In life like in therapy, it is always interesting to check where we started and where we are now. Here is an article I wrote about the pandemic. Exactly on the 28/04/2020. How much have we moved on since then ! Interesting. The article is long as I wanted it to offer a wide window on what we were meeting. The information is non-stop and massive in the media even though we still don’t know that much about the covid-19 virus. We need distancing and a comprehensive approach in our personal and professional lives, so we may manage the current situation in the long run. The aim of this article is to offer a broad approach on how covid-19 is affecting us. This virus is impacting the whole world and touches all sectors of society as well as different levels of our psyche. Being social animals, we cannot ignore the psycho-sociological side of our lives. In this article, we will look at the suffering on the mental health issues of carers, children and teenagers. Grieving and the notion of death, both symbolic and physical cannot be avoided and will be considered. Some tips will be suggested in the body of the article, find them preceded and ended by ! We may wonder what Covid-19 is showing us about our own dys-functioning at an individual level as well as at societal organisations: health, economy, politics … Viruses First of all, let’s go back to basics: what is a virus? In the collective psyche, there is something insidious (7) in the threat viruses represent: they are very small living entities that aim to live and expand at the expense of other living cells and organisms, exchanging genetic material. For this, they mutate, adapt and are contagious. Their size and the above three characteristics exacerbate the rise in anxiety, as linked to the unknown and uncontrollable: all very distasteful for us Homo Sapiens Sapiens. The contagiousness creates a feeling of suspicion within our own species, first at the current known scale: fear of propagation or catching the illness. One development in Europe that will also probably develop in the UK and the USA is that some people begin to fear close physical interaction, which may continue even when the ‘lockdown’ is eased. ! A factor important to take into account, getting a sense of control back into your life will help you feel better and safer ! It is interesting to consider the viral adaptation strategies; how much can we learn from them? ! Creativity and adaptability ! are two qualities to develop when facing distressing challenges. We and viruses have a complex and inescapable relationship: viruses helped our evolution in some ways, such as the change of the interface between mother and foetus (provided to our primate ancestors by a virus) (9) and they are being increasingly used in gene therapy in case of antibiotic resistance. They also, of course, can harm us. Our societies Behavioural and cognitive trends Covid-19 is offering us and our societies the mirror of our own limitations and dysfunctions The International Labour Organisation (ILO) (2) assessed a situation of profound socioeconomic inequalities. The capacities of being protected from the virus’ transmission, depending on whether we have an accommodation, a work and an access to the internet. Socially disadvantaged groups have greater social contact in the public sphere and higher rates of covid-19 infection. Many face the ‘work or lose income’ dilemma (1). Migrants, refugees, the homeless and undeclared workers are particularly affected as are women, who are over-represented in the health sector. The virus spread began with people who had the means to travel but affects most the socially and economically vulnerable of our societies. In another section of our societies, data protection is a domain that is affected as well to a level that is new in western societies. (10) We need to decide the acceptable balance between individual sensitive data, health data and the knowledge of the virus spreading before stopping the lockdown. Around 60% of citizens have to accept this for the measure to be efficient. The CNIL (Commission Nationale de l’Informatique et des Libertés) in France (14) and the ICO (Information Commissioner Office) in the UK (15) advise much attention in the use of data collection in these exceptional times. It is important to keep in mind that scientists are still in the process of understanding the specificities of Covid-19. They still do not know much about it, hence the difficulty to gain control over and make decisions to live with it in the long run. This also increases the anxiety linked to the unknown. There is no previous research to help us deal with this pandemic. Previous papers include one from China, one from the Lancet, both considering smaller samples than this pandemic. Because of the different scale, the results cannot be projected for the understanding of the current situation; though they can give us an estimate. A study from China, done on 6/03/2020, examined 52.000 persons. 35% of them reported a moderate psychological stress while 5% needed psychiatric care after 3 weeks of isolation. The Lancet research from the 26/02/2020 (12) shows that the duration of isolation is predictive of PTSD, avoidance and anger. To this, I would add that, as stated above, the economic conditions, mental health before the isolation and the dynamic of relationships within the household have a major impact on this. In society, there are certain groups of citizens that hold more power. In these times, researchers, politicians, mass media owners, have an important impact on the decisions taken, potentially to our individual mental health. Societal decisions around prevention and care are linked with the political style of each country. Whether your beliefs lead you to trust or distrust your leaders will affect your cognition and behaviour; maybe changing them or reinforcing them, probably with more intensity. We all have been / are, or will go through different stages when facing a difficult and potentially traumatising event. Being a French national with friends and family in different countries, it has been quite amusing in a way, to observe the differences and commonalities of several countries. We all are social animals with layers of cultures and sub-cultures. Have we learnt from each other? That is another question … About 80% of current mass media information is linked to Covid.19. This plays as unsupportive hypnotic suggestions filling the mental space of those who read / listen to them a lot. The words constantly repeated leave an imprint: death / Covid / virus / hospital / contamination / anger / fear . The word ‘Contagion’ has been increasingly looked for on search engines, whilst the game and the film massively played. ! Choose to get informed one or twice a day maximum, decide on a precise moment and its duration. Choose which media you will consult: newspaper, radio, TV; and what is the exact information you are looking for. This will help you regain control over the information instead of passively receiving masses of it. And let’s be clear, the majority does not aim to inform you accurately you but to sell you their sensational story.! So as Homo Sapiens Sapiens, once we realise what is at our door step, quite literally, we begin to grieve and this is what happens to us: • denial : nah, not for me but the others, I am fine; Heinrich Heine, German writer and poet of the 18th century, described the cholera epidemic in Paris like this: ”Parisians were giggling with much joviality on the boulevards” (16): denial is a part of our human psychology. • A wave of fear and anger as there is a threat that we do not control. With erratic behaviours: out of control toilet paper hording (if someone can explain this one to me?) and food purchase; the feel of loss of control begins • An outburst of search for causes as we need to understand so we can make sense of what is happening. That goes with our human nature to oppose the fragility perceived. In the middle ages, the cholera epidemics went with causes declared as God being angry at humans or women or animals: the others from the point of view of those running the society (8). • Then comes negotiation : ‘OK to be in lockdown for 3 weeks and then, it has to be over’; trying to regain control over the situation. • Sadness which is an unpowered acceptance (symbolised by the lungs in traditional Chinese medicine) (5) • Acceptance and re assessment of our cognition and behaviour (3). This is where we regain control and are realistic, so the management becomes possible to the best of our ability. • Learning, understanding growing from what happened to us, that phase called post traumatic growth in positive psychology. Walter Scheidel, a contemporary Austrian historian, states in his book ‘The Great Leveller: violence and the history of inequality from the stone age to the twenty-first century’ (13) that the biggest re assessments resulted from the most severe shocks, lethal pandemics being one of them. We are touching on that notion of post traumatic growth. ! You may consider seeking professional support when you cannot deal with the situation by yourself ! Daniel Kahneman, a writer who explains economy through the lens of cognitive psychology, tells us that ‘Nothing in life is as important as you think it is, while thinking about it’. This statement can be understood as the fact that when we think about only one thing, it is like self-hypnosis and suggestions, using the fast thinking and memorising circuits. By filling in the majority of the mental space, it will stop the access to another thinking process whose function is to allow distancing and perspective: a phase of control regain (12). Our Psyche Bessel Van der Kolk tells us that we all are in a state of ‘pre-traumatic state’ (9). Indeed, trauma is about feeling helpless to change a situation we are living in; when the whole sense of time disappears, no predictability nor trust; these are the roots of trauma. We are dealing with external unpredictability, hence the importance of creating our own predictability: new routine. ! • Structuring your daily activities is important as it allows you to regain control over time: decide on what you do and decide on the time frame of each of your activities. It helps you get some routine back as previous routines have disappeared. Routine offers a sense of stability, predictability that is a guarantee of a sense of safety • exercise, go out; there is no need to become an athlete, just make that body • move as emotions need motion. • Practise yoga perhaps. • Call your family and friends: physical distance is not social distance ! We are in a marathon here, not in a sprint; so it’s better to get our mental boundaries and choices as clear as we choose to have them. With the lockdown, the conditions for the rise in violence are being created. When the living space is too small, each person is deprived of their physical territory and that leads to violence and creates a sense of dangerous invasion (experiments have been done on rats decades ago where those mammals ended up killing each other). There is no outside counterbalance for existing abusive relationships as social services and health care are over busy with Covid-19 and do not have the same level of vigilance due to social distancing. Hence the increase of domestic violence towards those who were already targeted; mainly women and children. We have the responsibility to share the different emergency numbers that can be reached by those in danger. How about a poster on your front door? The reality is that it is needed. ! At the moment, we all need structured days, the establishment of extra routine. That routine needs to be both firm, flexible and realistic. Those with mental health issues are even more in need of this time structuring. ! The most affected among us Naturally, they are those who are already affected by a mental health issue; though these people may find secondary advantages in the current situation. Some of the people I am working with, who are dealing with either severe depression or severe anxiety, describe their situation precisely: what bothers them is when they have to manage a contact with someone outside of their mental or physical territory. The isolation for them is reassuring in two ways: • Even less social contact and potential stimulation that is triggering their difficult mental state and • The fact that now, everybody is at some level of social isolation… like them. For once, they belong to the social norm. Indeed, when you are suffering from mental illness, you are de facto in social isolation to a certain degree. However there is avoidance there, used as a coping strategy; and we know that avoidance is not a solution for better management. Anxiety and depression, like any mental health issue, even though causes, symptoms, cognitions and behaviours differ, lead the individual to shrink their world to only keep a small amount of routine and expel the rest as much as they possibly can. ! If you are suffering from a mental health issue or you know someone who is, finding professional support allows to manage avoidance and reach a healthy management of the symptoms. ACT is an approach to consider ! People who are addicted to a substance, isolated persons, those suffering from chronic illnesses, individuals who are grieving after loss of a loved one and as stated above, children and women at risk. Violence, anxiety, depression and psychiatric decompensations increase during high and repetitive stress (4). We are not all equal when facing stressful events. It depends on how our previous life routine was organised mentally, economically and how we can reach outer and inner resources (11). Carers Those working in hospitals / parents / therapists A golden rule for carers? Look after yourself before caring for others. Seriously. A healthy mind does not come with a profession. Let’s act on it or we add another layer of mental health issue to those we are supposed to care for. Compassion fatigue is real, some of its symptoms are exhaustion, physical pain, sleeping issues, physical pain, muscular tension, gastro-intestinal problems, feeling isolated and helplessness (6). - Healthcare workers have to face the worry of bringing the virus back into their own family, to support the loneliness of their patients who are isolated from their families and the angst of the families who cannot connect with their loved ones (11). Healthcare workers also have to face a large increase of work dealing with deaths. - Parents must deal with their own work when they have one and organise school work when they have children. - A child’s mental health will depend of that of their parents who may find difficult and sometimes impossible to manage their own emotions and behaviours. Active presence is important: being present and listening to the child. Adolescents are like hermit crabs: in between or without shell reality: the childhood one that has become too small and the adult one still too big. To make the situation even more interesting, the specific brain functioning of the adolescent frontal cortex is not mature yet, so the teenager cannot easily access planning, reflection or strategy building hence they are under the spell of their emotions with this unique capacity of immediately acting on those emotions. Imagine what can result from being locked at home away from their teen-tribe; they may need to go outside even though it is forbidden. Children and teenagers need a clear frame of education, a balanced between a structured day, a participation in the life at home and their own space. ! Be genuinely interested in the content of your child and your teenager’s world. Make time for discussion; listen to them; be flexible and lowering expectations is OK at times ! Therapists equally need to work on their emotional management to clear the way for the people they are working with. For example, I always have about 5-10 minutes prior to working with a person to clear my mind and my body, whilst my after-session work always includes a period where I reflect on what I’ve been feeling (and at what time) during a session. Supervision is a must have too. Death Symbolic and physical We all are grieving (5). At our individual level and at macro levels. Grief, according to David Kessler, centres on death. Grieving is to deal with separation. With Covid-19 preventative measures we say goodbye to the life we have had so far; we may say goodbye to the people lose. There can be the interruption of a relationship we cherished and never thought we would lose in such circumstances. We have momentarily lost the familiar sense of normalcy. We have lost control over some parts of our life. ! So we need to understand, regain consciousness so we can adjust and manage what can realistically be managed in our environment ! Messages related to death and religion became salient after January 20th in China. If there is one single thing we can be sure of when we were born, is that we will die one day. This reality is avoided in our society. Most of us live in denial of death: we are supposed to be good looking, rich, young, in a good health. We may be distancing ourselves from our elderly. Our rituals around death have been deeply shaken with the covid-19 pandemic for security reasons. We cannot be with our relative when they are in hospital, not gather with family and friends to accompany them to the cremation or burial. The goodbyes become very complex when rituals are not there anymore. We need to recreate a way to manage the loss caused by such death (7). Even when a death is traumatic, we can say goodbye in a way that connects us, instead of separating us. It’s about creating a different relationship with our loved ones who are dead or dying; or when we ourselves will be dying. Building a realistic and original link between the dead and the living can offer an important peace and the permission to be happy and stable again, enjoying life to the fullest. This can occur in alignment with the steps of grieving. There is no denial of the pain nor the loss, but the construction of additional psychological mechanisms. This therapeutic approach, that I am developing and calling ‘befriending loss and death’ is an acceptance process and the construction of a liberating relationship with the notion of loss. It does not require to be supported by any religious beliefs but can be at the same time. It is interesting to remember that our species has organised rituals around death since the dawn of time, whether linked to polytheisms, monotheism, shamanism, syncretism, atheism or lack of religious belief. Conclusion A golden rule? I believe the solution is in creativity and adaptability. Today is a time for shifting; create your own new realistic routine. And seek support if needed. Some researchers are telling us that the causes of the pandemic may be an imbalance of the biodiversity. We are part of this biodiversity. What does imbalance tell us about our individual life, so that we can decide on either changing our position or staying stuck? REFERENCES (1) University of Surrey, Department of Sociology, Class inequalities and the Coronavirus: A cruel irony ? March 2020, Sara Arber and Robert Meadows. https://blogs.surrey.ac.uk/sociology/2020/03/23/class-inequalities-in-health-and-thecoronavirus-a-cruel-irony/?fbclid=IwAR08LrXJx8YmJCeuhcG_- JCKTooDrfmqtHGJ_U3__QNrO3XmYs8Ef26ZSwM (2) ILO, COVID-19 cruelly highlights inequalities and threatens to deepen them March 2020, Patrick Belser https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_740149/lang-- fr/index.htm (3) Philip Strong, Epidemic Psychology: a model, AIDS Social History Management, Department of Public Health and policy, London School oh Hygiene and tropical medicine, Vol 12 N 3, 1990, ISSN 0141-9889 https://onlinelibrary.wiley.com/doi/pdf/10.1111/1467- 9566.ep11347150?fbclid=IwAR2XXrVE4YiW5QiMxt9jzKd9G5IcIS0wD6vS9Hl3Fce4XpxltMYEjD3EUA (4) Huffingtonpost.fr, Pendant le confinement, mes conseils pour éviter le stress et les troubles de la sexualité-Blog, Magali Croset-Calistro, 30/03/2020 https://www.huffingtonpost.fr/entry/pendant-le-confinement-mes-conseils-pour-eviter-lestress-et-les-troubles-de-la-sexualiteblog_fr_5e7cd0eac5b6cb08a9299081?fbclid=IwAR08LrXJx8YmJCeuhcG_- JCKTooDrfmqtHGJ_U3__QNrO3XmYs8Ef26ZSwM (5) Harvard Business review, That Discomfort You’re Feeling Is Grief, Scott Berinato, 23/03/2020 https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief (6) Sciences humaines, Quand la compassion rend malade, Philippe Zawieja, juin 2017 https://www.npr.org/2012/11/13/162742151/antidote-prescribes-a-negative-path-tohappiness?t=1587800501593&fbclid=IwAR2vCg_71J18tqQoo1TyMabXVz4ny6R7Mdup DlrMWwnkhLhGAmQk90nlrug&t=1587977883903 (7) Sciences humaines, Ce que les virus font aux hommes, jean-François Bouvet, mai 2020 https://www.scienceshumaines.com/ce-que-les-virus-font-auxhommes_fr_42191.html?utm_source=MailPerformance&utm_medium=email&utm_cont ent=Ce+que+les+virus+font+aux+hommes_0033CZK&utm_campaign=NLCOVID19+200402_0015DW (8) Huffpost.fr, Comprendre les biais cognitifs en pleine crise du corona virus avec Olivier Sibony, Lauren provost, 2/04/2020 https://www.huffingtonpost.fr/entry/biais-cognitifs-conference-boma-oliviersibony_fr_5e837cb3c5b62dd9f5d6e9d1 (9) Bessel Van Der Kolk on Covid-19 https://www.facebook.com/NICABM/videos/152095299469756/?v=152095299469756 (10) Sciences humaines, Quand le coronavirus menace nos vies privées. Entretien avec Judith Rochfeld, 3/04/2020 https://www.scienceshumaines.com/quand-le-coronavirus-menace-nos-vies-priveesentretien-avec-judithrochfeld_fr_42195.html?fbclid=IwAR0IaTl9znhQo0kDhT79bidgj32i_4k7QhILl6ZeNo4Ytb QZ8D5n6-dz8H0 (11) France Inter, La tete au carré, mathieu Vidard, 7/04/2020, Colère, ennui, stress, isolement …: les effets psychologiques du confinement (12) The Lancet, The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. S. Brooks and al., Vol 395, Issue 10227, p912-920, 14/03/2020 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30460-8/fulltext (13) Walter Scheidel, ‘the great leveler-violence and the history on inequality from the stone age to the twenty-first century’ ISBN: 9780691183251 (14) CNIL, Publication de l’avis de la CNIL sur le projet d’application mobile “StopCovid”, 26/04/2020 https://www.cnil.fr/fr/publication-de-lavis-de-la-cnil-sur-le-projet-dapplication-mobilestopcovid (15) ICO https://ico.org.uk/about-the-ico/news-and-events/news-and-blogs/2020/04/how-we-willregulate-during-coronavirus/ (16) Heinrich Heine, 19/04/1832, Allgemeine Zeitung, http://www.heinrich-heine-denkmal.de/heine-texte/cholera.shtml
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