Covid-19: from objective to subjective trauma

Covid-19: from objective to subjective trauma

A concept that has always fascinated me is that of Critical Mass. I can’t say exactly why. It will be because if I think of my childhood the first emergency situation that I remember well is that of the Chernobyl disaster, it will be because astronomy has always fascinated me or perhaps because of my scientific training.

Simplifying as much as possible, this term in nuclear physics refers to the minimum quantity of some elements (for example Uranium or Plutonium) sufficient to trigger and keep active a chain reaction .

An irreversible point of transformation that from that moment changes the state of things without the possibility of returning to their identical previous condition .

I have also always been fascinated by the absolute neutrality of these Laws, intrinsically detached from any principle and moral judgment such as Good, Evil, Right or Wrong. However, I am not a physicist, but a psychologist, and if I chose this profession it is because the object of my passion is man and, above all, his brain.

It is thanks to this organ that we bend neutral laws and make them no-more neutral, giving them a direction: when, in the last century, we understood how to hit the unstable radioactive atoms of Uranium with neutrons, we made it both the most terrible instrument of death, is a fuel to produce electricity.

The concept of Critical Mass in Psychology

If we think about it, the concept of Critical Mass applies quietly to psychology (in reality it has already been done in the context of Social Psychology), just think of all those moments in life that constitute a profound transition of state, of transformation of one’s own inner world. A transition from which, once you have crossed the threshold, there is no reversibility .

If this is normally true throughout life, it will be even more so in emergency contexts, during which a critical event can determine the personal or social triggering of a critical mass.

Take as an example some of my patients already undergoing psychotherapy since this emergency: what effect has the critical event of this pandemic had on their psyche? Has it (already) generated an irreversible transformation in them? And, if so, in a positive or negative sense?

This type of patient to which I am referring today has come to therapy bringing mainly anxious characteristics: generalized anxiety for some, or panic attack disorders for others. Many of them also have specific phobias and hypochondriac traits.

In the initial lockdown phase these patients had worsened. In some of my patients with avoidant personality traits, for whom the beginning of the quarantine was experienced as a strong area of ​​anxiolytic comfort , with a consequent paradoxical perceived self-improvement. This is not about them.

The patients I describe today continued psychotherapy regularly during the “phase 1” of the lockdown, all online, by choice. They suffered, almost immediately, from the condition of forced isolation , so much so as to report a re-exacerbation of old anxious symptoms: physical sensations of “lack of air”, impatience, sleep and nutrition disorders, physical tiredness and mental, cyclic lowering of mood, attacks of anxiety, resurgence of old specific phobias especially in a hypochondriac key.

Over the past two months, through the passage of time and psychotherapy interviews, they managed to find a sort of balance, of adaptation to “phase 1”.

As I suspected, this balance turned out to be much more fragile than they imagined, to the point of cracking at the moment of the initial, so longed for, freedom to go out.

“I have been locked inside the house for fifty-four days, I went out very little even for shopping … do you know that just getting out of the car and coming here to the studio made me seasick?”

It was a phrase reported by one of these patients just seen live, which continues:

“Before I could not wait to go back to the studio, then already the day before yesterday I started to have anguish again … as at the beginning … this morning I had very strong feelings of anxiety and, if I have to be honest, at this moment I can’t focus on staying here: I just think of getting back in the car and going home. “

Many other patients of this type, during the first week of “phase 2”, aligned themselves on these characteristics: alarm and anxiety at the thought of going out, feelings of fear of being infected, anguish, anger, sense of estrangement, confusion.

Stage 2 anxiety

An interesting aspect explored in the talks was precisely related to the sense of confusion, which sometimes touched a sense of perplexed unreality.
I had already heard those phrases accompanied by typical facial expressions, tones of voice and postures and it was not difficult for me to find out their memories: they were from 2009 and, most recently, from 2016.

I have a specific training in emergency psychology, which led me to work with victims and rescuers, both in the earthquake of L’Aquila, and in what touched me very closely in the Marche region of 2016.

If you listen to an earthquake victim in the 48 -72 hours after the event, don’t forget those phrases and how they are told to you. I do not speak of victims with major physical injuries or with losses among their loved ones, I speak of the majority of victims who simply fled their own more or less damaged home.

The difference with these testimonies of “phase 2” , as far as I have heard, was only in the intensity of the emotional activation: an obviously greater intensity for the victims of the earthquake.

For the rest, the almost shock reactions were similar, especially when they bring back the hint of that light, but fortunately temporary, a sense of perplexity. A scent that makes many alarm bulbs light up in all clinical psychologists, since it is a symptom not to be underestimated: it is a sort of moment in which the person in question is no longer able to read and understand the world around him . It sees the reality as always, but its brain perceives it at the same time a little foreign, or in any case suspended.

In this case, a critical mass trigger is being prepared in one’s ego.

“I got so used to not having contact with people that now that I’m back here I feel uncomfortable. As I walked to the studio I noticed that my posture was also more closed and I passed very far from people … it’s not because of the fear of the virus itself, it’s just that it makes me strange! “, Says this patient while she looks at me with eyes wide open and holds his arms to protect his shoulders.

To understand: it is as if you are fixing a painting on the wall of your home and you have the feeling that today it is hanging slightly crooked, very little. But the others around you seem to see him as straight as ever. You would like to get your hands on it but it doesn’t work and you feel powerless, also the others keep telling you to leave it alone: ​​“it’s straight! This is exactly how it should be! ” How would you feel?

Paralyzed, slowed down, anguished. It is what the victims of disasters experience in the early hours , a state of temporality and suspended reality, no longer decipherable. The icing on the cake is that you are aware that something is wrong, that the problem is yours, but at that moment you cannot do anything about it.

Fortunately, after this state of shock, the mind re-adapts to read the “new” reality, the rational and emotional areas of the nervous system, perhaps, helped by the therapist, resume dialogue with each other and the person returns to see that picture without distortions.

It is not always that easy.

The first reaction of these patients was not to adapt to the new but it was the immediate search for the old: “I was not ready yet! On the one hand I would like to go back to quarantine … I suffered from certain things but I felt safe! Now it looks worse. How can you be ready for all this? “.

It is done by starting to reflect on the fact that all this is actually an attempt to return to a life like that of less than two months ago, that is, if we remain in the perspective of the comparison with the earthquake, before the traumatic event.

Here the real challenges appear and further differences emerge between the two traumatic events.

A clear challenge is to take note that, beyond the objective critical event, there is a subjective traumatic event generated . In this case, the objective critical event is nothing more than the appearance of a virus, for which there is currently no cure, which attacks humans and can cause them to die.

The subjective traumatic event, on the other hand, is very variable : what is it that I perceive as traumatic at the moment? The virus, isolation, loss of loved ones, job uncertainty, recovery from everyday life, or what else?

Based on the subjective response, further functional or dysfunctional perceptions of the event are created , which must be examined before intervening. Let’s see two.

Reversibility vs irreversibility

We can place the first on the reversibility vs perceived non-reversibility axis of the traumatic event. After undergoing a traumatic event, each person reacts differently, and one of the first cognitive and emotional evaluations he makes concerns the perception of reversibility of the event itself .

There are objectively traumatic events from which we can re-emerge having then the possibility of returning exactly to the lifestyle we used to do previously, without any modification. Other events are located in the exact opposite and, still others, on the line of this continuum.

Let us give some examples: a natural disaster, such as an earthquake or a flood, which made us fear of losing our life or our home (perhaps damaging it) constitutes a reversible traumatic event, if it did not cause victims.

The person goes through the initial shock phase more or less quickly, and, also thanks to the prospect of being able to return to his previous life, he overcomes the trauma. The more this perspective appears uncertain and long (let’s imagine, in our example of the natural catastrophe, a seismic swarm that continues over time, perhaps combined with the bureaucracy that does not rebuild the damaged house, etc.) and the less the person feels he has control over to be able to take back one’s life.

On the other hand, if we consider other traumatic events, such as an accident that causes an impairment or COVID-19 that makes us lose a loved one, we are objectively faced with irreversible events : we cannot go back to the previous life exactly as we did it. In this case, the positive overcoming of the trauma goes hand in hand with the acceptance of having / being able to open a new phase of one’s life. A typical psychological example, for non-professionals, is what we call “mourning rework”.

If we analyze this pandemic on the reversibility-non reversibility axis so far, what do we notice?

First of all, as we said, the event that triggers fear is subjective and not objective. Over the past few weeks, I have asked all my patients: ” What is the thing you fear the most in all this? “.

The answers are different, generally three: for my life, for the life of my loved ones who are elderly, for my working future. The interesting thing is that what perhaps for one person constitutes the main source of anguish (e.g. loss of job) for another is totally indifferent.

We understand that this is a particularity: by subjectively varying my concern, the reversibility of the consequences will change more or less objectively and will also change the perception of control that I can have on the event that terrifies me .

Furthermore, assisting with a sense of powerlessness, the fragility of the richest nations in the world, the scientific community that provides different etiologies, therapies and prognoses, to the conflicting responses of social and economic policies, does nothing but strengthen the victims of this trauma. a feeling of constant uncertainty, confusion and loss of hope that “everything will return as before”.

Who is responsible for all this?

We place the second dysfunctional perception on the axis of the sense of perceived responsibility, which has internal vs. external responsibility as a polarity.

This could be resolved with the typical question that the victim of the pandemic trauma asks: “Whose responsibility is it for all this?”. Indeed, in this second phase the question became: “Whose responsibility is it to continue all this? Or having to go back to total lockdown? “

We have already seen irritability and anger among the symptoms . These are situations, I think, familiar to most of us: who hasn’t come across at least once, in this period, in explosions of anger in the supermarket or in aggression and exasperations on social networks?

We are all victims in this great traumatic event. The more our perception of the event, in this second continuum, will shift to the polarity of external responsibility, the more we will tend to attribute the cause and responsibility of our frustrations to the behavior of others .

At that point there will no longer be scientific explanations: by now our anger will have “seized” all the logical and rational baggage. There will remain only a hypertrophic tank of resentment to feed our internal moral judge, who, hooked on any target, will issue a guilty sentence to reach the inner catharsis.

It is the fault of the runner who stands alone in the middle of the field, of the neighbor who together with the dog or the child has moved more than 200 meters from home, of the mask of the non-compliant passer-by or of the gentleman who touched the fruit at the supermarket if I ca n’t go back to my former life. And it is right that HE pays the consequences.

Evolution and strategies.

As we face the first pandemic in the globalized world, the evolution of risk perception is linked to entropic socio-economic-health factors.

At the beginning we had asked ourselves the effects on the psyche of the critical event as questions: in the case of the patients observed we are very close to triggering a potential Critical Mass , without knowing yet whether the transformation that will take place will be destructive or productive.
As for the strategies, they must be imagined with caution and could thus be outlined.

On the axis reversibility vs perceived non-reversibility of the traumatic event, we know from psychotraumatology studies that it is useful for the victims to imagine and visualize a future situation in which everything is going to return as it was before or in which it will approach a new stable balance.

This time the mental effort to open a short, medium or long-term planning is probably counterproductive: an unnecessary source of stress. It will be more efficient to compress this capacity to the maximum, focusing on living moment by moment the gradual and uncertain steps that we will take towards normalization.

On the internal vs external responsibility axis, the best strategy is to shift the focus towards internal polarity: think about your behavior with rationality, respect and common sense without channeling fears and frustrations in making fleas to other people’s behavior.

In short, one must take one step at a time, without looking back with nostalgia, nor too far with terror or with excess of expectation. It is essential to overcome illusory temptations such as going back to a too romantic vision of a protective (psychological) isolation or looking for a scapegoat that catalyzes our inability to proceed with lucid calm and patience.

Those who love walking in the mountains know it well, when suddenly they find themselves in uncertain, dangerous passages, with changing weather and with a drop in strength: you don’t go back, you shorten your pace, you don’t pay too much attention to other hikers, we concentrate with all attention looking at the next two meters on the ground.

And when you get there, you look at the next two meters and so on. Then the wide and comfortable path will return, but let’s not think about it now.

Right now the best “therapy” to adapt is to find the right step.