Mind
From individual trauma to massive social trauma. Prevention, support, community in complicated mourning and psychological distress at the time of the pandemic

From individual trauma to massive social trauma. Prevention, support, community in complicated mourning and psychological distress at the time of the pandemic

In a period of uncertainty such as that in which we find ourselves living, both mental health professionals and the whole community are called to take charge of the pain and mourning of the individual, to work out together the social trauma that the epidemic brings with self and do not lose hope.

 

Advertising message Celebrate these verses of Sophocles, which describes the tragic pain of Antigone who is denied to bury the body of his brother Polynice, by edict of King Creon, almost to the point of wishing his own death. More current than ever, in a period that for ‘edict’, however fair it may be, unfortunately there cannot be a ritual that marks the beginning of that process which is the elaboration of mourning.

Everyone, in his own small way, is called today to elaborate his own personal mourning. Who for the atypical disappearance of loved ones, who often spent alone in a hospital bed, who for their own life who knew each other and who was forced abruptly to interrupt, for the loss of their sense of security, of a job, habits, sometimes physical and mental integrity, so that new scenarios of psychological urgency are being redesigned: the difficulties of adaptation and suicides among various sections of the world population of any social class are increasing, starting with the Finance Minister of Hesse in Germany, touching many teenagers who are unable to manage the quarantine, those experiencing economic problems, people tested positive and those at risk of contagion, those who can not live in uncertainty and use the latest desperate attempt to control themselves, the same operators engaged in the front line, such as doctors, nurses, law enforcement, but crushed by pressure on the front against the coronavirus. One thing is certain: the personal and social trauma that each one individually experiences during the epidemic has exacerbated the suffering and mental pain, which has become unbearable for some so as to reach the most fatal end.

Scholars identify critical event trauma in any situation that causes an overwhelming sense of vulnerability or loss of control (Roger M. Solomon, Ph.D.) and that leads people to experience particularly strong emotional reactions, such as to interfere with their ability to function both now and later (Jeff Mitchell, Ph.D.). The processing takes place through a first phase of normal general alarm, followed by a reaction of shock, of confusion, then by the emotional impact with extremely different times from person to person. The coping phase follows: the person faces, understands, elaborates on an emotional level what has happened, finally accepts it and modifies the idea of ​​himself according to what has happened. However, both the individual vulnerability caused by previous life events and the pre-trauma psychological set-up, that the presence of networks of support and social support can affect the psychological response of subjects to external events. It is intuitive to think of the difficulty of elaboration, therefore, in a situation whose leitmotiv is isolation.

The most recent example of a worldwide pandemic, namely the Spanish flu of 1918, has left, due to the censorship aimed at containing mass hysteria, few but important testimonies concerning the traumatic stress of the survivors and health mental. Again, the quarantine consisted of a ban on gathering in all circumstances, including funerals. Psychiatric hospitalizations increased sevenfold, even in states that had not been affected by the great war, and an unusual state of anxiety had developed among the population that pervaded many patients after the acute phase of the disease and sometimes persisted for years. Many of the Spaniards infected subsequently exhibited somatoform symptoms similar to “chronic fatigue syndrome”, others were diagnosed as “schizophrenic”,

Advertising message Nowadays, collective trauma is manifested through those military wagons that bring dozens of coffines out of the city, naked bodies, stripped of the circumstances and illness of their personal objects, but above all of their affections and their identity. . Imagine the familiar and friendly constellations that surrounded the lives of those deceased, who now mourn them softly, also barricaded in their own golden cages or not, deprived of the community that in similar events physically tightens around them, and who with their hands , caresses, hugs, soothes wounds and wipes tears, also giving the possibility of being able to externalize feelings, memories and emotions on your loved one.

Culture, human history, civilization, were born when the first man was buried by the community, which through a public ritual honors the deceased and exorcises pain, suffering, fear, all the emotions that line death in the present , and which are regulated through shared emotion. Today this is denied: you cannot accompany your loved one until life dies, you cannot cry on his still warm body, bury him or at least assist and put on stage that ritual that is the funeral, made of affections and consolation. Lives of guilt alternate with fatal pain, with blind anger, certainly with impotence. Atypical bereavements such as those found today, will probably result in unresolved bereavements, in which suffering does not subside or become chronic, interfering with the ability to function in daily life. Unresolved or complicated mourning can lead to depression, as well as other physical and mental health problems. How to deal with death and mourning in similar conditions?

said good Shakespeare, and after long centuries this is certainly the first step in dealing with trauma. Giving words to pain, symbolizing anguish and suffering is certainly indispensable for elaborating mourning in an emergency situation of this magnitude, trying to reestablish a certain sense of control and direction in everyday life. Let go of the guilt, for not being able to do anything, for not being there ‘physically’, for not saying goodbye with words and gestures. Concentrate on the good memories and on the relationship that you had with your loved one, rather than on the loss, even dedicating a letter to her, writing what you could not say to her. Small personal rituals can serve to metabolize the loss, such as lighting a candle in the window.

But above all, one must be there for each other, although the theme of death is often a taboo. The typical phases of trauma and mourning, as mentioned above, need the “other” to be able to take place, the other who listens, who consoles. The tendency to close and estrange, the mismatch, the traumatic dissociation made of feelings of emptiness and unreality, can surely be overcome through adequate psychological support, but also through the community, which must continue to ‘tighten’ around those who suffer, through the tools that are granted, organizing commemorations or funerals online for the deceased, video calls in which emotional regulation is still facilitated despite physical distance. And, if possible, eventually accompany those who are dying with compassion,

Community, empathy and sociability are also indispensable to manage the ‘quarantine mourning’, the inability to stop and let go of the life of before, which perhaps will return or change definitively when the epidemic is finally contained. Of course, they do not help the fear of contagion, boredom, isolation or entanglement in dysfunctional relationships that can heighten depressive experiences and self-heterodirect aggression. Also in this other type of mourning words are indispensable, recognizing and giving a name to the emotions and feelings of loss experienced, not feeling left alone with one’s mental pain, or with one’s illness, in the case of contagion. Not feeling rejected, marginalized, ‘contagious’. In the most risky cases, timely action should be taken:

Teaching with undisputed experience in the field comes from Prof. Maurizio Pompili, an internationally renowned suicidologist and head of the Suicide Prevention Service at the Sant’Andrea Hospital in Rome. Quoting his words:

It is what we need to work on, and that the National Health Service itself should guarantee: prevent and recognize psychiatric emergencies, increase the psychological support services for the citizen, take care of his mental pain, giving relief, hope, a perspective in the uncertainty, before it reaches catastrophic levels, since he himself wishes to return to live. Specifically, the operator should participate emotionally in that pain, be able to listen and symbolize, act, to put it in Bion’s words, as a container: to help metabolize unacceptable experiences, all those presymbolic and visceral sensations that anxiety and pain bring with itself, transforming them into words and emotions that are in any case tolerable and worthy of being tried. Make the person feel understood, offering assistance and comfort, but at the same time increasing awareness of her identity and resources, stimulating new coping strategies and helping her to feel self-effective, finally able to manage the situation. Lastly, to intervene on the whole community by giving meaning to the events and helping it not to lose hope, to see, albeit slowly, a way out: by nourishing hope, through small reassurances, tenuous glimmers of reopening and rebirth which, however, does not put their safety at risk.

In this context, network resources that support mental health and create a context of inclusion should certainly be activated despite the distance of citizens, as has already happened in China, in terms of public health and not only at the level of volunteering. Following the Chinese model, a first remote online psychological assistance intervention should be carried out early to identify and help the target groups that need support (the infected, families, vulnerable groups, health workers, police officers) followed by a rehabilitation phase, until psychiatric and psychological emergencies are reached (suicidal risk, intra-family violence, etc.), through a pyramidal configuration that involves the whole population: the community is at the base, and as you climb to the top you meet the various operational teams (health workers, community workers, police) until you get to the supervising group, which provides operators with psychological skills and pre-event stress training focused on the psychosocial impact of the emergency, in order to develop resilience skills to manage stress. Certainly, the psychological emergency will be more urgent once the epidemic is contained, however it is never too early to play in advance, provide new support and ‘inclusion’ services despite the distance and allow for ‘community’ management of a discomfort, traumatic and mournful, which from the inside of the houses could become chronic and cause even more damage. police) up to the supervisor group, which provides operators with psychological skills and pre-event stress training focused on the psychosocial impact of the emergency, in order to develop resilience skills to manage stress. Certainly, the psychological emergency will be more urgent once the epidemic is contained, however it is never too early to play in advance, provide new support and ‘inclusion’ services despite the distance and allow for ‘community’ management of a discomfort, traumatic and mournful, which from the inside of the houses could become chronic and cause even more damage. police) up to the supervisor group, which provides operators with psychological skills and pre-event stress training focused on the psychosocial impact of the emergency, in order to develop resilience skills to manage stress. Certainly, the psychological emergency will be more urgent once the epidemic is contained, however it is never too early to play in advance, provide new support and ‘inclusion’ services despite the distance and allow for ‘community’ management of a discomfort, traumatic and mournful, which from the inside of the houses could become chronic and cause even more damage. in order to develop resilience skills to manage stress. Certainly, the psychological emergency will be more urgent once the epidemic is contained, however it is never too early to play in advance, provide new support and ‘inclusion’ services despite the distance and allow for ‘community’ management of a discomfort, traumatic and mournful, which from the inside of the houses could become chronic and cause even more damage. in order to develop resilience skills to manage stress. Certainly, the psychological emergency will be more urgent once the epidemic is contained, however it is never too early to play in advance, provide new support and ‘inclusion’ services despite the distance and allow for ‘community’ management of a discomfort, traumatic and mournful, which from the inside of the houses could become chronic and cause even more damage.