April 06 2020

Personal reflections from a psychologist on COVID-19

‘Six months in a leaky boat, lucky just to keep afloat’. Professor Antonia Bifulco, Professor of Lifespan Psychology at Middlesex University, gives her perspective of the UKs social distancing.

We are all in the same boat. Or at least in our own boats, but in perilous seas with the current COVID-19 crisis.

Split Enz (1982)

For some it may seem like being in a dingy, for others a houseboat or an Ark but none of us get to sail anywhere. COVID-19 has us housebound – either socially distancing, or for the elderly and infirm – in relative social isolation or lockdown.

So how are we faring at this relatively early stage of lockdown? How do we pace ourselves for a long voyage? Can a psychological approach provide any aid?

Why is the boat leaky?

Well firstly because not all the population respect the restrictions, and antisocial behaviour has involved flaunting advice on moderate food buying in favour of hoarding, of having social gatherings despite risks to self and others, and opting to travel to country locations and national parks endangering the local villagers.

Although the majority respect the restrictions in the hope of containing the virus, others are in denial of the dangers, or think they are the exception or simply don’t care about health risks to others. This can have very damaging effects in terms of effecting a quarantine.

Secondly because essential workers in a range of occupations continue as usual of necessity. This is of course approved and applauded but means we cannot have a total quarantine. Those in healthcare, food production and distribution workers, and those in transport or police service need to be operational. But such planned and considered ‘leaks’ are to provide some brake on the virus spread and aim to reduce and spread the ‘peak’ of contagion much talked about.

Getting the balance between isolating to stop the spread and keeping essential services and vestiges of the economy operating is a fine balancing act.

As a psychologist, what elements of my knowledge of attachment theory (of close bonding with others) and depression can be used to interpret current morale, distancing behaviour and threats, and trust in experts and government advice?

Here are some thoughts and pointers.

Morale and trust

Should we panic or not? Clearly panic is a bad thing, but too much downplaying of the threat can lead to a nonchalance which undermines the restrictions required.

The messages now given out by government, contrary to usual advice, for example over terrorism where there is an exhortation not to panic, is to – well – panic. At least to take dramatic steps to acknowledge the real and widespread danger of the virus and to change behaviour radically. The numbers reported of deaths to Covid-19 are now escalating and potentially causing real fear[1]. And the same is true worldwide.

For psychologists the issue is about emotional-regulation and how we can control negative emotions such as fear, distress and anger to enable us to take appropriate action and keep calm. Not just for ourselves but also in order to reassure others and set a positive tone in our households and (remotely) with family, friends and colleagues.

Techniques for good emotional regulation are varied but can be simple such as reframing the problem – social comparison of how our situation is better than that of others, positive thinking – knowing the threat will pass eventually and counteracting a tendency to catastrophise or look on the bleak side. Activities around structuring our day, getting some exercise, arranging social contact through technology, keeping work or hobbies going, even keeping a journal to express feelings can help[2].

Related to this is an issue of trust and whether those in charge can help to keep us calm. Do we trust health experts? Do we trust government action and advice? Do we see others as a threat to our safety?

Trust is a key tenet of attachment theory – those of us who felt safe as children develop a sense of trust in others which in turn leads to feelings of safety and security. Those with a problematic childhood are more likely to develop mistrust of others which can then persist as feelings of insecurity and danger into adult life. The current situation needs an amount of trust for social cohesion. This can be aided by being reassured and reassuring others.

There has been an evidence of greater trust shown to health experts and scientists. I suspect most of the population now know what an epidemiologist is, and how it varies form a public health expert!

Our government has highlighted scientific expertise in the advice given and taken. We need this to continue, but it will get harder as the rates of those affected and those dying of COVID-19 increase. It is heartening that scientists and universities have been at the forefront advising government, modelling the virus spread, giving health and distancing advice, and tackling research on vaccinations and antibody testing. Colleagues internationally have been swift in designing studies to help us understand this pandemic and its psychological effects on emotions, coping and clinical symptoms.

We are asked to trust in the government in order to keep national unity and they in return cease political infighting. The hope is that by taking initiative to protect the nation the more it will command respect. Much will depend on both government ability to communicate effectively at each stage of this crisis, and its effectiveness at managing it and the emotional tone[3].

The political discourse is of facing war to invoke fighting spirit. However, it is an invisible foe and we are asked neither to fight or flee but rather to hide, to ensure safety. Today on Radio 4 there was a call for a Dunkirk spirit of opening up a range of testing facilities outside those used in Public Health England to gear up for the massive numbers required[4]. Both a wartime reference, and the smaller actions of private firms, university labs and even the general populace given prominence – small boats to the rescue.

Yet most people will also be aware that whilst applauding health workers, and relying fully on them to deal with the crisis, for a decade or more our health and social care services have been under-resourced and effectively hollowed out – having lost thousands of beds, suffering high staff shortages and carrying large debt. The public at least are rediscovering the value of public sector workers and their essential contribution in keeping us safe and well. As a society we need to rebalance our values from wealth generation to societal wellbeing not just in this crisis but hereafter. Let’s hope this message will be endorsed after this crisis has passed.

The COVID-19 pandemic is of course global. All countries are affected and taking action to combat the disease albeit to different time scales and agendas. The outbreak has been worse earlier in some countries, for example Italy and Spain who have had less choice in their restrictive distancing agendas. Other countries have been tardier in both East (Russia) and West (USA) with the UK also not in the vanguard of taking action.

Maybe our tendency to keep calm and downplay which has worked well with coping with terrorism has let us down when very prompt action was required.

Social distancing and isolation

Whilst most psychologists would advocate utilising social support and increasing social contact with close others at time of stress, this has been curtailed in the current situation. There are of course ways round it using technology and social media, but the strong attachment instinct to rush to be close to others when under threat needs to be controlled.

This is particularly important for those in older age. In the UK, all those over 70 are required to socially isolate within their households. This means they cannot leave their homes – so provisions have to be delivered – and external contacts have to be through technological means. Such isolation is usually associated with increased mental health risk. Family members in this situation need additional support-at-a-distance from family, friends and neighbours.

This becomes particularly stressful when older age relatives get ill – whether from COVID-19 or other complaints – and families are unable to visit. Those suffering bereavement of a close relative to COVID-19, who then cannot observe bereavement practices and cultural funeral rites due to restriction of gatherings suffer even more. Pictures of churches full of coffins and mortuary vans taking those deceased away under cover of darkness shown on Italian television will become real here as well.

Social distancing is more benign. As we know, we can only interact face-to-face with household members, for anyone else a distance of 2m (6ft) is required on the rare trips outside the home. Everyone (apart from essential workers) must stay at home and only leave under certain conditions. This is to exercise; shop for basic necessities; and medical help or to care for a vulnerable person. Essential workers can also travel to work. Other valid reasons include attending the funeral of a close family member and taking children to childcare[5].

A psychologist would ask whether different individuals experience distancing or isolating restriction in different ways? Attachment theory suggests that these will vary in relation to our particular attachment (or interpersonal) style. Those secure will adapt to closeness and distance, but those with avoidant or distancing styles will find being in close confines with household members stressful with anxious, angry or shut down responses. In contrast, those with anxious-dependent styles will find separation from others outside the home most distressing and will show emotional volatility.

Individuals will benefit from understanding their own style and that of those around them and creating strategies to deal with the restrictions imposed[6]. Maintaining routines in the household will help and respecting each others’ needs for ‘time out’ even if this is just escape to another room, garden or to walk outside. Scheduling regular contact with others through technological means will aid those with separation issues, but control needs to be exercised in keeping messages transmitted as essentially positive and calming.

The attachment principles of distancing-mistrust vs closeness-cooperation also apply on a national level. The pandemic has had somewhat contradictory effects in Europe and beyond[7]. On the one hand distancing has been required by the closing of national borders and curtailing of travel. This has led to mistrust of others entering the country – and sometimes attributions of blame to other countries for not controlling the virus better. On the other hand, cooperation is required across nations for the search for a vaccine and antibody testing, for understanding timings around peaks of the spread, and getting nationals back home.

Each government is having to focus on its own people. It is likely some will prioritise their own citizens over others in providing healthcare. Governments are asking their populations to erect walls between states as well as individuals to halt the virus[8]. Yet the immediate dangers of contagion are likely from those closest rather than those more distant.

Response to future crises may change in relation to keeping open borders, yet it is a global crisis and we will need to work together to fight the crisis, share knowledge and resources[9].

Coping and threats

How do the bulk of us restricted in our homes cope? Particularly if this is extended over a period of months? Positive coping is defined in terms of practical strategising, retaining optimism, downplaying of negative emotions and using social comparison to feel lucky – these sustain us in relation to emotional disorder[10]. Conversely features of poor coping, whether of blame or self-blame, pessimism, denial of the problem or failure to access social support are more common to those with insecure styles (either avoidant or anxious) and much more highly related to emotional disorder.

As academics, working from home is familiar – we are used to spending our summers this way. Usually a good time to get written work done without interruption. However, we are not used to the current restrictions – only able to leave the house for relatively brief amounts of time and constrained from visiting family or friends or indeed travelling to conferences or research meetings. So the feeling is very different. And the thought of doing it for three or even six months is troubling.

For those, like myself, who live alone, being solitary can aid contemplation, and I find I am getting through a lot of work – writing, marking, REF preparation, retaining international collaborations. The downside is achieving balance – regulating the work hours, learning to differentiate weekdays from weekends (what is the difference?). For an extended period this calls for some rigorous personal timetabling. Slots for Skyping family or friends, exercise time, inventing a hobby…etc.

For others with partners and children at home, the opposite is likely to be true – finding space for thinking, balancing work/life and demands of home schooling. Much may depend on the living space and number of household members – in particular having garden space as we come into spring. My colleagues are finding teaching their own young children (as opposed to students) challenging at times. Their children not overly impressed with their expert knowledge (‘you can’t do kid talk!’; ‘Oh stats, I’ve done that’). Not so much time for academic contemplation of theory or analysis of data on human behaviour when young minds need instructing.

For some people the situation will indeed be dire. For people who do not experience their home as a safe haven, due to domestic violence or abuse, socially isolating will become entrapment. Calls to help services have increased. Other people for whom home is not safe are people living in refugee camps unable to follow the handwashing advice because they did not have access to water and unable to socially distance in their primitive living conditions. Some people are stranded abroad – holiday makers who could not get back before borders were close – but also immigrants who if they lose their jobs because of economic downturn cannot return to their home country. Many in the population will lose their jobs and experience hardship. Many businesses will fail. The financial consequences are a very real concern. People rely on the government as a collective defence against the pandemic to change people’s behaviour and find the resources to save the sinking economy. There is a conundrum between containing the spread of the pandemic at the cost of the economy or tolerating a higher human cost to save the economy.

Reasons to be cheerful

There are, at least, some positive aspects to the situation to help us retain some optimism.

Our children do not seem to be affected by the virus
Most of us can distance ourselves in comfortable surroundings in a setting in which we feel safe (i.e. our homes)
We have great benefits from technology and most of us now have the means to communicate for work, education, social and leisure activity
The government is active in giving out funds as needed. There is also plentiful information on the ever-changing situation in the media
Health workers are being applauded for their unselfish contribution and the ‘outbreak of altruism’ in terms of neighbourhood schemes and volunteering is heartening
The environment seems to be taking a break from pollution – in London bird song can be heard and seems more plentiful. We also benefit in London from mild spring weather. As stated on the European website:

As we look up at the quiet of empty skies above us; rejoice at the return of marine life to Venice’s canals; and marvel at the dramatic improvements in air quality in the world’s cities – so we can hope that the unfolding tragedy of the coronavirus will at least have long-term environmental benefits. We may, for example, conclude that periodic shutdowns of normal human activity, if pre-planned, would be a blessing – how about an annual World Respiration Month? (30 March 2020)[11] N Whitney
The virus pandemic will pass… and lessons will be learned.

Reading

As others, I have had much opportunity to read in the last weeks. I have just completed a very engaging book, which ironically, involves a character put under house arrest in a hotel for 35 years! This seems topical. ‘

A Gentleman of Moscow by Amor Towles, depicts a Russian aristocrat punished by Bolsheviks for his assumed anti-revolutionary views in 1917 by enforced and indefinite house arrest in his then residence in the rather luxurious Metropol Hotel central Moscow. He eventually leaves forty years later, the hotel meanwhile, encompassing his whole world.

The book is a keen observation not only of social survival but adaptation to restricted circumstances to which with attuned social skills, keen coping, optimism and wonderful gourmet observations of Count Alexander Rostov leads to his reflection of how lucky he has been in life. The hotel proved something of a safe haven as the most dire, political conflicts of the 20^th century unfold. His friend Mishka, writer and poet, whose life took a different path involving being deported to a labour camp, on refusing to edit from his commentary of exceptional Russian literature a quotation of Chekhov’s stating Russian bread wasn’t the best in the world, comments:

‘’Who would have imagined’, he said ‘when you were sentenced to life in the Metropol all those years ago, that you had just become the luckiest man in all of Russia’.”

Maybe we will yet find benefits from our current predicament – looking back after all this is over and maybe recalibrating our lives.

References

[1] https://covid19uk.live

[2] https://www.verywellmind.com/emotion-focused-coping-for-stress-relief-3145107

[3] https://www.ecfr.eu/profile/archives/P2160 De Gruyter

[4] https://www.dailymail.co.uk/news/article-8179185/We-need-Dunkirk-spirit-Francis-Crick-institute-demands-testing-change.html

[5] https://www.bbc.co.uk/news/uk-51506729

[6] https://www.verywellmind.com/attachment-styles-2795344

[7] www.ecfr.eu.

[8] https://www.ecfr.eu/article/commentary_seven_early_lessons_from_the_coronavirus

[9] https://www.ecfr.eu (Varma)

[10] https://www.harleytherapy.co.uk/counselling/good-coping-skills.htm