In March 2020, almost worldwide was introduced a state of isolation. For more than two months of our normal life was put on pause. Work in the best case was transferred to online, at worst — it simply is not. Meeting friends — only video, and calls to elderly parents, grandparents — more and more alarming. We were isolated, in order to save the coronavirus, but did save us from ourselves? Edition of Esquire has learned what psychological problems people faced during the regime of isolation, as well as the predictions of psychologists about the impact of the pandemic on our mental health.
In February, the scientific journal The Lancet published a study of how isolation affects the psychological state of people. The authors have analyzed more than two dozen articles on the effects of quarantine on mental health, written during or after the known world epidemics (in particular, the outbreak of Ebola in 2014, and SARS in 2003). Most of the articles says that isolation can lead to various psychological consequences of high levels of anxiety, insomnia and emotional instability to post-traumatic stress disorder (PTSD) and depression.
The results of this study cannot be fully correlated with the current situation as a pandemic coronavirus for the first time in history led to exclusion on a global scale. Scientists have yet to study this revolutionary historical period and its impact on the psyche and human health. But now psychologists see an increase in anxiety, suicidal tendencies, domestic violence, and the emergence of panic attacks and emotional dysregulation. Particularly severe psychological consequences predict people who recover from Covid-19. Not for all the quarantine was a serious challenge, anyone found in this situation are many advantages and, conversely, does not want to go back to the old format.
“Pandemic, isolation, and uncertainty — perfect conditions for the development of depression and the emergence of suicidal thoughts”
“The real impact will be seen only later — says a practicing psychologist, the member of the Association of cognitive-behavioral psychotherapy Olga Kalyagina. — At the moment a complete picture of how a quarantine and pandemic impact on the psychological state of people there. Members of the psychological community predict that after the end of the epidemic the number of referrals to psychologists will increase as the circumstances in which we now were, is a real threat of the virus, lack of control, uncertainty, social isolation, changing a habitual rhythm of life — ideal conditions for the development and strengthening of anxiety and depression”.
Kalyagin notes that isolation can exacerbate the psychological problems that existed in humans before. And if it does not find ways to cope with them, it can lead to depression and in severe cases, even suicide: “a depressed Person sees the future dark and hopeless and themselves as helpless and worthless. Now in a pandemic, many people may receive the idea that it will never end, it turns out that they are not able to cope with it. And some of it may provoke the emergence of the idea that suicide is the only way out of this situation”.
However, clinical psychologist Mental Health Center, cognitive behavioral therapist, Eugenia Smolenskaya believes that to speak about the isolation as the cause of outbreaks of psychological problems around the world, as all depends on the individual, how stable it felt to quarantine.
“Pandemic, quarantine, isolation will clearly lead to an outbreak of psychological problems across the world. This is already the place to be, says Smolensk. But if we are talking about specific people, not everyone when faced with such a serious change in his life must get upset to the psyche. It depends on many factors: personality, the presence of mental disorders, resources (financial reserves, social support, etc.) and others. Some factors play against human — we call this “risk factors”. For example, a history of anxiety disorder a specific person increases the risk that in isolation it will happen aggravation. Other factors, on the contrary, protect (factors-protectors); for example, an introverted programmer, who was working from home, can almost not notice significant changes in your lifestyle and mental state in connection with the pandemic.”
Speaking about the possible outbreak of suicides, Olga Kalyagina notes that at risk are the elderly, found themselves in complete isolation, and middle-aged men who have lost their jobs and financial stability. Women, according to Kalagina this subject, but they are statistically more likely to visit specialists and find other ways of solving problems.
“A man crush stereotypes about their financial and personal viability: many men are told from childhood that they must earn a lot, to be the breadwinners in the family, not to show weakness and not to ask for help. In General, now the situation is gradually improving: men becoming more likely to seek help from psychologists. But women among clients of psychotherapists still more,” explains Kalyagin.
Evgenia Smolenskaya, too, notes that women in General are more tolerant of uncertainty than men.
“Doctors, like any other people that have weak spots”: why psychological problems encountered by doctors working with Covid-19
Director of the Center for cognitive therapy, clinical psychologist Yakov Kochetkov and his colleagues in the Association of cognitive-behavioral therapists was launched in April of this year, the program of psychological assistance to doctors and health workers working with Covid-19. In the program — five free consultations with professional psychologists. During dissemination of coronavirus infections in Russia aid program was used by about 40 doctors and medical workers.
“Doctors, like any other people, have weaknesses. And there are a number of problems they faced working with coronavirus infection, says Kochetkov. — Often the problems are disorganization of the system: the lack of means of individual protection, pressure management, non-payment of funds and so forth.”
According to Kochetkov, the most in this situation affected health workers-perfectionists: “Imagine, people perfectly carried out their work prior to that, faced with an uncertain situation. He doesn’t know will follow his appointment. A person with a very high level of responsibility for the result, it can cause severe anxiety and restlessness. As a result, doctors no longer sleep, constantly thinking about work, all the while going over in my head, from their point of view, erroneous actions, which in fact could not have been foreseen. In addition they have problems with emotional dysregulation. Hard work, strong pressure from different sides, extreme fatigue — all this causes bursts of anger, irritation,” says Kochetkov.
Veronica Salimgareeva — a clinical psychologist from Perm, who worked with doctors and patients in the “red zone” of the Perm city clinical hospital №7. At the end of April Salimgareeva she contracted the coronavirus and can monitor the status of doctors on the part of the psychologist and the patient.
“The constant processing, the lack Sizov, the lack of clear algorithm of treatment often lead to depletion of health workers: in this state, the psyche strives to operate with the usual automatic action, avoiding difficulties, says Salimgareeva. — The doctors and nurses, reduced the level of empathy, defensive reactions are deprived of the ability to imagine what another person feels. This leads to ineffective strategies for communication with patients: for example, avoidant behavior or threats by the police.”
Kochetkov, and Salimgareeva at this point, that the main wave of psychological problems will cover people later. In particular, doctors may be signs of a moral injury that comes with participation or prevent events against human values.
“Relatively speaking, there are not enough drugs or the ventilator and the doctor need to very quickly make a choice who to help, — says Kochetkov. Later the doctor begins to think about the situation, scroll in mind all the details. He will feel that he made the wrong choice, he will blame himself and suffer. As far as I know, such a tough choice had to face the doctors in Italy. In Russia, at least in Moscow, to a lesser extent. But we can assume that over time some of them will still reflect on your experience. This can cause moral injury.”
“If the doctor asks for help, it does not mean that he is weaker or worse”: how psychologists help providers
“First and foremost, it is important to understand that if the doctor calls for help, and his colleagues — no, this does not mean that it is worse or weaker, stresses Yakov Kochetkov. — We all have our weaknesses. In this sense, there is nothing wrong to seek help”.
The psychologist notes that it is important to learn to relax, not only physically but also mentally. “Our goal is to teach doctors to rest between shifts, stresses Kochetkov, to work with their anxiety, with anxious thoughts. We give advice on how to shift their focus, learn to demand less from yourself, to treat yourself with more compassion and more support. Also working with insomnia and help restore healthy sleep”.
“I was often called the “red zone” and said that the patient’s psychosis”: what problems faced patients with Covid-19
“When I got sick and I came to the therapist in a protective suit, disturbing thoughts have already appeared. I was afraid that even if I have a common cold, a doctor visit before that in a hundred calls, can infect me, — says Eugene recovered coronavirus. — Then there was a lot of excitement because of the uncertainty. The first test result for coronavirus were negative. But she had fever, lost sense of smell and sense of taste. To recall the doctors I feared.”
Back home, Eugene passed the test for antibodies, which confirmed that he had Covid-19.
“Of course, the level of anxiety in this period increased significantly, — says Eugene. — It was disturbing and from what doctors have not yet proven treatment plan, and how they will develop the disease. The consequences of the virus are unpredictable. Worse information pressure, because the Internet and the media are constantly talking about the horrors of the “red zone”.
At the end of mode isolation, Eugene decided to go to a psychologist: “Such a desire has arisen before. But the quarantine has brought many problems: accumulated a lot of fears, my emotional state became unstable. And I don’t think an appeal to the psychologist is a sign of weakness, it is an attempt to build a sincere dialogue within himself.”
Psychologist Veronica Salimgareeva working with coronavirus patients and itself undergoing infection, remembers that one of the main causes of psychological problems associated with uncertainty and lack of awareness about the disease and about his own condition. “When I was summoned into the “red zone”, I often heard from doctors that the patient “began psychosis”. Talking with a person, I knew that there was no psychosis, of course not. Imagine it is locked up, restricted movement and with him, in fact, no one talks and doesn’t explain what and why. This causes great anxiety and anger. Someone can handle it, and someone does not work self-control, and he starts to show aggression. When we don’t know what happens to us, we begin to head to draw a different kind of horror, the catastrophic scenarios. The nervous system responds to such thoughts with the activation of stress hormones, because the brain doesn’t distinguish real threats from imaginary ones. But isolation deprives a person’s instinctive defenses against anxiety — flight or activity,” says Salimgareeva.
In addition, according to her, the psychological state of the patient largely has a negative impact an ill-conceived organization of hospitals. For example, the contents in one compartment of patients with different types of pneumonia.
“Imagine a man with pneumonia, but without Covid-19, which is already at the stage of recovery, sat in the chamber coronavirus patient, explains Salimgareeva. All, a person is considered the contact, and his hospital stay is extended for another two weeks. This approach has led to the fact that patients in one of the Perm hospitals staged a revolt”.
Yakov Kochetkov believes that the proportion of patients who survived Covid-19, may subsequently develop post-traumatic stress disorder (PTSD) or panic attacks: “mostly affect those who came to the emergency room or at least were hospitalized, emphasizes Kochetkov. — The more severe the condition, the worse the consequences. According to studies, more than 30% of people who have been in my life through intensive care have post-traumatic stress disorder. This is a very high figure. Therefore, we can expect that the survivors Covid-19, may well develop PTSD. But even the people with less-severe coronavirus infections may be manifestations of the so-called panic disorder, simply put, a panic attack. Kovid is often associated with a sense of suffocation, a person, recover from them, there is an experience very unpleasant condition when it is difficult to breathe. After recovery, the person begins to listen more closely to yourself, it may seem that with it’s easy something is wrong. Then the panic starts and people start to choke, although the objective reasons for it not”.
“In isolation, the violence becomes more brutal”: how isolation influenced the situation with domestic violence
In terms of quarantine and imposed due to coronavirus restrictions around the world has increased dramatically the number of cases of domestic violence. In early April the UN Secretary-General, antónio Guterres, stated, “we are witnesses of horrific global violence in families.”
In early may, the Commissioner for human rights Tatyana Moskalkova said that in Russia during the regime of isolation, on April 10, the number of cases of domestic violence increased by 2.5 times.
“For many professionals who work with this problem, the growth of domestic violence was not a surprise because different extreme situations, which include pandemic, usually to such consequences and result — explains psychologist of the St. Petersburg Crisis center for women Elizabeth Velikodvorskiy. — People who are prone to violence, in particular domestic violence, in isolation resort to it more and more violence is becoming more brutal, more heavy. Secondly, quarantined possibilities of assistance to victims becomes much less.”
In may 2020, the Crisis center of St. Petersburg turned 1009 women. This is almost two times more than in the same period last year. Every month since the beginning of the spread of infection in Russia the number of applications increased by 10-20% (in March — 795, APR — 852, may — 1009). The center’s specialists expect that this number will grow further.
“When a woman is faced with domestic violence, it is very difficult to talk about it. The subject is considered shameful and often we can hear: “Yes, it was her own fault, she chose it, she brought it”. But the first thing we recommend to everyone caught up in this situation — ask for help: call or email to a crisis center or any other organization working on this issue. Breaking the silence is one of the most important steps on the way out of a domestic violence situation,” — emphasizes Velikodvorskiy.
Since it is not always possible to call, especially in terms of quarantine when a partner is always close, in the crisis centre it is possible to write accounts of the centre are in all social networks. Then it all depends on the situation: victim can receive psychological or legal assistance and to apply for asylum.
“We quarantined together with the St. Petersburg hoteliers have launched a joint programme to help women who have experienced violence by a partner — said Elizabeth Velikodvorskiy. From may of the hotel provided the center with several rooms that can accommodate women, because in isolation they are not always able to go to elderly parents or friends, and a safe haven in some cases simply vital”.
“We need to observe hygiene for the sake of hygiene, and not for the sake of peace”: how to get out of quarantine if the virus has not disappeared
“I didn’t leave the house 68 days. And only in early June for the first time the isolation came on the half-hour walk. In all that time I never even went to the store, I have a completely non-contact delivery. But I noticed that once a week when I take products (though I do not see the courier), on the same day or the next, I begin to cough. It is psychosomatic because I am very afraid to get infected, says Elena (name changed). — When I first went outside after isolation, I was wearing a mask, did not go to the shops, just half an hour walk. But when I came home, it seemed to me that I can’t breathe, I started coughing, I started to shoot in the lungs.”
As noted by the clinical psychologist Mental Health Center Evgenia Smolenskaya, afraid to get infected even after the lifting of restrictions and the regime of isolation — objective problem, because the virus has not disappeared: “If, because of a fear of Contracting a person is in constant anxiety, refuses to work, will not release children, all without end pours sanitizer, it destroys his life. It is necessary to formulate a new conception of the world, including radically accept the increased risks of getting sick or dying, and continue to live with this understanding. Radical acceptance is one of the skills that psychologists teach their clients. Even if we abstract from the virus in a person’s life a lot of situations where he has to radically accept any reality. Not accepting it, it creates a lot more problems. It destroys his life. Acceptance, even if it is accompanied by a high level of discomfort or emotional pain, it brings less suffering”.
Yakov Kochetkov, who specializiruetsya work with obsessive-compulsive disorder (OCD), adds that one of the possible consequences of a pandemic will be the development of OCD: “One of the main types of obsessive-compulsive disorder — fear of infection, contamination and compulsive hand washing. People with OCD long before the pandemic wash their hands dozens of times a day, for hours, comply with very high health and have suffered because of this. Now, most likely, many people who have had this in the past, can appear some symptoms of OCD. It is important to understand that it is necessary to observe hygiene for the sake of hygiene, and not for the sake of peace. If you wash your hands to calm down is a bad sign. If you wear the mask, wipe the products after the store, pour the sanitizer to calm down, and then do the same thing the second time, and third, the need to seek the assistance of a specialist,” concludes Kochetkov.
“To say that isolated people suffer and only suffer, you can’t”: what are the positive consequences of a pandemic and quarantine
Despite the complexity of the situation, caused by a coronavirus, many have found it advantages. The most obvious — no need to waste time on the way to the office or school, that protects the nervous system, allows more sleep and save money. We have more free time to find a hobby or start to play sports.
“To say that isolated people suffer and only suffer, it is impossible. It would be an exaggeration — emphasizes the psychologist Evgeniya Smolenskaya. — There are no guarantees that if you will be put on quarantine in a situation of uncertainty, then you will definitely develop depression, anxiety disorder, panic disorder and PTSD. Is a very stable substance and very fragile at the same time. What one wins is a pretty unpredictable story. Many people have discovered the many advantages and advantages in the new world. For example, some of my colleagues began to gather in the Zoom and learn to belly dance”.
According to Smolensk, for some people, such stressful situations, on the contrary, be the impetus for something new in life. For example, for startup or to rebuild its business under the digital environment and the needs of society in a pandemic. So, many companies decided to convert their production to the production of antiseptics and medical masks. Particularly positive insulation effect on the business logistics and IT companies, as the demand for delivery and online services during this period increased significantly.
In addition, the Russians during the quarantine began to list significantly more money to charity. According to the monitoring fees more than 600 Russian NGOs that assist vulnerable groups, in March the number of online transfers increased by 37% compared to February, and in April grew by 38%. Moreover, in April, the average transfer increased by 7% and amounted to 1021, the ruble is the highest figure for the last year and a half.
According to analysts, funds at the very beginning of the epidemic, appealed to the people to help those in time of crisis became even harder. And people responded, although many of them experience anxiety about their own future.