by Amal Mandal 24 August 2020
Abstract
Covid19 pandemic is not all about physical health devastation, more critical and enduring are its mental and psychosocial ramifications in the sense that panicked and traumatised people are not only vulnerable to virus infection but also their obsession with survivalism undermines social trust and solidarity. To maintain a reasonable balance between physical threat and mental health some policy correctives, as suggested, are imperative.
Arguably far more enduring adverse impact of Covid19 (commonly coronavirus) pandemic which has swept the world and shaken the foundation of human society is on the mental turmoil and psychological distress. Survival hardship, unemployment, indebtedness, or domestic violence might have afflicted the vulnerable, daily wage earners, women and poor disproportionately but the anxiety, fear, uncertainties, hopelessness, loneliness, stress, and trauma are universal across social classes. Almost everyone is quivering as if we are about to have perished, thereby each one is engrossed with how to protect and survive from the impending cataclysm. And if mental health concerns are not taken care of in right earnest that will have enormous long-term consequences perhaps surpassing the fallout of the otherwise physical health devastation.
According to a survey conducted by the Indian Psychiatry Society, the number of reported cases of mental illness in India had risen by 20 percent just within a week of the start of the first lockdown on 24 March, one whooping proportion when the absolute figure of 150 million people with pre-existing mental health issues is considered. And what has eventually unfolded can be guessed from another survey published in the Indian Journal of Psychiatry where about 3/4 participants reported a moderate level of stress. Even quarantine singularly leads to numerous emotional outcomes: stress, depression, irritability, insomnia, fear, confusion, anger, frustration, boredom, and stigma, many of which persist after lifting the quarantine. Drawing lessons from the erstwhile SARS epidemic, another review in The Lancet demonstrates a wide range of psychological impacts of quarantine and social distancing.
Together with the elusive therapeutic remedy and extensive spread of the pandemic, the alarm woven around and continually publicized on Covid19 pandemic and the segregation and aversion meted out by society Covid19 patients, as in India, have created trepidation on the public psyche that accentuating fear psychosis is generating mental distress and behavioural responses which tend to have shattered social cohesion and solidarity. And this is inevitable given the rumours, appalling visuals, and print reports circulating round the clock and horrid life experience of the general public.
Whenever tested positive, one is isolated or insulated within the family where other members shy away from taking care so as to steer clear of potential peril of infection thus leaving the patient in the lurch. In other cases, the patients are shunted to designated cure corner without having the reach of relatives. The house of the victim is invariably barricaded, the locality/apartment is declared containment zone and everyone else shun all sorts of dealings with the family members. The family members are ostracized within the locality and kept at a far distance. Even a few Samaritans here and there encounter social shunning. Those recovering from the infection are also stereotyped or stigmatised. The design seems to be the new avatar of the tainted Indian untouchability praxis.
The frantic search for and futility of getting admission to hospitals, thereby death sometimes in the vehicle, the exorbitant monetary fees charged by the private institutions and if unfortunately the patient succumbs the outrageous dealing with the dead bodies all tend to have ingrained the paranoia in the cognitive sphere of the public and has caused panic perhaps beyond salvation.
The frontline fighters like doctors, nurses, and health workers who deal directly with Covid19 patients are being implicated with suspicion and abhorrence. Many have been asked and some have been compelled to vacate their apartment. When the very defenders are so perceived and mistreated it substantiates how hysteric is the public perception and phobia.
The survival obsession has reached such a pass when the dead bodies are treated so outrageously never observed even on the battlefield. Ironically, the dead bodies are causing greater panic than living patients. The bodies remain untouched in the house for days until the police take over. Somewhere relatives simply dump those in and around crematorium, sons throw away father’s body in a flooded ditch, blood relations abandon dead bodies (in hospital) and refuse to perform last rites fearing they could get infected ̶ the instances testify how covid19 scare is demolishing the age-old social norms and Indian culture. In hospitals such bodies are wrapped in plastic sheets, private carriers either refuse or demand a huge fee for ferrying those to crematorium/burial ground. Those bodies are disposed of stealthily in the exclusive corners. The crematorium personnel demands huge money for handling those hazardous bodies and frequent ruckus flare up with the local people.
During epidemic and pandemic the behavioural pattern of the people changes, more so along with the severity and mortality. The common phenomenon is the proliferation of fear amidst infectious outbreaks and the consequent panic leads to deviant or “anomie” behaviour and to psychosomatic problems. The more is the fear the more panicky, intolerant and punitive becomes the public reaction and response. Who else would prefer to land in such sickening and stupefying soup?
Having been exceedingly scared the Indian people are frantic in avoiding the appalling experience of the infected persons and are displaying obsessive isolationism and survivalism by presuming every other people as the potential threat ̶ or enemy ̶ to health and life. It is otherwise ‘coronaphobia’ that is reigning supreme.
Much of the public perception and neurosis have oddly been moulded and entrenched by the propagation of alarum by the media and public agencies. The relentless real-time information and harrowing reports have negatively impacted the public psyche and have pressed the panic button.
Curiously, the Covid19 pandemic is better known as ‘misinfodemic’ at the inconceivable global scale and proportion. The UN Secretary-General António Guterres has rightly warned: “Falsehoods are filling the airwaves. Wild conspiracy theories are infecting the Internet. Harmful health advice and snake- oil solutions are proliferating. Hatred is going viral… stigmatizing and vilifying people and groups”. More doom-mongering has been the role of the electronic and social media where even doctors are furnishing contradictory delineations. As a result, the people, in general, are undergoing moderate to severe levels of tension, strain, and horror.
The ever wavering public advisories and incessant fact-files and reports displaying horrific incidents in the print, electronic and social media have perpetuated the despondency in the face of approaching apocalypse. The language of siege ̶ ‘we are at war’ (Donald’ Trump) or ‘wildfire’ (Narendra Modi) ̶ being repeatedly used by politicians is reinforcing the conviction about the impending devastation through the pandemic, thus everybody is fixated with how to remain safe and how to ensure self-survival.
Few ramifications of such self-safety prepossession are unequivocal. i) The extended anxiety and fear about the health havoc ̶ together with anger, frustration, boredom, or depression resulting from a prolonged disconnect from social interactions ̶ deteriorates the immunity system, thus makes one vulnerable to the possible infection. ii)The isolation/quarantine and stigma etc. debar the patients from getting family level care, cooperation, compassion or the emotional support and sustenance so imperative during any illness and the usual practice of fending for oneself worsens the mental health and psychological robustness of the patients which in turn aggravates the prospect of their immediate recovery. iii)When everyone is frenetic not to get the infection from whatever sources ̶ corporal distance and use of mask within family confine by doctors even ̶ new genre of social relations emerges where altruism, reciprocity or social solidarity gives away to the ethos of self survivalism precipitating what Slavoj Žižek ̶ ‘the dangerous philosopher in the West’ ̶ in other context termed the “disintegration of trust” or Richard Horton, editor of The Lancet, apprehends “fissuring in our communities, fragmentation of our solidarity”.
Our knowledge about the nature of the virus is admittedly rudimentary, thus definite policy frame is tricky. Yet the public policy so far has been indecisive and awry ̶ when and how long to impose lockdown, imperviousness to anticipate the attendant problems of the largest containment experiment in history, type, and usage of mask, where and how to get medical treatment, how not to trivialise the status and efficacy of the government hospitals (as politicians/ministers availing only private facilities).
However, few policy redesigning and correctives are both feasible and desirable.
- Intermittent lockdown is inefficacious;
- The racial (north-eastern people as carrier of Wuhan Virus), religious (Tablighi Jamaat or Corona Jihad) and rural profiling is unacceptable;
- Banishing the misconception and pernicious practice of treating social distancing as social discrimination;
- Promotion of preventive measures that would moderate the threat of the virus infection;
- Categorical curb on rumour and wishful propagation in any form and manner;
- Issue of guideline including a warning that reporting in every form of media be contextualised with the total number of people tested, recovered, died and facilities and treatment being made available;
- Regulating the profiteering practices of private hospital sharks during the health crisis; Toning down the war-cry;
- Instilling positivity that would scale back mental trauma, otherwise, that would prolong the magnitude of infection;
- And clear advisory following experts’ advice as to whether and how respiratory tract viruses can emanate from the inert surface of dead bodies.
Besides the therapeutic intervention, the success in confronting any pandemic is predicated upon the ability to ensure the sound mental health of the people in general, particularly through mitigating the panic. Thus, it is imperative that people are not inordinately stereotyped and traumatised with the incessant reporting and propagations implicitly or explicitly confusing the corona canvas and conveying the impression that it is the end of human civilisation. A reasonable balance between the threat posed by the virus and haplessness of the patients as well as the community people has to be maintained until the pandemic is over. Mankind has survived many epidemics and pandemics and the Covid19 outbreak can be overcome by concerted and collective efforts and by instilling the ‘virus of determination, collectivity, and trust’.