At Starehole Bay in South Devon there is a submerged shipwreck. It is a place I have visited throughout my life, but I have only seen it with my own eyes once because, to be visible, it requires an alignment of unusual circumstances – a very low tide, a stunningly clear sky and the sun at a particular angle. In ordinary times you don’t notice it and it only takes ripples on the surface, or debris from a storm to obscure the upturned hull from view. The pandemic threw up a similar once in a generation alignment, one that elided in the UK with the divisiveness and xenophobia of Brexit and worldwide with the slow-burning panic of climate change. It laid bare the broken timbers of our own society, exposing its inequality, its injustices, and its cruelties for all to see. Usually, these aspects of how we live are made invisible by distortions, lies, smoke or mirrors. When they surface in episodes of violence or tragedy they are quickly pushed back under the surface – procedures whereby the more powerful get to render the less powerful invisible and construe their difficult circumstances as personal failings.

The daily death toll and rising case numbers soon highlighted those groups who were physically and economically the most vulnerable, those who were the most exposed, those who were the least rewarded and those ‘key workers’ who were to become the most relied upon. Small ripples of generosity surfaced in the early days, but these soon dissipated and now, while it is by no means all over, it seems as if this period, while painful to live through, has offered up important lessons. As Beckett (2021) remarked: ‘A pandemic is a political event. It exposes who is vulnerable and who can afford to escape, who is prioritised for treatment and who is neglected. The politics of a pandemic are both large-scale and intensely personal.’ In other words, the pandemic was a relational event, upending the networks within which we all live but also making inequalities explicit in the reciprocal roles that were enacted between individuals, communities and helping agencies.

CAT began its life as a radically social model of psychotherapy and one in which poverty and disadvantage were not allowed to be a barrier to receiving a service. It was paced and spaced so that it could be provided in public health settings within a limited time frame, and in a spirit of collaboration, without falling back on the more mystical all-knowing interpretations of orthodox psychoanalysis. Over time, and under pressure to produce measurable outcomes, this commitment to equality has been diluted, and CAT in the 2020s is at risk of being seen as just another therapy that is ‘delivered’ or ‘done to’ people seeking help for their distress or their sense of dispossession.

Many people within the CAT community have been trying to reset this imbalance by including within our formulations of what hurts, those structural disadvantages that seep into a person’s soul. We have been seeking practice that rehabilitates social injustice as a proper explanation of mental ill-health and as a legitimate focus for shared understanding with our patients. The pandemic has made this adjustment even more necessary.

When a person grows up with insufficient or insecure income, it undermines the stability and connectedness of their relational lives. Poverty has even been shown to affect the developing brain of an infant at a neurological level leaving its indelible stamp on their progress through life (Rocheleau 2019). But international data at population level, compiled by Wilkinson and Picket (2011) demonstrated that it is not only the level of absolute poverty in a country that creates social ‘problems’ but the scale of inequality. Their analysis suggests that this is because it undermines social bonds and cuts across solidarity. Inequality is therefore closely correlated with addictions, suicides, early pregnancy, depression, violence, divorce, stalled longevity, infant mortality, and other societal difficulties. The data proves, once and for all, that structural issues percolate down to cause individual stress and distress. A CAT under- standing of this data might be to postulate that inequality fundamentally destabilises reciprocal roles making them more ‘asymmetric’ than truly reciprocal (Emilion and Brown 2017; and Brown 2019).

The pandemic provided further evidence, if it was needed, of the extent to which more unequal societies fare worse. Writing from the experience of the UK, years of austerity in relation to public services since the financial crash of 2008 had led to extremes of inequality within and between regions. Poverty then came to be implicated as a cause of increased mortality and morbidity in line with these existing inequalties. Pre-existing conditions were evident in the demographics of the early mortality statistics, as the virus took lives that had already in part been compromised. The final turn of the screw is that the pandemic has left an disparate legacy in human and economic terms that is creating even further tears in the social fabric and placing a still heavier weight of disruption and dislocation on the shoulders of the already disadvantaged. Our government put mandatory restrictions in place that were too little and too late, and they weakened their effect by accompanying official public health information with mixed messages as influential people close to power flouted rules and appeared unmasked in public. This hesitancy and ambiguity played a significant part in our country’s higher numbers of infections and deaths to date than those in comparative countries.

Black and minority ethnic communities were disproportionately affected by a juxtaposition of biological vulnerability and long-term discrimination in the labour market, by the increased likelihood that people from these communities would be working in public-facing, economically insecure employment, and by the fact that they were often living in more crowded housing and in more densely populated and poorly served neighbourhoods. The international outcry that erupted in the face of the appalling racist murder of George Floyd, resonated with the voices of many who already felt that they had been unjustly left behind including those who had been hit disproportionately hard by the virus and further impoverished by its economic impact. People were also suffering from many bereavements washing over them in waves, many of which are laced with anger and ‘if-onlys’. This sense of an overdue reckoning also emerged in relation to incidents of violence against women. When Sara Everard, Sabina Nessa, Nicole Smallman and Bibaa Henry were killed going about their ordinary lives, it was as if there had been what we call in CAT a ‘bottling up’ procedure that the pandemic forced into the open. People protested despite the risk of infection, and they protested against the backdrop of burning forests and flooded streets.

In the UK, it is unlikely that anyone would have escaped the pandemic’s ramifications. For some this will have meant painful separations and bereavements. Some found themselves better off with incomes held steady and reduced outgoings, while others have been plunged into poverty, debt, and homelessness. Some found the retreat into relative isolation calming, while others experienced it as alienating. For anyone living with a violent partner or family member the risks and pressures increased. What is clear is that many will not return to ‘normal’ at home, in their workplaces, their politics, or their sense of themselves. In CAT terms, reciprocal roles have become so changed and so charged that the procedures that previously worked no longer cut through. In this editorial I want to think about what we can learn as relational therapists about naming inequalities and acknowledging the impact of so many overturned reference points.