Mental Health in Pandemic Times

By : Alberto Palacios
Jefe del Departamento de Inmunología y Reumatología del Hospital de los Angeles Pedregal en CDMX

05 June, 2020

"We are filled with data, studies, and scientific information, mixed with uncertainty and fear. No prayer, barrier, or medication can stop this microscopic enemy which kills quickly and silently."

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In different forums there have been several deliberations regarding the psychosocial impact that this pandemic has caused. I will try to present my contribution to this compilation of speeches with a more individual and unconscious perspective, which, in the end, is the iceberg below the surface.  

For the first time in history, an epidemic phenomenon is known in real time throughout the world. Territories as distant as China, Sweden or South Africa provide their contagion and death data on a daily basis, in such a way that they make us simultaneous co-participants of their tragedy without any kind of filter. We are filled with data, studies and scientific information, mixed with uncertainty and fear. No prayer, barrier or medication can stop this microscopic enemy, which kills quickly and silently. 

The constant images of nurses and doctors dressed as astronauts increase the general terror towards this relentless virus. Moreover, the excess of news under lockdown also accentuates the whole paranoic scenery: are we safe within these four walls? Will that thing get in through the windows or cracks? Will it come latched to the meals they bring us every week? Or maybe will the people in charge of cleaning the house or office will bring it? Perhaps in their shoes, fingernails, or their breath?

There is nothing more sinister than what cannot be seen, therefore, the imagination starts running to try to materialize it and to give it some meaning. A miasma, a demon, an invisible germ that takes away lives without discrimination, it may be lurking everywhere and nowhere. The sinister and evil thing has taken shape and however, is still in the ghost universe of our hallucinations. 

For a more dismal effect, the virions are structures that dwell between the living and the inanimate. They replicate through nucleic acids that define them, but they lack own existence; they need to parasitize a live cell to subsist. They use our messengers, latch onto our tissue receptors, but their purpose is to subjugate us, use us, to trigger an alarm and cause damage. They are evil entities (in the figurative sense, evil requires will) that take advantage of our organic nature to attack us and to reproduce; from one individual to another, from a different species to colonize humanity. Terrifying, isn’t it?

They have encouraged me to stay at home because – they assure – it is the only way to prevent contagion, but every day they update the number of deaths, which have not decreased, and we also know about many cases of deceased in our neighborhood and among close family members. is it then a distant desolation that surged from a fish market? Or is it a perfidious cloud that will fall upon us at any time no matter how much we take refuge?

I must first state that sinister is that which we assume to be hidden and that suddenly appears into reality. It is the contrary an reciprocate to what is familiar, pleasant, and intimate. Opposed to that which generates solace and security at the same time; and, in a conscious way, mimics the voice and caresses of a mother to scare of any danger. So that the ineffable, and the mournful brings us distress, and of course, fear of death or abandonment. In a certain way, a lot of what is sinister is sustained by the animistic conception of the Universe. Under this ideology, every natural phenomenon must hold a purpose and a certain faculty, so that it is produced and inhabited by a spectrum or a creature that carries it out. 

It is clear that in the contemporary world where movies, tv series or comics are filled with fantastic beings, this animistic conception takes on another dimension. It is no longer about chimeras or supernatural monsters, now it is about viruses or molecules, the tiniest of our cultural background and therefore potentially dangerous if it gets out of control. 

It is precisely during that lack of control where its volatility lies, because by lacking measures that contain it or vaccines to neutralize it, or even more, considering that no one is exempt from its attack, the virus gains a terrifying magnitude. But here I am also referring to the lack of internal control, meaning, that there is no way to present it (no matter how many comics and electronic scans are published) and even less, there is no way to have any control over its contagiousness and its destructive capacity in my organs. 

The counterpart of this anxiety is what psychologists call denial. It is a defense mechanism that allows to assume that the ideas that prevail do not concern the subject that exercises it as a conceptual wall. It makes me think about that historic middle age saga where the towns built walls to stop the bubonic plague. Of course, it is useless and paralyzing. But perhaps it serves to subsist in a collapsing world. While scientific information helps put the real risk into perspective, it does not untie the knot of anguish that cuts off our speech and breath. People may place themselves out of the vulnerable groups, evaluate their physical integrity as an act of transitory affirmation, but in everyday life, death lurks and does not discriminate.  

Of course, not all the population has access to the psychotherapeutic support that this catastrophe requires. There will be countless people who will become depressed or that will suffer anxiety attacks that will only be mitigated with psychotropic drugs. Others, whose suicidal risk leads them (hopefully in a timely way) to an emerging mental healthcare service. And many more whose state of anguish and desolation will incline them to fracture their health, peace of mind, marriage, or their family. Casualties of war.    

The ideal would be (if it exists) to peep into inner space, seeking comfort in nearby objects, trying as much as possible to decipher the fear of this that we cannot see and that is everywhere. Epidemics are inherent to the human condition and to population concentrations. That is why they attack more cities than ranches. But, in fact, no one is protected against a new virus and a certain generalized immunity (estimated at two thirds of a society) needs to be achieved to mitigate the danger and to have the smallest proportion of affected individuals die.  

This is where the “healthy distance” measures lie. On a first instance, they allow the contagion to be more gradual and limited (although they do not avoid it completely), but on the other hand, they also create a collective feeling of abandonment and anxiety. The French literature has been very eloquent in this respect and has helped us, without any publicity stunts, to understand the motivations of human beings invaded by a ghost and locked up in their fate. I encourage you to read The Plague, of course, by Albert Camus, or The Quarantine, by Jean-Marie Gustave Le Clézio. Both are Nobel Prize winners and extraordinary novelists to dissect the psychological paradigms that concern our helplessness, since we are born and, a few years later, when we become aware of our finitude.


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