Living with Coronavirus

Nicolas Marketos: Psychiatrist-Psychotherapist

e-mail: nmarketos@gmail.com

 

They had not been many days in Attica when the plague first began amongst the Athenians,… but so great a plague and mortality of men was never remembered to have happened in any place before.

For at first neither were the physicians able to cure it through ignorance of what it was but died fastest themselves, as being the men that most approached the sick, nor any other art of man availed whatsoever. All supplications to the gods and enquiries of oracles and whatsoever other means they used of that kind proved all unprofitable; insomuch as subdued with the greatness of the evil, they gave them all over.

Now let every man, physician or other, concerning the ground of this sickness, whence it sprung, and what causes he thinks able to produce so great an alteration, speak according to his own knowledge.

For this was a kind of sickness which far surmounted all expression of words and both exceeded human nature in the cruelty wherewith it handled each one and appeared also otherwise to be none of those diseases that are bred amongst us, and that especially by this

….

But the greatest misery of all was the dejection of mind in such as found themselves beginning to be sick (for they grew presently desperate and gave themselves over without making any resistance), as also their dying thus like sheep, infected by mutual visitation, for the greatest mortality proceeded that way.

…whereby many families became empty for want of such as should take care of them. If they forbore not, then they died themselves, and principally the honestest men. For out of shame they would not spare themselves but went in unto their friends, especially after it was come to this pass that even their domestics, wearied with the lamentations of them that died and overcome with the greatness of the calamity, were no longer moved therewith. [6] But those that were recovered had much compassion both on them that died and on them that lay sick, as having both known the misery themselves and now no more subject to the danger. For this disease never took any man the second time so as to be mortal.

Besides the present affliction, the reception of the country people and of their substance into the city oppressed both them and much more the people themselves that so came in. [2] For having no houses but dwelling at that time of the year in stifling booths, the mortality was now without all form;

Neither the fear of the gods nor laws of men awed any man, not the former because they concluded it was alike to worship or not worship from seeing that alike they all perished, nor the latter because no man expected that lives would last till he received punishment of his crimes by judgment. 

Thucydides, History of the Peloponnesian War 2, 47-54

Thomas Hobbes. translator. London. Bohn. 1843.

The above passage is from www.perseus.tufts.edu/hopper/ site

 

Life in the days of the SARS-CoV-2 pandemic (referred below as coronavirus) flows through the sombre background of fear, of social distancing of uncertainty, of insecurity, and of pessimism.

“Coronavirus” ” is the master of the meaning of our times. All the individual and collective fantasies around the virus present it as a demonic force, the quintessence of evil, insidiously invading the body, violating the limits of the Ego, and destroying the organism (M., Bassols). A situation that creates a collective hypochondria.

The outbreak of coronavirus dramatically brings to the forefront how vulnerable our biological dimension is, reminding us that we are mortals; the fantasy of absolute control, underlying the ideological project of science, comes into conflict with this uncontrollable reality of the mystery of life, a reality that the Western world, with its totalitarian utopia, tends to deny (Lauret M., 16 March 2020). It comes and overturns the fantasy of immortality that the Western world fostered to reassure humans from the fear of death.

The pandemic prolongation produces chaotic experiences, which threaten to break down the psychic boundaries between what is understood and finite and infinity (Lawrence, W. G. 2000).

 

Psychological processes

As a deadly threat, the coronavirus gives rise to persecution anxieties. Persecution anxieties and the sense that familiar persons may be carriers of the ultimate evil rather than being resources of love and safety, turn the subject to enclosed and fortified individuality and undermine any sense of trusting in the neighbor (Sideris N., 28 March 2020).

But on the other hand, the denial of the reality, that we are at the mercy of a virus, again leads to fantasies of omnipotence and the grandiose illusion of the “supposedly immune”.

 

Pandemic ravages cause traumatic experiences of loss

We lose the other as a social partner since he is potentially a carrier of the threat. We lose the environment of the community, where forms of coexistence take place -and meaning is woven- because they can be turned into points of infection. Finally, we experience real loss and bereavement when loved people are dying because of the disease.

 

Distancing the lockdown

This crisis has taught us a lot about isolation.

Julia Kristeva

The measure of distancing and the confinement led individuals to experience loneliness, as isolation inevitably excluded the established ways of avoiding the encounter with self; for many individuals, this loneliness seemed unbearable (Jamieson W., 5 May 2020).

Families were allowed to enjoy coexistence, but protection measures deprived children and grandchildren of contact with vulnerable family members. Family members continuous interaction brought to the fore problems that everyday life had put aside. Most worrying of all was the outbreak of domestic violence. Families with adolescents experienced more stress; particularly young candidates for universities felt plunged into gridlock, which was reflected in the results of this year’s nationwide exams.

 

Impact on Mental Health

Official bodies (W.H.O.) and reputable scientific journals (Lancet) have raised the possibility of mental disorders global outbreak, due to coronavirus. The most vulnerable are young children and healthcare workers who cope with patients dying from COVID-19.  The experience of death and mourning for losing familiar persons, the confinement and isolation, the fear of infection, the guilt if they transmit the infection to others, the anxiety of stigma, the uncertainty, the economic insecurity, and the fear of losing work are stressors for the manifestation of anxiety and emotional disorders and post-traumatic stress disorder. The above-mentioned factors affect any existing mental disorders.

An article in the Lancet Psychiatry highlights the association between the coronavirus and the increased suicide risk, domestic violence, child abuse, and drug addiction (Rogers et al 1 August 2020).

Survivors of the disease, or those who have been quarantined, as well as those working on the front line in the health care of patients, are at risk for developing post-traumatic stress disorder, for which long-term mental health care should be available (Shanahan L. et al, 23 June 2020).

 

Psychosocial considerations

The virus is as it travels along the cracks of a society, too dedicated to the enjoyment and denial of death, exposing us to our weaknesses and failures, to how fragile our identities or our safety as a group are (Jamieson 5 May 20).

According Badiou (23 March 2020), the tribulation of the epidemic dissolves everywhere the inherent activity of the discourse. The discourse tries – and fails – to tame the «experiences of threat and loss, and ” subjects are compelled to relapse to regrettable practices such as mysticism, myths, prophecies, conspiracy theories, search for messianic hopes, such as those once familiar in the Middle Ages when the plague was ravaging the population. The population is becoming more vulnerable to state power and messianism”.

Continuous individual protection can produce new forms of discrimination and erosion of community ties. We have already seen unjustified forms of prejudice and stigmatization against individuals (who have been sick), against social or ethnic groups, and also against the category of the ‘disobedients’ who do not comply with protection measures -as government actors define them- and are ‘irresponsible’ and potentially dangerous.

As the pandemic continues, a predictable pattern emerges.  First, idealization, usually of health care and rescue workers, followed by creating scapegoats and finally blaming adimistrators and social groups.

(Leader D., 19 August 2020).

During the pandemic, the language of science undertook to unite social groups through a common scientific language.  Politicians turned to scientists to find a reassuring “answer.”  There were arguments concerning the performance of religious rituals and mysteries, which essentially was expressing the confrontation of rationality and metaphysics. Science promises to overcome anxiety with knowledge; religion promises to overcome it with meaning (Bassolls M., 25 March 2020).

 

Coronavirus and politics

The spread of Coronavirus is also a political and ecological issue: the dominant productive and economic model destroys the ecological balance of the planet which is necessary for the preservation of life.  Many agree that the destruction of ecological balance appears to have produced the virus (Lew R., 18 May 2020).

Several theorists have called into question the very principles that led to the current disaster.  The French philosopher Jean-Luc-Nancy argues that: “We are told everywhere that the whole system reveals its cracks” (Jean-Luc Nancy 10 May 2020). For Jean-Luc Nancy, there is a strong possibility that the pandemic will shed new light on today’s world inequalities. The virus reminds us of the sovereign right that death exercises over life; the fact that we are mortal is perhaps what makes us equal. Although the virus itself does not make any social discrimination, it is obvious that protection against infection depends largely on living conditions, which may be more or less favorable to prevention.

The pandemic highlighted the contradictions of the neoliberal establishment policies, as many scholars and politicians – across the whole political spectrum – recognize now the need to strengthen the welfare state and the public health care system and, generally, to reorganize society to be able to respond to emergencies and to the needs of the most vulnerable.

 

The management of crises

Governments, aiming to ensure the public health, have created a state of exception and surveillance by abolishing or restricting civil state’s rights and guarantees of freedom. This is an unprecedented intensification of bio-power and is carried out through biopolitics strategies, as first analyzed by Michel Foucault (2004). Although legitimate health reasons have forced situations of exception and surveillance, we must not ignore that they violate the values of autonomy and solidarity and pollute the relational world with mistrust. We should be vigilant the situation of exclusion not to be made permanent, where for security reasons civil liberties are sacrificed. Particular vigilance is needed to resist the enormous surveillance power of modern technologies and the possible abuse of it by authoritarian regimes.

The media and the government agents have turned into all-day health guardians, imposing phobic syndromes to persuade people to comply with security measures, and they are stressing the obedience and the individual responsibility dimensions. On the other hand, they make constant critical comments. But treating citizens as if they were irresponsible children fuels their opposition. Acts of denial can be their resistance to regression and a way to rescue their subjectivity (Leader D., 19 August 2020). For others, these are attempts to maintain a sense of control and others are expressing by this way their intolerance to the uncertainty and the unknown. On the other hand, critical comments produce psychotic reactions.

 

What to do

On the political level

Planetary health and ecological destabilization invite us to build new political thinking, a new political imagination, that will give us a new vision (Douzinas K., 4 April 20) and will promote the values of interdependence and the emancipation.

 

The “recovery” will be more than ever interpersonal and socially supported

It is necessary to find and give meaning to the pandemic through interactions in our communities. The new forms of action will be actions towards the reconnection of the fragmented social body, ideally and specifically with multiple forms of aid and ideas and specifically with multiple forms of help and survival (Mezzina R.).

We the therapists

As experts, we should not strive to close out the corrosive threat, which is the coronavirus, and what this means for our lives, our profession our identity. We should step back from recommendations, prophecies, and theories, as the “omniscient” talking heads do and work against penetrating denial and the desire to cover up the reality of death (Jamieson 5 May 2020).

What is the role of the therapist in such a situation? What is there to analyze when there is too much Reality? We listen, feel, understand, reflect, respond, and move forward with the process. An important way we can assist our patients is by helping them find the meaning of their responses to the crisis, by carefully differentiating the defensive from the more adaptive coping strategies (Green L. S., 17 March 2020).

 

References

Badiou Alain (23 /3/2020 ) Sulla situazione epidemica. Δημοσιεύτηκε στην ιστοσελίδα Filosofia in Movimento (http://filosofiainmovimento.it/sulla-situazione-epidemica/),

Bassols Miquel 25th March 2020 http://www.amp-nls.org/page/gb/49/nls-messager/0/2019-2020/4131

Douzinas Kostas- (06/04/2020) https://poulantzas.gr/kostas-douzinas-viopolitiki-pandimia-ke-ta-dikeomata-ton-kyvernoumenon/

Green L. Sandra 17/3/2020 Thinking Analytically in the Time of COVID-19 https://manhattanpsychoanalysis.com/blog-post/thinking-analytically-covid-19/

Jamieson Webster and Alison M. May 05, 2020 https://www.artforum.com/slant/jamieson-webster-and-alison-m-gingeras-discuss-psychoanalysis-during-the- pandemic-82992

Kristeva Julia (May/June 2020) “In the current state of war, it is our most inner selves that we must save“.  Appeared originally in special edition of L’Arche, no. 681, entitled “The Day After”

Lauret Monique 16 March, 2020 What can we Learn from the Chinese Covid-19 Crisis? http://www.journal-psychoanalysis.eu/what-can-we-learn-from-the-chinese-covid-19-crisis/

Lawrence, W. G. (2000) ‘Thinking refracted’, in Tongued with fire: Groups in experience. London: Karnac, 1-30. L

Leader Darian 19/08/2020 Some thoughts on the pandemic https://www.journal-psychoanalysis.eu/

Lew René May 18, 2020, Politics of the Letter (27) in reference to Nestor Braunstein  https://www.journal-psychoanalysis.eu/

Mezzina Roberto Mental health services, individuals and the “social body” in the coronavirus era

Nansy Jean-Luk 10.05.20 https://www.efsyn.gr/themata/idees-palies-kai-nees/242679_i-isotita-antidoto-stin-pandimia

Pelegrinis Theodosis (2004) Dictionary of Philosophy, section Michel Foucault, Hellinika Gramata

Rogers Jonathan, Chesney Edward , Oliver Dominic, Pollak Thomas, McGuire, Philip Fusar-Poli Paolo AUGUST 01, 2020 Psychiatric and neuropsychiatric syndromes and COVID-19 – Authors’ reply LANCET PSYCHIATRY VOLUME 7, ISSUE 8, P664-665,

Shanahan Lilly, Steinhoff Annekatrin, Bechtiger Laura, Murray Aja L.  (23 June 2020)..Emotional distress in young adults during the COVID-19 pandemic: evidence of risk and resilience from a longitudinal cohort study Psychological Medicine DOI: https://doi.org/10.1017/S003329172000241XPublished online by Cambridge University Press:

Sideris Nikos (28.03.20)https://www.efsyn.gr/nisides/237025_aorato-prosopo-toy-thanatoy