By Robert DePaolo
This article discusses psychological and behavioral after effects of the covid 19 virus and various restrictions placed on people around the world. The central premise of the article is that specific and difficult to reverse psychopathology could result from those restrictions, which the medical community either did not foresee or did not address in their clinical calculations.
The covid 19 virus has presented a rather unique problem for the medical community and the public in general. As has been well-established, it is essentially a hybrid of the common cold, albeit with a rather dangerous genetic quality. Most viruses – even corona viruses (of which covid is one) have a structural trait that makes cellular invasion difficult. To “breed” and co-opt the structure of normal cells it must first join with the normal cell. While the common cold does so – millions more people are infected with it than were with covid – the covid virus has a protein spike attached. This is an appendage structure that enables the virus to attach to cells much easier and to remain attached to normal cells for longer periods of time. The unique spike also makes it fairly easy for the immune system to recognize and destroy, which is one reason young people rarely if ever become sick or even feel symptoms. Because it can last longer in attachment and propagation it can, despite being recognized, force the immune system to engage for longer periods of time. If the pulmonary system is compromised – for example people who are smokers, have lung disease or immunological disorders the length of stay of the virus will lead to build up on fluid in the lungs and over time severe illness of even death. Ovid is a long distance runner that outlasts the vulnerable to those and other reasons covid is a bizarre illness that affects most people minimally – in many cases less than the common cold or the flu. It is however highly contagious, which prompted the medical organizations and governments around the world to institute strict preventative recommendations.
As a result of these restrictions suffering and great inconvenience in health areas (many medical procedures and surgeries were denied patients) occurred. Also massive numbers of jobs were lost and lives and economic futures were negatively affected.
To say the covid policies were a trade-off would be a gross understatement. It could be argued that more streamlined policies would have dealt effectively with the outbreak without these other drawbacks. However the disease was new in the beginning and scientists had to learn about it on the fly. As a result a certain amount of trial and error was involved in these recommendations and restrictions. Medical personnel did their best
That does not address the potential after effects of the policies – which were not coherently addressed. Where was the mental health community in all this? Hard to say. However there are very significant and specific psychological phenomena that should now be dealt with by the medical and political organizations.
One place to start is with behavior theory. A central, unassailable principle of learning theory is known as negative reinforcement. It is a process by which fixed habits, compulsions and neuroses are created. It works like this. If a degree of tension or anxiety crops up and is ameliorated by a behavior pattern (typically called an escape or avoidance response) the relief from anxiety will serve as a reinforcer, and will sustain the behavioral habit. Just as the response alleviates anxiety, so will deprivation of that response re-exacerbate the anxiety.
Mask wearing and social distancing are two behavior patterns that fit into that scenario. If mask wearing reduces contagion anxiety it will become not just a disease preventative measure but also an anxiety reducing reinforcer. By the same token removing the mask even after the disease is under control will provoke anxiety – even if the person is cognitively aware that a vaccine and/or decline of the spread is imminent. That is because conditioned response are typically sustained after the aversion is removed. Social distancing adheres to the same process. Keeping away from people – either by remaining at home or by not conversing or interacting in normal close contact will reward that social avoidance behavior by alleviation of the contagion anxiety. \
Even after closeness and going out are permitted by the medical and political communities the negative reinforcement dynamic will persist and will require a lengthy period of desensitization or relearning to re-adapt to normal circumstances. This would be particularly true for introverted personalities and those with anxiety and depressive typologies. It might also pertain to those with a high baseline of sociopathic behaviors and explosive personality disorders. Simply put, socialization normalizes us, while detachment does the opposite.
Many people will likely incur pathologizes such as social anxiety disorder, agoraphobias and even possible anti-social tendencies. – the latter because much of the pro social attitudes and behaviors in people are a function of the reality checks provided regularly in school and workplace interactions. Beyond that is the possibility of work aversions, which would result from people being adapted to passivity, feelings of relief from avoiding work-related duress and contagion anxiety. Shaking hands, close contact, meaningful conversations and other relationship builders could be affected. In short, a whole habit structure circulating around the globe could present us with a psychiatric pandemic rendering large numbers of people relatively dysfunctional.
The question is; now that we know more about covid 19, are politicians and physicians willing and able to parse their concerns, streamline their restrictions, offer encouragement to re-engage socially or in their narrow concern for physical health, will they continue to warn the public about “possible this and that” and thereby continue to foster a pandemic of psychopathology.
Most in the world community consider medical practitioners and even some political organizers to be heroes. Doctors, nurses and other staff were indeed involved in heavy risk taking in treating patients – especially when little was known about covid 19. However, at this point I would like to suggest the next wave of heroes will be the ones who see the big picture, are willing to acknowledge that people must be able to function, not merely remain alive, and as vaccines, treatments and reduction in the rates of disease occur, encourage people to get back to normal. One strong and necessary measure in all this might have to be a reduction in testing. There will come a point where the panic induced by media outlets who report on each and every infection will present rather permanent psychological barriers to re-normalization. It seems to me the least vulnerable need not be tested unless they have regular interactions with the most vulnerable. in simpler terms, with increased vaccine availability and reduction in rates there might not be any reason for a 30-year-old husband and wife with a 7-year-old daughter to be tested, unless either works or interacts with the elderly or have severe medical conditions involving the pulmonary, immunological or cardiovascular systems. At some point society has to turn off the red light and flash the green so people can once again cross the street toward normalcy.
There will likely still be a psycho pathological after-effect of the restrictions resulting from covid 19 and at that point mental health practitioners might, in their typically understated way, comprise the next wave of heroes. Hopefully their efforts will lead to a significant degree of personal and social equanimity.