Post-traumatic and post-confinement stress. Psychological effects and vocation for collective work
Víctor Hernández Ramírez. The psychological effects of Covid-19-related confinement have been pointed out by the latest mental health studies[i]: anxiety, depression, sleeping disorders, alcohol and/or other drug abuse, perceptual disorders and concentration difficulties, feeling of isolation and loneliness, low motivation and negativity. On top of all these effects caused by confinement-related stress, there has been an increase in domestic violence[ii] and the negative perception of ageing and loneliness[iii].
These effects will not vanish at the end of confinement; we will most probably see a wide variety of symptoms associated with post-traumatic stress: anxiety episodes or states of anguish in different degrees, different types of depression, psychosomatic symptoms, expressions of phobias that make the return to “normal” life more difficult and general difficulties in reconstructing a sense of meaning for the future.
The Covid-19 crisis gave place to an opportunity to meditate on the society we are part of and the imposed stop gave us a certain perspective from which to appreciate the priority of health and life-care. Nonetheless, our conceptions of health and life are also mediated by medical technologies and health and safety measures. These condition our perceptions of health and illness, or health and death and a new perspective on individual wellbeing arises, one that demands distancing and identifies the other as danger-of-contagion and its dreadful consequences.
I do not want any misunderstandings; I do not advocate for a rejection of the prevention measures (which are mandatory), but for an analysis of its effects in our perception of others and in our notion of health, simply because these effects have a direct influence on the psychological aspects of our life: recognition in the gaze of others, bodily expressions of affection, gathering and celebration rituals, rites of passage and farewell, the humanisation of shared spaces when inhabiting them without fear of threats. These are the things that are exceptionally suspended or limited by the biopolitical measures we have to follow.
In other words, there is a dimension of health, which is mental health (individual and collective), that is sacrificed (or strained) to stem the pandemic and avoid as many deaths as possible. In other words, the exceptional measures impose the priority of collective survival at the expense of an impoverishment of the psychological aspects of our life.
What stays behind, what gets excluded or repressed even, are those things that need to be named, and naming them requires all our strength and psychological work: how can health encompass the end of emotional isolation and allow us to meet other people in person? How do we get over the anguish of listening patiently and of constructing narratives? How do we reconcile in the midst of threats and ghosts of fear? How do we tell each other about the pain and apprehension of almost 100 days of confinement?
The worst thing to do would be to think that the effects of post-traumatic stress will disappear with time, as we move on. It will not be so. Nothing is as false as believing that time cures all ills. It is never so. Not in the psychological realm. It has been a long time since Freud spoke about the return of the repressed in the repetition or insistence of symptoms.
Nonetheless, the work coming will not be reduced to that of mental-health specialists only. That is the fractal view of the medical perspective of health: the experts will deal with it. It will not be so, or not just so.
An experience like the one we lived through with the Covid-19 crisis is the perfect time to return to a vocation for collective work: everyone is called to contribute to the multiple tasks of assistance, support, relief, and especially, to the reconfiguration of meanings of health and life that are not reduced to the biomedical perspective (something that has been a fundamental tool in the fight against the pandemic).
This collective work, this vocation for a joint effort implies:
- Synergies and cooperation above competences or prominence. In the same way that interdisciplinary work is fundamental to the mental health field, it is just as fundamental that every area of activity can acknowledge interdependence. All functions have been fundamental to the implementation of virus contention measures (from healthcare workers to cleaning staff). However, this interdependency will be even more important in the short- and medium-term. We must abandon all desire for the limelight and avoid practical reductionism as now is the time for collaboration and synergy.
- Community and sense of community. Now more than ever, it is necessary to value the social fabric provided by networks and community practices: churches and faith communities, associative groups, groups that create alternative spaces for life in neighbourhoods. It is also fundamental that virtual networks are understood as networks with a sense of community: virtual communication practices may incorporate the goal of achieving a sense of community.
- Arts. Artistic practices have been fundamental to help us cope with confinement. The creative ways artist, professionals and non-professionals, found to share their art were moving and very valuable: from balconies to social media. Art will also be a fundamental tool in expressing and giving new meaning to the “collective trauma”. For this reason, it will be important that groups, communities and general society facilitate artists’ work.
- Spiritual practices. Spiritual practices play a very important role in extreme situations (illness, crisis, death), life cycles and rites of passage. They can be either religious (prayer, meditation, singing, liturgical celebrations, sacred text, devotional bodily practices) or non-religious (disciplines of reflection, meditation, search of meaning or simply silent practices). It is important that such rituals and practices are considered valuable elements when accompanying crisis situations (for example, interreligious and non-confessional chaplaincy). Spiritual practices are a very valuable resource in the processing of post-traumatic stress.
Finally, we must admit that the vocation for collective work (adopting synergies, increasing community actions as well as boosting the arts, accepting the value of spiritual practices) is not easy. We should even assume that our (neoliberal) society encourages an “uncooperative self ” (as Richard Sennett expressed[iv]), and the Covid-19 crisis will not eliminate fears and prejudices per se, nor indolence or the tendency towards social withdrawal.
Collective work has to be understood as a calling, as a vocation in the classical sense: a purpose, a voice calling from life to come, a request. That voice calls for us to think together, to rethink life and health, relationships and work, contingency-driven restrictions, illness and mourning. It calls for us to think of the named and the unnameable, as the psychoanalyst Maud Mannoni said when reflecting upon old age and death[v].
We are called to think about all this within the framework of collective action, common work and interdependency, which reminds us that we are not isolated or alone, that we are the other for those who gaze upon us, who may know, despite everything, that they can count on us.
[i] See: Perceptions of an Insufficient Government Response at the Onset of the COVID-19 Pandemic are Associated with Lower Mental Well-Being [Survey in 58 countries, about 100,000 subjects], (April 16, 2020): https://psyarxiv.com/3kfmh
Psychiatry in the aftermath of COVID-19 (april 2020): Rev Psiquiatr Salud Ment (Barc.). 2020. doi: 10.1016/j.rpsm.2020.04.004: https://ereprints.elsevier.es/9PS0S01#Abstract
Epidemic of COVID-19 in China and associated Psychological Problems (June, 2020): https://www.sciencedirect.com/science/article/pii/S1876201820302033
Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science (June 2020): https://www.sciencedirect.com/science/article/pii/S2215036620301681
Psychological effects of the Coronavirus disease-2019 pandemic https://www.rhime.in/ojs/index.php/rhime/article/view/264
COVID 19: Impact of lock-down on mental health and tips to overcome (april 10, 2020): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151434/
[ii] The pandemic paradox: The consequences of COVID‐19 on domestic violence (April 2020): https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.15296
[iii] “We Are Staying at Home.” Association of Self-perceptions of Aging, Personal and Family Resources, and Loneliness With Psychological Distress During the Lock-Down Period of COVID-19 (Journal of Gerontology, April 13, 2020): https://academic.oup.com/psychsocgerontology/advance-article/doi/10.1093/geronb/gbaa048/5819592
[iv] Richard Sennett, Together: The Rituals, Pleasures and Politics of Cooperation, New Heaven: Yale University Press, 2012.
[v] Maud Mannoni, Le nommé et l’innommable: le dernier mot de la vie, Paris : Denoël, 1991.