Coronavirus: The word ‘social distancing’ was poorly chosen, says Dr Vikram Patel

Though it gets barely any attention there is no denial of the fact that the COVID-19 pandemic has triggered a series of psychological problems among people, who struggle to cope
with isolated living and the fear of uncertainties and unknown. DH spoke to Dr Vikram Patel, one of the world’s foremost experts on mental health and the Pershing Square Professor of Global Health at the Department of Global Health and Social Medicine, Harvard Medical School, on the issues. Excerpts:

Q. Why has mental health become important amidst Covid-19, a disease with low fatality rate. Why such panic?

Mental health has become a key concern not because of any direct impact of the virus, but as a consequence of the reaction of the media and the government to the epidemic.

Just the word ‘pandemic’ and the dramatic way it was announced by the WHO after weeks of the epidemic unfolding around the world was a hair-raising moment. Then, there was the apocalyptic messaging by the media on the risk the disease posed, for example failing to communicate that the median age of death in most countries was in the mid-70s, and that the illness would be asymptomatic for the vast majority of our people who are much younger.

The ghoulish reporting of cases each day on the front-pages, without any nuancing about what those numbers actually mean, served to confirm that the virus was inexorably sweeping the country. The final nail in the coffin was the unprecedented national lockdown, announced with just three hours’ notice late in the evening, with a scope and stringency that has never been seen in history. In this context, unless you are an epidemiologist who is well-informed to correctly interpret the numbers and read between the lines, the wide-spread reactions of panic and fear are totally understandable.

Q. What kind of mental diseases are being seen?

In the short-term, while the lockdown is in place, the major mental health problems are acute stress reactions, characterised by anxiety, fearfulness, sleep problems, loss of interest, irritability and feelings of hopelessness.

These are triggered by the fear of getting infected, to worries about one’s economic future, to losing the routine and social connections which each of us relies on for our mental well-being, and to the continuing uncertainty about when life might return to normal. They are mostly rational responses of our minds to the extraordinary realities that we are facing.

Q: What kind of impact has been created by the lockdown and social distancing norms?

Social networks are inherent to all societies. As others have argued, the word ‘social distancing’ itself was poorly chosen; what should have been emphasized is physical distancing and, that too, primarily with regards to protecting older people and those with underlying medical conditions. We should never be distancing from one another socially.

Q: Should we be prepared for a second surge in psychological issues post-lockdown because of the economic slide and the consequent job loss.

I believe we should. As Angus Deaton and Anna Case reported after the economic recession in 2008, there was a dramatic reduction in life expectancy in working-age Americans from what they described as ‘deaths of despair’; these were deaths not so much due to material hardship but because of loss of hope due to the lack of employment and rising inequality. Suicide and substance use related mortality accounted for most of these deaths. India shares many of the ills of US society, from its deep inequality to its weak social security net and fragmented health care system; in addition, we have the largest number of hungry people in the world.

This toxic combination of absolute poverty with vulgar levels of inequality is a recipe for a similar surge of depths of despair in India.

Our mental health care system is ill-equipped to deal with this surge, not only because of the paucity of skilled providers, but also because of the narrow biomedical models which dominate mental health care.

Q: Are there special needs for the kids?

Children must also be feeling anxious, not least because the important adults in their lives are also fearful and uncertain about the future. Even more than adults, children thrive on routines, which include going to school and playing with friends. Suddenly, both of these are disrupted and suffused with fear. Yet, it is also true that children are remarkably resilient and they will cope well with these unusual restrictions with appropriate parental guidance.