<br />Dr Julita Garbacka, psychiatrist and psychotherapist: Epidemic of Fear

Dr Julita Garbacka, psychiatrist and psychotherapist: Epidemic of Fear

Social isolation during COVID-19 increases the amount of depression cases, anxiety disorders and post-traumatic stress disorders. What effects can be expected in the short and long term for society as a whole?

It turns out that social isolation is a stress factor, whatever the cause. The past year mobilized many researchers to summarize the negative impact of the pandemic and isolation on people’s mental health. Several meta-analyzes on the mental condition of people in quarantine have been published. Please remember that SARS-Cov-2 is not the first contagious pathogen. And thanks to this, we have quite a wide knowledge on this subject.

Reactions to isolation can be short-term and long-term, they concern a whole range of disorders, starting from anxiety disorders, increased irritability, anger, sleep disturbances, to depression and post-traumatic stress disorder (PTSD). In 2020 „The Lancet” journal published some interesting articles illustrating the scale of the problem. Imagine that even 20% of people isolated due to potential contact with infected people reported fear, 18% sadness, and 10% guilt. More than half of those isolated for many weeks after quarantine avoided people who were coughing or sneezing, 1/4 avoided crowded places, and 1/5 of them refrained from using public space for a long time. We also found out that even a quarantine that is shorter than 10 days had a negative impact on the mental condition of isolated people, even up to 3 years after this experience. Professor Jonathan Rogers from University College London took the trouble to analyze the research carried out on previous SARS and MERS epidemic and compared them with the current COVID-19 disease data and it turns out that the results are similar: up to 15% of people who contracted the infection showed symptoms of depressive disorders, similarly more than 14% of people were affected by anxiety disorders and even 32% by symptoms from the post-traumatic stress disorder (PTSD) spectrum.

In the case of previous MERS or SARS infections, every fourth patient with PTSD did not return to work within 3 years. It is hard to expect that COVID-19 will bring less losses, given the scale of the problem and the chronicity of the threat. I would like to point out that the problem is caused not only directly by the number of infections and illnesses, but also, which I have to admit with regret, wide negative PR and marketing, which means that we receive a lot of “fake news” that mislead people and generate serious stress-related anxiety and mood disorders, anger, irritability and sleep disturbances. Many people suffer from these disorders even without being in contact with the virus, nor with infected patients. During the scientific conference which I recently attended, one of the specialists in the field of sleep, prof. Adam Wichniak, pointed out that at the end of last year, every second adult Pole was to complain about sleep disorders. During isolation, people live less hygienically, eat worse, disturb their circadian rhythm and the balance between work and duties. The amount of stress that is generated by the current situation is virtually impossible to measure.

In Poland, 1.5 million people use psychiatric care. It is estimated that due to the psychological effects of the pandemic, this number will increase by about half a million. What does this mean for the country and society?

At this point, the average waiting time for an appointment with a psychiatrist is three to four months, and it will probably lenghten. Only from my own experience can I say that the pandemic has a big impact on people’s mental health. Apart from the stress resulting from the threat to their own and their relatives’ health, for many people isolation, prohibitions and injunctions are restriction of freedom and deprivation of the possibility to meet basic personal and social needs. And I am not questioning the correctness of the epidemiological decisions that were made, but I am describing a reality that affects us all and has a clear impact on our mental health. We like to be free. We like to decide how we spend our time and even if we decide to stay home, the feeling that we are doing it of our own free will gives us a sense of influence on our own life, and the result of lack of influence is stress. The EZOP-I study showed us that over 23% of the Polish population, i.e. 6 million working-age adults, suffer from at least one of the mental or emotional disorders defined in the International Statistical Classification of Diseases and Related Health Problems (ICD-10) or Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

I note that this is data from before the outbreak of the pandemic, and given the impact of stress on us at this point, we can probably expect much higher rates. To show the scale of the problem generated by stress, I will present two pieces of information: 1. Imagine that in 2018, 46% of Medicover patients receiving psychiatric and psychological assistance were diagnosed with F43.2, i.e. a reaction to severe stress and adjustment disorders. 2. According to the Mental Health report, in 2012-2018 the number of days of absence from work due to mental disorders increased by almost 40%. What will the post-covid statistics be …?

Mental health of many Poles has been ruined by the prevailing “epidemic of fear”. It turned out how many people are prone to anxiety. How can we counter this when the media provides us with a lot of bad, often manipulated information every day?

Often the only and, what can I say, the most effective solution in this situation is to give up tracking the information that the media provides us with. You need to lower the level of anxiety and stress, which is often fueled by news channels that compete in sensation-seeking and getting “the clicks”. I suggest going outside, going for a walk, going outdoors, to the park. There is ample evidence of nature’s beneficial effects on both physical and mental health. I encourage you to be physically active, if possible, play sports. Movement lowers tension and increases the release of endorphins, our inner happiness hormones. Please do what relaxes you, cut yourself off from negative information, do not bother your mind with issues that are beyond your direct control. Please note that each of us, when we are in fear or stress overwhelming our adaptability, automatically the field of vision and conscious perception of the environment narrows. Then, due to these “blinders” we are not able to use the knowledge and experience that we have. At the same time, we get rid of empathy because it is no longer needed and the level of aggression increases in us that generates further stress. Let’s protect ourselves from unnecessary stress.

The virus changed the image of everyday functioning in the family, school and work, significantly reducing the quality of life. Will interpersonal ties break down? Will the collective mentality change so that we will become a distanced society, perceiving other people as a source of danger?

It is worth going back to the end of the last century, when Americans studied the impact of computerization and general access to cyberspace on social relations. It turned out that with its progress, the level of depression and anxiety increased. Fewer real interpersonal contacts in depressogenic and anxious, and cause the loss of social ties, starting from the family level. For all of us, the 21st century is associated with the rapid advancement of technology, the high expectations we have for ourselves and our loved ones, and the enormous amount of stimuli that are provided to us from all sides, every day. And beyond the possibilities it gives us. the present day also provides us with enormous stress, exceeding the adaptability of many people. I remember the training, 2012-2013, so it was quite long ago, where EEG tests results were presented for the group children who play on the computer, use the phone and at the same time, glance at communicators and listen to “something in the background”. This is roughly how our children function today in the online age. And it doesn’t bode well.

Imagine that after some time the brain of such a child, bombarded with information and notoriously distracted, loses the ability to generate alpha waves – responsible for rest, relaxation, creativity – even at night. It is not difficult to guess that the package will often include sleep and mood disorders, chronic fatigue, irritability and anxiety. Our children learn remotely today, they have unlimited access to the cell phone, and their social contacts are significantly limited. All this has a huge impact on their development. The most important developmental task of schoolchildren is practicing real interpersonal interactions and social skills training. The Supreme Audit Office[1] report on the availability of psychiatric treatment in Poland in 2017-2019 (it is a pity that newer data are not available) shows that 630,000 children and adolescents benefited from psychiatric help and this number will undoubtedly increase. Lack of peer contacts generates anxiety and blocks the development of social competences, and this will have a long-term impact on the children lives. When it comes to family and work, new problems arise when the time between duties and rest at home is blurred. In order to create successful relationships, we sometimes need a break from each other and we have to long to appreciate our partner and the time we spend with him. The era of “easy access” significantly spoils interpersonal contacts and works against mental hygiene. Longing and anticipation are essential to be happy.

The problem of isolation is also the more frequent use of alcohol and other psychoactive substances in order to temporarily deal with the deterioration of the mental state. In the long term, this may lead to an increased incidence of addiction development, especially alcohol dependence. Do you confirm this theory?

Unfortunately, in the face of the pandemic, the sale of alcohol in our country is increasing. People who look for an escape from problems, to make it easier to fall asleep, to “relax” after a day of stress, turn to alcohol. It is the most readily available anti-anxiety agent, it works quickly, it is over the counter, and its negative effects are often overlooked, especially in the long term. It is worth taking into account that when we fall asleep easier after a drink or two or a few glasses of wine, unfortunately the quality of this sleep will be much worse, we will wake up less refreshed, even if we sleep more hours in total. Alcohol will also provide temporary relief and reduce anxiety, relax, but we forget that after its elimination from the body, anxiety will return, and frequently with double strength. This is due to the way it works. When alcohol becomes a remedy under severe and chronic stress, it also becomes a dangerous trap. We like to forget that an addicted person thinks for a long time that he can stop drinking at any time, which is often not true. There are many, the so-called well-functioning alcoholics, who drink in the evening and get up to work the next day and it would seem that they have no problems with it. On the other hand, the damage accumulates in their health and in their families, because an inebriated parent is never able to provide adequate care for the child, and the drunk partner often fails at important moments. Before the outbreak of the pandemic, the number of addicts was estimated at 3 million, or around 12% of the adult population. We do not know yet what the consequences of the epidemic will be in this regard.

Scientific research indicates that the mental health effects of COVID-19 can cause significant economic losses. Combined with the economic crisis, it is a deadly mix. Can living and economic fears significantly increase the number of suicides?

In 2019, almost 12 000 people attempted suicide, which is 7% more than in the previous year. We do not have a summary of 2020 yet and the year 2021 will also be puzzling, when the economic consequences of the lockdown will accumulate. The most numerous group among suicides are men aged 30-39, which may also result from alcohol addiction. But this is only a small fragment of reality… We have already talked about the enormous importance of stress for health, I am waiting with anxious curiosity for the “post-covid” data, since before covid Social Insurance Institution[2] reported an almost 39% increase in sickness absence caused by mental disorders in 2012-2018 ( sic!), and the costs for social insurers and the labor fund related to diagnoses of mental disorders between 2012 and 2016 increased to over PLN 1.5 billion, i.e. by 70% (!). Will it be worse? WHO predicts that in 2030 depression will be the most frequent diagnosis in the world. It is impossible to separate the soma from the psyche, and poor mental state affects the somatic state and lowers immunity, which increases susceptibility to infections and diseases. Isolation and loneliness increase mortality in all age groups, but it has the greatest impact on seniors. I do not want to scare you, but I appeal: since we already know this, let us take this knowledge into account when planning our own life activities, social contacts, and raising children.

Also before the pandemic, business required coping skills and gave lessons in humility. Can you find a positive aspect of current situation? Can the pandemic be attributed, for example, to the mobilization of entrepreneurs towards improvisation, looking for innovative solutions, greater flexibility and openness to changes?

Business has always been demanding. Of course, the pandemic also affects this sphere, I am sorry to look at the mass closure of economic activities, listen to the history of human misfortunes. Many companies had to close or “re-branch”. However, from the very beginning, I believe in entrepreneurs and Poles who mobilize themselves to new activities and to find new solutions, for example in remote actions. Lock down personally motivated me to change; now, each of my patients and clients has a choice whether the meeting is to be held remotely or stationary. It seems to me that after the first shock, it gave many people freedom and a chance to find the ability to improvise in themselves. It is a great opportunity for people whose mental resistance is at a sufficient level. There will also be those who will contribute, at least temporarily, to the mass of the unemployed and will need specialist help. If someone wanted to check if they meet the criteria of success, i.e. if they are mentally resistant, I will remind you what features make up them: focus, patience, internal discipline, self-confidence, perseverance and responsibility for own decisions and the ability to visualize, positive thinking and tolerance to pain, both mental and physical. These features are important for the occurrence of mental and somatic diseases as well as for running a business. According to CNN, the millennial generation is supposed to be less mentally resilient than their parents. This position can be considered because people “born with a cell in their hand” had less chance to develop some of the features I mentioned, which is a natural consequence of the mass implementation of technological achievements in everyday life, promoting solutions “here and now” and “immediately”, beliefs about the availability of the world 24/7. This would also explain the popularity of various types of training, the need for coaching and psychotherapy, because who does not want to be successful in life? Finally, I would like to add an interesting fact: there is a belief that stress is associated only with negative experiences, while stress can also take the form of positive stress, and a person who meets many, potentially very good things, may experience a level of stress similar to a person who has experienced difficult things.

More and more people are hypothesizing that the current pandemic is the result of mass hysteria and not a real threat. It is said that those at greater risk of experiencing a hysterical epidemic are people prone to extraversion, neuroticism, or people with low IQ. What do you think about this theory?

The real threat in the form of “there is a virus, I or one of my relatives may become ill / fell ill” certainly exists, therefore I would avoid the term “mass hysteria”. In contrast, pandemic and isolation decisions themselves have a real impact on mental health. I also believe that one of the biggest problems in this regard is seeing the pandemic as a sensation and the belief that ‘bad news is good news’. Fear is contagious, and a person who is afraid and feels threatened seeks escape and rescue at any cost – automatically reaching back to primary behavior – this allows us to understand many inadequate human behavior. Much of the overreaction on the part of message recipients is due to acute or chronic anxiety. The first results of demographic surveys, at the beginning of the pandemic, showed that women and people with low levels of education are more often afraid. I didn’t follow these statistics after that. Indeed, knowledge helps us to correct anxiety, but I would not associate that with IQ. We all fear similarly, we only have different ways to deal with anxiety. The biological susceptibility to stress is also of great importance here, which is an individual thing and is most strongly shaped, simplifying, already in the womb and in the first year, maybe two years, of our life. Fear itself is not bad, it is an inseparable companion of humanity and paradoxically it is a sign of our mental health. What is harmful to us is “infecting” with fear, so thoughtlessly sharing unverified data, looking for sensation, “clicking” without thinking the “share” button, ostracism towards people who think or behave in a way that worries us, etc. etc. to the deliberate manipulation of data and its falsification. To summarize: If we can limit the flow of information that increases our stress, let’s do it! In this way, we lower the level of our own anxiety. As anxiety levels decrease, our own resources are available to help us solve problems and control our own lives. Good luck!

[1] Polish: Zakład Ubezpieczeń Społecznych, abbreviated ZUS

[2] Polish: Najwyższa Izba Kontroli, abbreviated NIK

Dr Julita Garbacka

Psychiatry Specialist, Psychotherapist, Coach. Currently, she has her own business. She also worked as a trainer and manager in pharmaceutical companies. She graduated from the First Faculty of Medicine of the Medical Academy in Warsaw in 1997. She specializes in psychiatry. She has a multidisciplinary education and many years of psychotherapeutic experience and knowledge about the specifics of working in corporations. She has undergone numerous clinical psychiatric and psychotherapeutic internships in certified/accredited centers and clinics throughout the country. Among others, she worked, at the Department of Psychiatry of Developmental Age at the Medical University of Warsaw, in the Second Psychiatric Ward of the Nowowiejski Hospital. Currently she is employed in Bielański Hospital.

Last Updated on April 13, 2021 by Karolina Ampulska