Introduction: the psychological dimension of Covid-19
The spread of coronavirus (Covid-19) throughout most of the globe is not only a serious risk to the physical health of much of the world’s population but also to their psychological and social well-being. Although my focus in this article is on the UK’s experience so far of Covid-19, I think many of its sentiments will apply to other countries as well. At this point it’s probably worth mentioning that I have a background in mental health and psychotherapy, and therefore have a particular interest in the psychological and social dimensions of this pandemic.
Just over a week ago the UK went into near total lockdown, and there have been rumblings ever since that things could get even more restrictive. Although ‘unprecedented’ has probably become the most overused word in the English dictionary, it’s hard to think of any previous period in history when virtually the whole population was ordered to stay indoors for at least three weeks and quite possibly a lot longer. Even in the darkest days of the Blitz citizens were being encouraged to come together not self-isolate.
It’s clearly too early to judge with any accuracy what the psychological and social effects of such measures are likely to be, but it doesn’t take much imagination to see that they could be very dire indeed. There is already growing evidence, both in this country and around the world, that incidences of domestic abuse are increasing, as partners and families suddenly find themselves forced to spend prolonged periods of time together in what can sometimes be very confined spaces. As Paul Daley writes in this Guardian article, there is a “pandemic of severe depression and anxiety that will sweep over the world as the unemployment rate pushes into previously unseen digits, families who’d prefer to be socially distant are thrust together and young people are denied the certainty and structure of school.”
I’ve also heard reports that some people are committing suicide because they think they may have contracted Covid-19, even though the death rate is, statistically speaking, very low.
Then, of course, there is the question of what weeks, and possibly months, of lockdown is going to do to those people whose mental health is already fragile and who are already living psychologically on the edge. This short Lancet article, based on the Chinese experience of Covid-19, provides a sense of what might be about to hit the rest of the planet. The authors of the article point out that mental health disorders can actually increase the risk of contracting Covid-19 in the first place for a variety of reasons, including cognitive impairment, lack of awareness of the risk, and possible discrimination against people with mental health problems from health care services. There is also the possibility that mental health comorbidities could make effective treatment of Covid-19 more difficult. Furthermore:
…the COVID-19 epidemic has caused a parallel epidemic of fear, anxiety, and depression. People with mental health conditions could be more substantially influenced by the emotional responses brought on by the COVID-19 epidemic, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population.
And finally, outpatient appointments for people with mental health problems are likely to be severely disrupted during any lockdown period.
For health and social care workers at the frontline of the Covid-19 war, there are an even greater set of challenges. Not only have they got to worry about their own health and those of their loved ones, but they also have to focus on providing the best possible care for their patients. Although the overall death rate for Covid-19 is relatively low (on average 1%) and most people will only experience mild symptoms, figures from Imperial College suggest that on average about 10% of symptomatic patients will require hospitalisation, and for the over-80s this figure increases to nearly 30%. Of these, 20% will require critical care (70% for the over-80s). Furthermore, a recent report from ICNARC (Intensive Care National Audit & Research Centre) shows that of those patients who do require critical care, the average survival rate is in the region of 50%.
So, from a front-line health workers point of view, the overall low death rate in the wider population is of little comfort because by definition they will be confronted with the most serious cases, many of whom will die a horrible death.
Trauma, anxiety and Covid-19
One of the problems with Covid-19, apart from the immediate health risks it poses to the population, is that it calls into question many of those things that we take for granted. Not least, the fact that at the moment the majority of the population is having to stay at home for most of the time, and for some people this means remaining under what is essentially a form of house arrest for at least three months. And leading on from this there is the problem of social isolation and lack of direct physical contact which most of us take for granted. On top of this, for many people there is the economic impact of businesses and workplaces having to shut and the effect this has on their livelihoods.
At a broader level, there is the fact that ‘normal life’ itself is on hold until further notice. And perhaps this is what hurts most of all; for most people there are certain expectations about what constitutes ‘normality’ and ‘normal life’, both in their personal lives and in the wider society. Being in a state of lockdown and subject to quite extraordinary and relatively draconian state powers is not, for most people, ‘normality’.
Of course, it’s too early to say how long this period of abnormality will last, and what its long-term psychological effects are likely to be. And it’s not even clear whether once the immediate crisis has passed there will ever be a return to what was once considered ‘normal’. In the meantime there is the constant anxiety around who will be the next to succumb to the virus and whether they will be one of the fortunate majority who will only experience mild symptoms, or whether they will be amongst the unlucky few (in statistical terms) who become seriously or even critically ill from Covid-19.
It is probably not too much of an exaggeration to say that for some people at least, this whole experience is very traumatic. But what do I mean by this? One of the key characteristics of traumatic experiences is that they do not make sense to the individual; to put it in more psychological terms, the individual cannot ‘process’ the experience and fit it into their view of the world. This is the essence of trauma and is the basis of many of the very distressing symptoms experienced by individuals who suffer from post-traumatic stress disorder (PTSD), which include flashbacks, nightmares and panic attacks.
At this point it’s important to point out that such symptoms may not be experienced straightaway; often there can be quite a time lag between the actual experience and the appearance of symptoms. In other words, for some people the psychological and traumatic consequences of the current crisis may not become apparent for many months or even years. At the same time, though, for some people the effects will be more immediate and they may well start to experience PTSD type symptoms very quickly. This has certainly been the experience in China, which was the first country to experience the full force of Covid-19.
What is to be done?
But what can be done to mitigate such problems? To start with it might help to try and keep a perspective. Yes, Covid-19 is serious and yes, if you watch the media reporting it would appear that people are succumbing all over the place to it, and in very large numbers. And yet, the reality is, only a small percentage of people who are infected with Covid-19 will require hospitalisation, an even smaller number critical care, and an even smaller number will die. This is, of course, no consolation to those who are in that small percentage or have lost someone to the virus, but it might help to keep a sense of proportion.
Furthermore, it is important, in this new world of self-isolation and social distancing, to find new ways to strengthen the social bond with others. Of course, social media has already been making this possible for years now, and in the current crisis many people are increasingly turning to social media and video-conferencing platforms to reconnect with their friends, family, work colleagues and the wider world. In my view it is a mistake to think of such platforms as a ‘poor substitute’ for the ‘real thing’, i.e. direct physical contact. The reality is, such direct physical contact has been on the wane for a long time, and all Covid-19 is doing is to accelerate and further embed such a process.
For some people it may be helpful to seek more professional support and although face-to-face counselling is clearly out of the question at the moment many services are offering telephone, email and video support. See for example, the information re Covid-19 and therapy on the UKCP’s website. The BACP website offers similar information and most NHS IAPT services appear to be offering ‘remote’ alternatives.
Perhaps most important of all, though, is the ability to find new forms of meaning in the midst of the apparent collapse of meaning, of all that we took for granted. It is worth remembering that in many ways the idea of a ‘stable, normal life’ is itself an illusion, and that life is perpetual change and adaptation. If anything good comes out of Covid-19 it might be that it helps us reassess our lives and to decide what really matters to us. This is not to say that life is necessarily going to be dramatically different ‘post-Covid-19’; in fact, history tends to suggest otherwise and that often there is a mixture of change and continuity in the wake of major crises. On the other hand, I would be very surprised if things could ever be quite the same again and if we could ever quite be able to go back to ‘normal life’. More probably, there will be a new ‘normal’, although it is still too early to see what shape it will have. The key point here, though, is being prepared to be open to this new world instead of trying to hold on to the ‘old normal’ and past assumptions.