Struggling Against the Grain

I was told this week about a 93 year old Russian woman, the mother of a friend, who has been talking about these Covid times as being worse than the hardships of living in Russia during the second world war or at any time in between. It’s not the only comparison to the Second World War I’ve heard this week: the number of excess deaths in this country is similar to the number of excess civilian deaths in 1940. It reminds me of an item on Channel 4 News early last year. I’m afraid I can’t remember the name of the epidemiologist being interviewed who likened the suffering that was about to hit the world to the Second World War. Cathy Newman was taken by surprise, looked shocked and asked rather anxiously if he didn’t feel that was disrespectful to viewers who were veterans of that war. I suspect her response nearly a year ago now makes her cringe.

Such comparisons are of limited usefulness and have to be corrected for growth and age of the population. But there is no doubt these are truly grim and terrible times for many people.

The suffering and deprivation caused by the virus and our attempts to limit the damage it causes have laid our society bare, with dysfunctional dynamics that have simmered for decades, now exposed as  ugly wounds, with no plan or confidence that we can bring the gaping edges back together. Many individuals are struggling with fear, helplessness and exhaustion. Some of us are ok – just about –  but others are being faced with situations that seem well beyond their capacity, pushed into experiences beyond their imagination, asked to dig down to layers they don’t know if they have. Am I imagining it, or is there more fear in the eyes of the people I glimpse above their masks? More ambulances speeding towards our already full hospitals?  Certainly people seem to be having more nightmares. Perhaps I am over influenced by the struggles of frontline clinicians, traumatised by the nature of the illness, the sheer number of deaths and the fear and exhaustion of being spread so thin with no end in sight.

One of the reasons this pandemic is taking such a toll, is that the behaviour demanded of us is counterintuitive: it goes against our nature.  Human beings are not designed to socially distance under stress.  Even for ICU clinicians, the need to socially distance – the discomfort and imposed isolation of PPE, the prohibition on their usual social coping strategies, the physical absence of family and friends – looms large in their narratives. During the war, trauma, loss and hardship were mitigated to some degree by the sense of camaraderie. The war bound people together, broke down social barriers, brought people closer in all sorts of ways. But any sense of camaraderie around during the first wave of this pandemic is in short supply nine months later. Even the more introverted amongst us are starting to recognise how much we need face to face contact with our fellows. Even those of us living in relative comfort are confounded by how weary we feel. Even those of us practiced at living in our heads are realising that such satisfactions have their limits. We are all in a state of deprivation. We are not evolved to live alone or shut away in closed-off nuclear family groups. I would have hated sheltering in a crowded underground station night after night during the Blitz, but maybe it would have satisfied my need for human contact – ‘skin hunger’, psychologists call it – more than the present situation.

I’ve been interested to observe how many of my patients are developing symptoms of crude separation anxiety: agitated pacing and searching behaviours, insomnia, intrusive, irrational, repetitive frightened thoughts often linked to death anxiety. They have lost the ability to soothe themselves, and like young children, need repeated consolation.  As with other animals, what we call ‘attachment behaviour’ in infants is instinctive and serves to maintain proximity, thereby improving the chance of survival. Infants separated from their primary carers experience anxiety and anger and, if prolonged, this will lead to helplessness, hopelessness and despair. As we grow older, we develop the capacity to hold people in our mind and become less dependent on physical proximity. But under threat we are thrown back to more primitive feelings and behaviours.

As psychotherapists never tire of saying, much of our brain is shared with our primate cousins and has evolved over millions of years to deal with a very different life-style than our own. The pandemic has pushed us one more step – a gigantic step – away from our natures. Whilst we agonise and rationalise and work out how to obey the rules and keep ourselves safe, a large part of our mostly unconscious brain, equates safety – indeed survival – with the opposite and urges us to huddle together, to run protectively towards rather than away from each other, to visit and embrace our families and never let them go.

We really need to understand the psychological experience we are going through, including this exhausting struggle with our deeply embedded evolutionary programming. The effects are not going to go away anytime soon. Perhaps working out what makes this pandemic a different experience from other apocalyptic events would be more helpful than making complicated comparisons of the number of deaths.

Penny