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| PERSPECTIVE/VIEWPOINT - COUNTRY/REGIONAL |
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| Year : 2020 | Volume
: 2
| Issue : 2 | Page : 115-119 |
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Impact COVID-19 and Mental Health
Rachid Bennegadi1, Boris Cyrulnik2
1 President, World Association of Social Psychiatry, Medical Referent of the Sigmund Freud University of Paris, La Garde, France
2 Department of Continuous Formation, Université de Toulon, La Garde, France
| Date of Submission | 17-Jun-2020 |
| Date of Acceptance | 18-Jun-2020 |
| Date of Web Publication | 14-Aug-2020 |
Correspondence Address:
Dr. Rachid Bennegadi
Medical Referent of the Sigmund Freud University of Paris 14 rue Alfred Roll 75017, Paris
France
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WSP.WSP_59_20
In the face of the violence and terror generated by this corona virus, each of us needs to protect ourselves with the means at our disposal. In terms of personality structure, we are all equal thanks to the psychological development supported by our domestic environment within the framework of a secure attachment, and all our social and societal supports. The difference lies in the defense mechanism that will be privileged to fight against the fear of being annihilated, against the terror that this virus may take away the people we love and want to protect. The authors analyze the impact on society and on the person with the eyes of anthropology and on the importance of the process of resilience which should be the priority of the action of mental health professionals to avoid any process of search for scapegoat. Getting out of posttraumatic stress is a real psychotherapeutic process which will have to take into account the place of social determinants and cultural representations to avoid any untimely stigmatization.
Keywords: Mechanism of psychological defense, posttraumatic stress disorders, resilience, scapegoat, stigmatization
How to cite this article:
Bennegadi R, Cyrulnik B. Impact COVID-19 and Mental Health. World Soc Psychiatry 2020;2:115-9 |
The current situation in France concerning the impact of the Coronavirus is very interesting to analyze. Indeed, this health crisis opened the field of possibilities concerning all the believable or unbelievable suppositions on the part of both health and governmental authorities.
No one questioned the competence of the public hospital and private general medicine practitioners to provide access to care and manage medical emergencies in times of the COVID-19 epidemic. However, major debates arose surrounding the place of scientific competence as a decision-making body, and regarding the fact that governance of mitigation of the health and economic effect created by the coronavirus isn't science's prerogative but the government's.
Such discussions are not shrouded in confusion, but perplexity. Indeed, it seemed that everything and its opposite is expressed by one party or the other. However, all along, medical intervention has continued to save thousands of human lives.
Unfortunately, hospitals endured a real carnage, the virus dramatically impacting a series of patients with several different characteristics and whom, despite all the resuscitation techniques, did not survive.
This debate continues to this day, fed by communications from the World Health Organization, the Ministry of Solidarity and Health, the Directorate General of Health and the French Public Health Agency (https://www.santepubliquefrance.fr).
Every day French citizens have been informed of the evolution of this health tragedy.
In a way, there was a real demand from the citizens, however, it also created incredible collateral damage, such as fear, anxiety, uncertainty, in short everything irrational despite the rationalizing, scientifically structured and politically competent speeches made by varying parties.
What happens in the face of archaic fears, growing uncertainty and above all, in the face of the fact that the virus is still there and therefore so is the risk, lessened and lightened in comparison with the last two months; certainly but the fear is still there.
Historically, anthropologically and sociologically, human beings faced with archaic fears seek all means of reassurance available.
The first and more ancestral reflex, most typical of human beings, whatever their competence, level of knowledge, intellectual comfort, social comfort, political opinions, religious beliefs, is that of seeking a scapegoat.
We recognize this as a psychological defense mechanism called projection.
Projection allows us to externalize the problem by accusing the scapegoat, that is to say, a danger coming from the outside and the more we can name it, the more this defense mechanism is powerful and operational.
This is not unique to this or that continent, to this or that culture, to this or that governmental structure.
The defense mechanism of denial sometimes allows us to take the time to find a psychologically stable solution to either repress or displace the problem and sublimate it.
In this respect, the Freudian approach is particularly relevant.
Having said that-today, in the face of such catastrophes, we realize that the capacity of social determinants to modify the psychological structure of the subject is great if archaic fears organized the structure of the personality on such or such phobic or depressive patterns in a posttraumatic context.
Faced with the incomprehension and violence of the virus, despite all our scientific knowledge which is perfectly capable of explaining the existence of an epidemic, human beings remain perplexed by the anguish of death.
In France, debates around the future of the French society after this sanitary and economic crisis are exceptionally animated.
For some, everything needs to be reinvented; with, of course, a change in governance. For others, the government has done a good job of protecting the French people.
For others, it's the fault of the Chinese who didn't do their job properly or who wanted to harm the rest of the world.
The situation on June 4, 2020 in France, according to the Ministry for Health is that 29,065 persons have died, 69,976 persons got back home safe, 13,101 persons are still hospitalized, and 1163 serious patients are in intensive care.
Conspiracy theories flourish in the face of such a dramatic situation, and it is surprising to see that whatever the intellectual level of those who are supposed to give meaning to all the strategies put in place by the government, the irrational discourse continues despite all the attempts at trivialization.
Indeed, we were not used to emphasizing the social determinants of the impact on personality.
We were talking about people who were more or less fragile, more or less informed, more or less organized and more or less resistant to disease, virus or any other health impact.
It so happens that presently, almost everyone living in France is informed as well as possible about the reality of the danger, the possibilities of treatment, and the search for any vaccine prevention.
Projection represents the most powerful psychological defense mechanism to protect oneself from this anguish of death.
How to find the solution to appease one's archaic fears and enable everyone to better manage this individual and societal crisis.
An approach seems interesting and effective to us because it has proven its worth in psychotherapeutic reality.
We are talking about resilience in the sense that Cyrulnik[1] explains and analyses it: In the face of the violence and terror generated by this virus, each of us needs to protect ourselves with the means at our disposal.
In terms of personality structure, we are all equal; thanks to the psychological development supported by our domestic environment within the framework of a secure attachment, and all our social and societal supports. The difference lies in the defense mechanism that will be privileged to fight against the fear of being annihilated, against the terror that this virus may take away the people we love and want to protect.
Two approaches merit an in-depth analysis. Firstly, the strategy of resentment with, of course, the designation of a scapegoat, the desire for revenge and the risk of taking action.
Indeed it is a first way to protect oneself and to give more or less rational explanations but sufficient to be able to sleep without thinking obsessively about the risks of contamination and death.
Resentment, in reality, is not a strategy. It is a tactic; and let us recall here that strategy is a set of tactics more relevant than simply a reaction. A strategy is a set of reactions put together following a certain logic and in relation to personality structure.
So scapegoating, attacking government strategies, insulting everything that is societal, and trying to settle accounts by naming and possibly insulting this or that person or this or that social group, very quickly shows its limits. Speaking of limits, we are referring to the harmony established at the psychological and social levels so as not to lose touch with reality and remaining effective and operational in the urgent handling of events that may endanger a person's life.
Take an example-if I happen to undergo a very serious event that puts my existence at stake and if socially I am not completely at ease, the psychological energy that I must deploy to find a contact with a pragmatic, coherent reality and that could revive my vital momentum, I would benefit more from a coherent work of resilience, that is to say, to get back to myself, to take things back to the base, to use the energies I have, to look for resilience tutors if possible to avoid the terrible ease of scapegoating which qualifies more of a ridiculous, useless and dangerous loss of energy than an economy of psychic energy.
Then this would mean that one needs to call upon my mature defense mechanisms connecting me, consciously with reality and not to unconsciously de-structure myself in front of archaic fears.
Here again, we are in the extraordinary debate between the emotional and the cognitive, yes there are solutions, it can be a quasi-therapeutic approach when the person suffers from a post-traumatic syndrome which can be translated by a more or less masked depressive state or by more or less severe personality disorders, in any case, which can only be managed by calling upon a mental health professional.
However, if one feels able to proceed without professional therapeutic help, if firstly, one becomes aware of the phenomenon; secondly, one analyzes what is happening; thirdly, one sees that one possesses the means to resume the process of restructuring one's personality and psyche, one puts self in a psychological and social situation to restructure oneself.
This could be called an individual process of psychological and social resilience if one places this approach in a group context.
By this, we mean that if we are lucky enough to be able to take charge of oneself, it would be wonderful if our social group also helped in restructuring oneself without stigmatizing anyone.
Is this enough to protect oneself from the risk of severe depression or a more extreme psychological decompensation? It all depends on the power of the impact on the personality, its brutality and possibly its repetition.
What will tomorrow be made of? This is what it is all about at the moment because the traumatic impact of this epidemic has put the whole of French society in a situation of societal posttraumatic stress disorder.
Not only is there a real risk of physical death, but there is also the risk of social death with the loss of employment, income and marginalization.
In today's globalized world, it is unthinkable to imagine a national solution when this epidemic is global and completely shatters international relations.
Do we have the means to talk like that today?
Yes on paper, intellectually, in a phenomenological dimension of apprehension of the future. However, today the pragmatic, coherent and relevant implementation is far from simple.
Yet we possess the means of communication and one could imagine that the power of social networks would allow the circulation of relevant information and essential advice to survive.
On the flip side, this positive part of the flow of information through social networks comes accompanied by the extremely dangerous negative part of fake news.
Nothing causes more danger than misinformation, creating anxiety and even capable of creating severe decompensation; yet, this is what is happening today with issues that go beyond individuals and nations. Why did we have to wait for such a terrifying viral impact to force us to change our algorithms, to think about globalization on the social and societal level?[2]
This thinking is only philosophical, it is not even political at the moment.
The national feeling is invigorated in a reflex to rely on its environment, its society, its family, its social group or membership, to avoid degradation and the risk of death.
How can such a message be conveyed at the global level today with all the differences in cultural and social representations of the disease, the treatment of the disease and the notion of vaccination as prevention, the possibility of access to care for everyone regardless of their social and economic level?
This indispensable and inescapable sanitary construction, while intellectually feasible, remain sociologically very far from us.
How can this message reach people without creating terrible anguish, even worse than the fear of the virus? What words could convey it by use of masterful metaphors, communication, feedback, and humanist commitment?[3]
We stand in an exceptional position where we must be motivated by an unfailing humanism, within the framework of the universality of the problem.
When we spoke of the philosophical dimension, we meant that we know how to think about the problem, but we presently lack a method for its application and this creates a terrifying dichotomy.
Yes, it is more than a dialectic in the classical sense of the word. We are rather facing a dialogical one, that is to say, management of two events exceptionally essential for human life, that is to say, at the simultaneous time to find a sanitary answer and manage the economic catastrophe, all this in a globalized world.
There is no place today for reflection on this aspect of decision-making on this issue.
Existing international organizations do not have the competence or the means to bring together all the decision-makers of the whole world to not only understand this issue, but also because it is now that all the strategies must be put in place to find a response to the viral threats and their health and economic consequences.
Humanity must not die for not knowing how to apply universal values.
Humanism is not a national or local phenomenon; the virus has no passport, humanism should have no borders.
We know today in psychiatry and in all the professions that manage mental health or well-being, that the importance of cultural representations and social determinants is no longer questionable. It is not a question of limiting the subject to cultural or sociological references, it is a question of integrating them into a person-centered approach and of applying therapeutic methods that are appropriate to this issue.[2]
So what can we do apart from posing the prolegomena of this universal and so difficult to manage human imbroglio?
The responsibility is immense, as much that of scientists, researchers, doctors as that of governments.
The responsibility is terrifying next to the extent of the work to be undertaken.
But if we do our best now to explain via the media and social networks the difference between resentment seeking revenge, which designates a scapegoat and the work of resilience which consists in rebuilding oneself within the framework of universal and humanistic values, this task is possible. It will be necessary to put the financial means to allow mental health professionals to be trained in this approach and to never abandon the subject to these irrational and emotionally destructive approaches which can lead to action.
This is not the first time that human beings have encountered a crisis of this kind, it is not the first viral pandemic crisis attacking humans, not to mention all the other warlike events that have massacred half of humanity with arguments that are impossible to understand today, since the scale of the catastrophe in no way corresponds to the problem it has created.
This capacity to designate a scapegoat and to attack it, to sacrifice it, to stigmatize it is a plague on humanity denounced by all beliefs and completely analyzed by all sociologies in all continents.[4]
Humanity and its subconscious present a real problem for a calm, structured, respectful of others and nonaggressive social life.
Today we hold the therapeutic means to put in place preventative strategies that will preserve us from committing the irreparable. How can we explain to each of us the reality of the anguish of death, the stupidity of looking for a scapegoat, letting stereotypes invade the field of our consciousness? How can we recover this notion of strategy, such as a set of intelligent, operational and humanistic tactics, without passing for a dreamer, or someone who is out of place, or someone from another planet?[5]
As much as the philosophers of the renaissance allowed us to understand that the stake of happiness is a true work on oneself and the sharing of values, as much as today it is very difficult to pass on this potentially optimistic message, because it is totally out of step with what the world of today offers us, in a context of total freedom of communication, love of individual freedom, and the search for happiness if possible not limited only to spirituality.
We reiterate the importance of cultural representations in the most anthropological sense, in the most universal sense. We are all the same and all different in the way we hear, understand, analyze, and manage any serious event we are confronted with.[6]
So, once again, beyond the usual pleas, beyond the discourses intellectualizing the reality of the present suffering generated by the coronavirus pandemic, it is necessary first and foremost to make medical treatments and vaccines available, and in the meantime, or rather at the same time, as Paul Ricoeur[7] would say, in a context of dialogue, as Edgar Morin[8] maintains, it is necessary to set up spaces available for every citizen traumatized by the pandemic or by the loss of a loved one through the risk of death by contamination, the possibility of being able to analyze their psychological tools and accompany them on the possible and concrete path of resilience, making sure that they keep in touch with their social group not in the clan sense, but in the universal sense of the humanism necessary to remain in the intelligent and structured space of respect for the other.
The debate will certainly continue for a long time to come on how to treat, the importance of vaccination, the need for social distancing, the importance of masks; all this will not stop overnight.
This epidemic is going to mark us permanently because it is the first time that globalization has shown us this terrifying face, as if that were necessary to wake us up and avoid going into the impasse of global misinformation.
Pascal[9] reflection would help us enormously to engage in a new art of living where science rubs shoulders with the comfort of consciousness, where emotions seem less destructive for each of us and where inter-connections between individuals do not systematically lead to one clan stigmatizing another by making them scapegoats.
If we can understand the morbid significance of this scapegoating, half the road is completed.
It is not only a matter of convincing people, but it is a matter of urging them to think for themselves, that it is not by fleeing from reality through the defense mechanism of projection that solutions can be found to solve certain problems that jeopardize our vital comfort.
Indeed, each one of us needs not only himself in a work of resilience, but also others engaged in a constant effort of tutoring resilience.
“By regaining my vital momentum, I help others to regain their vital momentum, and so I remain linked from a societal point of view to a strategy that protects the individual human being and society.” This is not a very complicated algorithm and we do not need to call upon artificial intelligence to understand this issue for the simple reason that it is in us, that it has been there since the beginning of humanity and that, today in a very brutal way, we are living a very complex moment because we know, we realize that the passive fatalism with which we managed past infamous crises that have affected humanity for many millennia no longer works. We need an active fatalism, one that asks us to think about the problem, to look for solutions, to look for them together and to never make the mistake of stigmatizing others again, or blame them for all our misfortunes.
Nothing is more simplistic than resentment or scapegoating.
Nothing is nobler than working on oneself and within the framework of social resilience.
Despite all the dissensions between researchers, epidemiologists, virologists and political leaders, and thanks to the management of the health crisis and containment measures that may have prevented almost a million deaths in France.
If on a global health level, the virus is a tiny biological problem, by its impact on human beings and the society of tomorrow, it is nonetheless a huge anthropological problem.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Cyrulnik B. The Whispering of Ghosts: Trauma and Resilience. Paris: Odile Jacob; 2005.  |
| 2. | Bennegadi R. Advancing social psychiatry in a fragmented world: Can information technology do it? Indian J Soc Psychiatry 2016;32:270-2. [Full text] |
| 3. | Jarvis GE, Larchanché S, Bennegadi R, Ascoli M, Bhui KS, Kirmayer LJ. Cultural Consultation in Context: A Comparison of the Framing of Identity During Intake at Services in Montreal, London, and Paris. Cult Med Psychiatry 2020;44:433-55. |
| 4. | Girard R. “To Double Business Bound”: Essays on Literature, Mimesis, and Anthropology. Baltimore: The Johns Hopkins University Press; 1978. |
| 5. | Kirmayer LJ, Bennegadi R, Kastrup M. Culture awareness and responsiveness in person-centered psychiatry. In: Mezzich JE, Botbol M, Christodoulou GN, Cloninger CR, Salloum IM, editors. Person Centered Psychiatry. Geneva: Springer International Publishing; 2016. p. 77-95. |
| 6. | Clifford G. The Interpretation of Cultures. New York: Basic Books; 1973. |
| 7. | Ricoeur P (translated by David Pellauer). The Course of Recognition, Cambridge, Mass.: Harvard University Press; 2005. |
| 8. | Morin E. From the concept of system to the paradigm of complexity. J Soc Evol Syst 1992;15:371-85. |
| 9. | Pascal B. Merriam-Webster Dictionary. Available from: www.merriam-webster.com [Last retrieved on 2019 Aug 14]. |
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