These times that humanity is living produce the abrupt modification of the routines that people usually have. Suddenly, the coronavirus is present in all aspects of human activities: if they read news, if they watch television, if they chat or chat with family and friends, if they go shopping … But it is also present. in the activities they carry out in the compulsory quarantine: many had to learn essential measures overnight and aspects of an unprecedented situation. After these profound changes that the world population is experiencing, there will surely be decisive conclusions when the pandemic ends. But in the meantime, people must continue with their lives and the state of mind is fundamental to be able to face up to those changes that society is experiencing. In this sense, to know what is happening in relation to mental disorders that may or may not exacerbate behaviors or sensations as a result of the spread of the virus and social isolation, PageI12 He consulted four prestigious medical psychiatrists (also psychoanalysts): the president of the Association of Argentine Psychiatrists (APSA), Santiago Levín, and three other members of the institution, María de los Angeles López Geist, León Daniel Matusevich and Liliana Mato.
–Are patients suffering from anxiety more vulnerable to an excess of news related to the coronavirus?
Santiago Levín: – It is important to clarify that anxiety is a normal response to certain situations such as the one we are going through in these moments of health crisis. In this context, not feeling or expressing any form of anxiety would be striking and problematic. A certain degree of anxiety, with intense peaks, can be considered normal, expected and even adaptive in the days that we have to live. With that said, I can answer the specific question. Yes. People who suffer from an anxiety disorder (that is, a picture characterized by episodes of anxiety that exceed what is expected as a normal response) are more vulnerable in these contexts, which are anxiogenic in themselves. That is why it is important, in all cases, not to discontinue the psychotherapeutic and psychopharmacological treatments already in place (which can be followed through virtual means), moderate the consumption of information on social networks and the news, carefully choose the sources of information, not abandon Whenever possible, normal routines, and keep in touch with loved ones. This situation is transitory: it had a beginning and it will have an end.
María de los Angeles López Geist: –-Anxiety sufferers now face a very anxious situation in itself, and the effect on those who can stay with their family all the time by their side is very different from the effect on those who live alone, are greater and they don’t handle technology. Sanitary isolation requires designing sociability in virtual ways so that social isolation does not occur. Too much news has an angiogenic effect not only on mental health users but on the entire population, especially if the information is highly sensitive and contradictory, or laden with unaccredited opinions. Not everyone can identify reliable sources or verify what the media says. The media have a major social responsibility at the moment. Those who are better trained in disaster coverage will have a greater capacity to accompany the population and provide the service needed. The construction of the news now requires a look that includes that information that allows the population to trust the measures that are asked of us, to foster confidence that it is possible to take care of each other. But we have another problem that generates even more anxiety: it is the posts on WhatsApp and other networks that the population naively takes as valid news and they are not. It is urgent to teach to distinguish the fake news and discard the information without author, without source and without responsible editor. Vulnerable people are often held more prisoner by these apocryphal viralizations. It is advisable to dose the relationship with the media, especially taking care of children from the news.
–It is said that it is normal to be afraid in the face of this situation. When does fear turn into panic?
Leon Daniel Matusevich: – There is a logical and normal fear, motorized and motivated by the situation we are going through, absolutely unprecedented for many of us and in which uncertainty plays a fundamental role. Such fear can contribute to positive behaviors, such as personal, family and social care. There is a pathological fear, which is not that of the majority of people, that when left free to their own evolution leads to paralysis, disorganization and panic. That is why what we said before is fundamental, the ways and the ways of communicating, a certain supervision of the contents that constitute the information, since many times the excessive consumption of news or bad information can trigger crises of unpredictable results, which affect not only to those who suffer from them but to society as a whole. The State’s offer regarding telemedicine spaces should be very clear and forceful, aimed at accompanying and containing those with episodes of extreme anxiety and / or panic.
Liliana Mato: –In these moments it is absolutely normal to feel fear, sadness, anger, rage, anguish, helplessness and it is essential to be able to talk and share those emotions, to be able to name them. We have to trust in the pacifying power of the word. That is why we say that it is vitally important to promote social ties, to be linked to others from our homes, and above all it helps to help others, to build solidarity networks where each one can find a place “to share with others”. Panic appears when the anguish becomes overflowing and all ability to express it is blocked, be it through words, or other expressive resources, it can be music, writing or others. Anguish in this case does not find an edge that contains it, and thus has a certain depersonalizing effect. Whoever goes through such a state, refers to it as a bodily sensation difficult to describe, that hurts, that leaves them speechless, we can say, without symbolic resources: an overwhelming invasion that hacks the limits of the self, the experience of bodily unity and feeling of itself. Various somatic symptoms occur: palpitations, pounding of the heart or acceleration of the heart rate, tremor, shortness of breath, pain in the chest or abdomen, the feeling of going crazy and others. Clinical problems somehow hinted at in the “current neurosis” model (Freud 1916/17), when he describes them in relation to a certain excess of excitement, which is not expressed through psychoneurotic symptoms but as manifestations such as physical fatigue, headaches, dyspepsia, constipation, insomnia, irritability, restlessness. Freud describes it as untied anguish, without representative substitution; that is, without symbolic mediation. In these cases the fundamental thing is to help deal with those emotions, we would say to put words to it, to be able to name them. Being able to identify what each one is most afraid of, more worrying about.
What is it that generates the most anxiety?
L.M .: –In recent days, what appears most insistently is the question of quarantine. Even when? How long? What are we going to do? It helps to remember again and again that we are going through a stage, that it is going to happen, that this is transitory. To think that we are not “locked up”, we are “protected”; It is not that we cannot do anything, we can do many other things and in different ways. Again the power of words: as the facts are named, they are lived and felt differently. Each of us has internal resources that he surely does not know, since we live in a consumerist culture that has taught us to calm down with external objects, which are used, bought and supposedly give happiness. The immediacy is privileged, the fast, dominates the concern in eliminating all conflict as soon as possible. Lacan, in his reference to the Capitalist Discourse, refers to the mandate of the superego to enjoy, in tune with the imperative of the time to be increasingly happy, to have more and better, everything more. The market offers objects as fixation points of enjoyment that lead to overflow and excess. Quarantine imposes a pause on us, requires us to develop patience, the ability to wait. It can be an opportunity to connect with our internal objects: our fantasies, ghosts, memories, desires. In the text “The capacity to be alone”, Winnicott defines it as “one of the most important signs of maturity in emotional development”. The English psychoanalyst maintains that the development of this capacity allows to be with oneself and to develop the autonomy and creativity that arises from the inner world. Surely, we can also learn from quarantine!
– Those who have obsessive-compulsive disorder are also harmed in these times than usual?
S.L .: – OCD is a complex disorder, which has various forms of presentation, in which anxiety plays a preponderant role. It is not unwise to think that a TOC picture in which, for example, pollution obsessions predominate, could be worsened by the alarming cataract of information that we receive incessantly from the media. But in mental health, it is not convenient to make generalizations, such as believing that all people with OCD will suffer worse during the pandemic. Some will, some will not. It is very important to insist on the continuity of the treatments established during the period of sanitary isolation. Do not abandon treatments, and keep in permanent contact with the treating professional or professionals.
L.M .: –The diagnoses cover situations that are usually very different and the impact of the current situation will also have different consequences. For example, just these days I am treating two patients with the same diagnosis and very different reactions. In one case, it is a young woman very distressed by all the measures arranged around handwashing and cleaning, since they re-updated rituals she had long ago and which were extremely disabling at the time. She is terrified of falling into the same situation again. The other case is about a young woman who, in the virtual session we are holding, also expressed to me the deep relief she felt at “having to be at home”, which freed her from the strenuous days that she imposed herself in her office. , ordering bibliographies and various documentation a thousand times.
– Are those people who suffer from hypochondriacal symptoms at risk of destabilizing themselves in this situation or is hypochondria only with diseases that the subject imagines they may have and not with a specific one?
S.L .:–The hypochondriac subject presents an excessive concern about his own health. “Excessive” means out of all relevance. It is healthy to worry about your own health, and in these days of health crisis it is essential to stimulate responsible behaviors of self-care and care for others. Returning to the hypochondriac picture, it is plausible to think that a person suffering from this disorder, characterized by intense anxiety and moments of anguish that lead to a constant self-checking of symptoms and signs of illness, may experience a worsening of their picture. The current communicational context is an anxiety generator for all people, without distinction. Constant infographics with the symptoms that should lead to the consultation could stimulate an increase in anxiety and self-checking behaviors in a subject suffering from this condition. Again, we recommend reducing exposure to sources of alarming and repetitive information, which instead of stimulating caring attitudes generates excessive fear, discomfort and sometimes terror.
– Are people previously diagnosed with a mental disorder the most vulnerable to suffer from this situation or is anyone exposed to a mental decompensation?
S.L .: –-The current situation is generating anxiety in itself. There is an unusual health emergency situation that involves a sudden change in routines together with a state of alert and permanent attention to news and indications emanating from the health authority. Usual tasks are interrupted, previously nonexistent doubts and fears arise, there are loved ones who quarantine remotely, and all kinds of false or incorrect news are disseminated through social networks and some media that prefer to sell rather than report. And it is also necessary to mention that many people do not have a home or basic services, so it must be considered that a significant number of people “quarantine” in the street, or in very precarious neighborhoods in which it is impossible follow the sanitary instructions to the letter. The situation affects us all, but especially the most vulnerable. We must think about vulnerability in its various dimensions, not just mental vulnerability. There is also the social, gender, economic, age (children, old). It is imperative to take care of everyone at this critical moment. In this scenario, special monitoring should be given to people suffering from serious mental disorders, implementing all possible measures so that they are not isolated from help and so that the established treatments are not interrupted.
– Are there other pathologies that you have noticed in these times?
M. of the A. L. G .: –-There are pathologies of confinement, which does not refer to physical confinement or quarantine but to those people who live isolated from their social responsibility, narrowing the world view, becoming increasingly prejudiced and intolerant, overvaluing their conceptions of the world. They are increasingly distancing themselves from community functions, or perhaps they have never accessed them. They become rigid, as if aging in advance. There are immeasurable loneliness of children and adolescents due to overworked parents or lack of work. Or by childish parents who do not protect them. They are children who often exploit or attack because they suffer. Another pathology of recent times is the cultivation of hate. Haters, political intolerances, criminalization of the most vulnerable. These people are fed with material related to their beliefs that the networks send by algorithm reinforcing them and they build imaginary worlds with a single input of information: the one that waters the feeling of hostility. That pathology in the long run reduces people’s ability to think. In the last days, many struggle with dilemmas about whether or not to visit a grandmother, or question the meaning of things in their life, in a kind of existential stress.