes and productivity of the group, and in the agency's ability to assert the idea that it is alright for uninfected men to not feel positive, in either sense of the idea.  On hearing about this group and its sister group, Positives Being Positive , Ed Wolf, longtime facilitator of  San Francisco HIV-negative groups, summed up the confusions succinctly:  "So let me get this straight.  It's fine for positives to feel positive, and negatives to feel positive.  But we don't want negatives feeling negative." 

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How group work is kept honest and productive, regardless of form, is a question with no simple answers.  A talented and experienced group psychotherapist to lead the group is a good start.  Therapy groups are most likely to offer such a leader, and this is the reason that I favor them above other forms of groups whenever resources can possibly allow them.  Peer-facilitated groups are more easily and less expensively organized and may also be productive.  The facilitator or co-facilitators should attend regular supervision with a talented professional; and the use of co -facilitators for peer-lead groups is especially recommended for important reasons too complicated to elaborate fully here.  Briefly, co-facilitation may help to balance and stabilize the "structure" of the group, and to correct the deficiencies of understanding or interaction of any single facilitator.  This is equally true of professionally lead groups, though perhaps not as often a critical requirement.  The San Francisco HIV-negative group co-facilitated by Woody Castrodale, who is so often cited in this book, is an example of a peer-facilitated group that has accomplished important work for its members, and may be fairly described as a therapy group despite its nonprofessional facilitation.  That Castrodale and some group members are men of exceptional intelligence and insight is no small part of this accomplishment.  There is no formula or structure that can substitute for such qualities, regardless of the experience or inexperience of a group's facilitator.

Finally, there is the possibility of the "self-facilitated" group.  Such a group can be useful, and many people have gotten together over the ages without even calling themselves groups and accomplished much.  The obvious dangers are a lack of experience, understanding, and insight of group members; the impossibility of external, professional supervision (who would be supervised?); and the lack of a presence in the group that maintains an overview of the group process and keeps it on track.  Such a group is highly dependent on the members' native capacity for insight.  A self-facilitated group should be an effort of last resort for HIV-negative men, because of the potential destructiveness of the issues that now ensnare so many.

Member selection is a critical element of any group, and, in a professionally-lead group, the careful screening and selection of members is one of the important benefits.  Homogeneity or "compatibility" in the ordinary senses are not the crucial issues so much as the potential for useful interaction between members.  A single group member who is distinctly less psychologically developed than others in the group, or distinctly less intelligent or capable of self-expression, can seriously damage the structural integrity and process of the group.  Such a member, especially when he engages in conflicted and hostile interpersonal relations, can be a shark in the water who keeps the other bathers too busy to attend to their original purposes for coming to the beach.  As another example, an introverted and chronically withdrawn, or a profoundly depressed member, may preoccupy the group and divert its efforts into guilt-motivated caretaking that will be unproductive for all.  The structural and process problems resulting from such problematic member selection - and a host of others - will be much more difficult, or impossible, for the untrained leader to correct.  Experienced and talented group leaders also sometimes make mistakes in selection and, when that happens, group survival can demand the removal of the mismatched individual.  This is a difficult process for any group leader if the problematic individual and group are both to be respected, and the group is to remain productive.  With an untrained and inexperienced facilitator removal of a badly mismatched member will almost always be traumatic and destructive to the individual member, the facilitator, and the group as a whole.

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I have already mentioned the basic requirement for all HIV-negative groups that selection be limited to those who believe themselves to be uninfected.  This is a largely straightforward matter of self-selection that usually poses no problems.  In the unlikely - but not unknown - event of a member intentionally misrepresenting his serostatus, the leader's task is similar to that in working with any mismatched group member.  One would hope for an experienced leader to deal with the situation.  The presence of an HIV-positive member, particularly one who has intentionally misrepresented his HIV status, poses a serious danger for an HIV-negative group.  Such misrepresentation on the part of a group member, whether about serostatus or other significant issues, sabotages the necessary environment of trust in which the group must do its work.  In the specific case of misrepresented serostatus, the issues of HIV-negative men, including guilt about positive men, cannot be honestly addressed because of the "serodiscordant" composition of the group.

A more subtle and difficult problem, and one most common in open-term groups (about which I shall say more shortly), occurs when an established group member seroconverts during the term of the group.  Again, the problem almost surely demands the skill of an experienced, professional leader, although, in this case, the answer is very unlikely to be simple removal of the now positive member.  The impact of a seroconversion on the HIV-negative group may ultimately be productive - if traumatic - for the group as a whole, for it offers an important, not easily explored opportunity.  If the ensuing process is properly handled, it is likely that the newly seroconverted member will ultimately leave the group for his own needs and reasons, and that this will be done with careful referrals by the group leader for both a new group, and, perhaps, individual work.  In a peer-facilitated or self-facilitated group, such an event may be immensely destructive to both the seroconverted individual and the remaining group.  The man who has converted may feel abandoned by his former peers, and those remaining in the group may feel that they have, indeed, abandoned him.  Such feelings, if they remain unexplored and unclarified, will only exacerbate the very issues, such as survivor guilt, that an HIV-negative group must address.   In general, groups are structured and conducted differently depending on their aims (therapy or support), expected duration, and attendance requirements.  Open-ended or limited-term (generally 8 to 16 week) therapy groups almost invariably have a fixed membership that is expected to attend regularly.  With such groups, the regularity of attendance and the extended time over which relationships may develop provide a maximally intimate and safe environment most conducive to psychological exploration.  To the extent membership varies session-to-session or the anticipated term of the group is limited, the environment is less suitable for therapeutic aims.  Thus drop-in support groups, in which attendance is optional and constantly changing, are generally limited in their psychological potential, and are usually not suitable for serious therapeutic approaches.

In general then, the longer the term of the group and the more stable the attendance, the better.  But there is an exception to this rule, the one-time workshop , which can be a powerful intervention for addressing HIV-negative issues.  Typically running from one to three full days, a workshop possesses, by nature, stability of membership.  But instead of time over which intimacy and a capacity for vulnerability are developed, the workshop relies on two devices that can, properly executed, provide powerful and productive interactions between group members.

The first of these special "devices" is the extended, concentrated period of time.  Spending an entire day together in a room partially suspends the consciousness of normal life, and thus many of the interpersonal and psychological defenses we employ there.  This phenomenon is used by the "retreat" meeting, by training programs such as est (or The Forum), and is an influence in the kinds of relationships that we generically call "shipboard romances."   The intensity of focus, capacity for vulnerability, and intimacy accomplished in such setting is often surprising, and often productive.

The second source of the power of the workshop is the use of a variety of programmatic devices that may include education, structured discussion, structured whole and small group psychological interactions, or a variety of designed "exercises" aimed at uncovering and provoking feelings and thoughts that would otherwise be defended against.  Such workshops are necessarily professionally conceived and conducted.  In the case of San Francisco's Shanti Project, which has pioneered such work for HIV-negative gay men in the United States, such workshops have proved immensely useful to participants.  The have taken one-day and three-day retreat forms, and have used a variety educational, group therapy, discussion, and designed exercise approaches.  Generally comprised of 40 to 50 participants, and facilitated by three to six facilitators (among them psychologists and experienced group facilitators), these groups have been a revelatory and transforming experience for many uninfected men. 

Bearing witness, in whatever form, is now a task of central importance for gay communities.  There is so much conflict about what the epidemic is or ought to mean, but we cannot allow this understandable confusion, or the huge inertia of internal and external denial to obscure our vision.  Denial, in whatever form, is the opposite of bearing witness, it is the lie : about the epidemic, our lives in it, and our lives after it.  Everyone, in his or her own way, must bear witness if we are to sustain or reinstate a sense of meaning in our lives by finding lives in other kinds of survival.  If we fail to bear witness and live only in hopes of outliving the future, we shall all perish in seas of living despair, or as zombies without the capacities to feel, love, or be loved, for fear that they will be perpetually taken from us by the meaningless or punitive conspiracies of microbes and time. 

FULL TEXT IS ALSO AVAILABLE ON THE FOLLOWING LINKS:

TABLE OF CONTENTS
INTRODUCTION
CHAPTER 2: THE PSYCHOLOGICAL EPIDEMIC


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