Mental Health in a Pandemic State

From Social Isolation to Loneliness

covid-19

The COVID-19 pandemic has already gained its place on the dark side of world history for a variety of reasons: sudden onset, speed of global transmission, mistakes in recognition and management, politically inspired neglect or minimizations. The already dramatic infection and mortality figures have led to seemingly desperate and extreme government decisions in many countries. Its social, economic/financial, and public health impact is very impressive and, obviously, more powerful and damaging among the poor and disadvantaged population segments worldwide.

Not surprisingly, the mental health implications of this crisis were recognized early in the process. Psychopathological and clinical terms were used from the beginning by the media and social networks to describe attitudes, pronouncements, reactions, and behaviors from individuals and groups in different scenarios: fear, cynicism, lies, or denial moving to anxiety, panic, hysteria, and even . The scope of these words quickly broadened and became the subject o administrative, community-oriented measures, including the need to provide mental health or psychological counseling. From the perspective of the mental health professions, it is important to assess the emotional impact of some of those dispositions themselves. One of the most relevant examples is that related to the so-called social distance, later enlarged to social isolation, first as part of preventive health care advice, and then, as a critical component of “shelter in place” or total lockdown decrees.

Every type of adverse situation, particularly in the health field, entails uncertainties and ambiguities. A measure such as “social distance,” for instance, is dictated in the name of social integrity, protection or solidarity; the imposition of “social isolation” invoked individual and group safety as its raison d’être. Social isolation may be just a phrase but, under the present circumstances, it is certainly a public policy order, a commandment, with intimations of punishment if and when not duly followed. It is precisely the type of disposition that can lead to a unique mood state, a multifaceted cognitive/emotional experience, mental feature—loneliness—that in some cases may generate demoralization and well-defined clinical conditions.1 In fact, the sequence of social isolationàloneliness constitutes an excellent example of both an etio-pathogenic route and a source of individual reflections, an opportunity of self-examination leading to a therapeutic pathway.

The many faces of loneliness

The term was first used at the end of the 16th century to define “the condition of being solitary.” In 1677, Milton’s Paradise Lost featured one of the first lonely characters in British literature, Satan, who describes his loneliness in terms of vulnerability. The word acquired its concrete meaning of “feeling of being dejected from want of companionship or sympathy,” only by the start of the 19th century. In an interesting essay, Worsley2 emphasizes “lonely spaces” as places in which one might meet “someone who could do you harm, with no one else around to help.” The term has evolved from being “usually relegated to the space outside the city,” that is, a merely physical condition to “moving inward . . . taking up residence inside minds, even the minds of people living in bustling cities.” The author concludes that by doing this, loneliness has brought “wilderness inside us.”

Thus, loneliness exhibits a complex conceptual journey. The dictionary definitions of being without company, unfrequented, isolated, or lonesome describe an individual feeling as well as a social experience, a perception of abandonment and/or a desire for company or refuge; the latter can also make of loneliness an existential state, a way of looking at life and people as components of a reality that belongs to others. Still, away from a truly clinical nature but already delineating fragile junctures, loneliness may have solitude as a synonym, a very personal requirement for the exercise of meditation or reflections—a refuge, again.

The feeling of loneliness leads initially to reflections about what is going on at the present time. The uncertainties of a future worst-case scenario (eg, positive coronavirus test, gradual onset of symptoms, hospitalization, complications, etc) may give place, later, to reflections about one’s own life, expectations and hopes, accomplishments and failures, self-criticisms and self-condemnations, a sense of no-return. Missing alternatives in the near or distant past, grateful moments unable to be re-lived, failed job opportunities or attempts to improve or excel, the present (or absent) impact of religion, spirituality, romantic encounters, personal phantasies, or impossible dreams are all material agitated by the apparently quiet psychological surface of loneliness.

Read more here: Psychiatric Times

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