It happened so fast. We watched with horror as COVID-19 spread first in China, South Korea, Italy and then all over Europe. Now it is here in the US and many have opted to self-quarantine — even those who are asymptomatic. How should we expect to respond psychologically and what can we learn from those who have already gone through this?
Public health experts warn that COVID-19 has not been contained in the US. We are now in the mitigation phase. Everyone has been advised to limit social contact, work from home, continue to self-quarantine if exposed, and self-isolate if symptomatic.
Social distancing, quarantine, and isolation are stressful and difficult. Psychological response to quarantine can include:
- Post-traumatic stress symptoms
- Depression, insomnia, anxiety
An example from China
My colleague Dr. Mark Smaller has been conducting psychoanalytic treatment with people in China for several years. He reported about a patient who had been quarantined for nine weeks.
"Ms. A" lives in a “community” consisting of a group of 30 high rises that were completely shut down for nine weeks, like the rest of her city and country.
She and her family initially were shocked at being completely housebound. As time went on, she reported various reactions. First, shock, then denial (“this will only be for a few weeks”) and then an overwhelming sense of helplessness, anger, and sadness. Gradually she worked through it towards various levels of acceptance.
Ms. A’s son resumed elementary school classes and piano lessons online, and she maintained virtual contact with friends. She and her husband worked remotely and shared time together doing homework with their son. “Fun” was watching favorite movies and television. A daily schedule proved very helpful. Any family tensions before the quarantine quickly waned as they paled in comparison to managing being housebound.
Ms. A reported hearing of a colleague diagnosed in Wuhan and who died a few weeks later. This brought the ongoing fear in the back of her mind to the forefront.
Last week, she reported she would finally be returning to her office for the first time in over two months. Children were out playing soccer, or riding bikes, though always with masks on. Some stores and malls have begun to open. Her mood has noticeably improved.
What can mitigate the psychological impact of quarantine?
Longer quarantine is associated with greater psychological distress so the duration should be kept as short as possible. Yet, with COVID-19, quarantine could go on for quite a long time. Those quarantined need adequate supplies and up-to-date information. But the psychological impact of quarantine also needs to be addressed.
- Keeping one’s social network alive through phone or video is imperative. The inability to do so is not just associated with immediate anxiety but also longer-term distress.
- The ability to communicate with friends, family, and colleagues is essential.
- Clear communication with health officials is imperative.
- Reinforcing that quarantine will help keep others safe can make a stressful situation easier to bear. (Lancet, March 14, 2020)
Factors identified by Ms. A that helped her to cope included establishment of a routine, her son’s resuming classes and piano lessons online, and working together managing a household. Her sessions with Dr. Smaller provided consistency and connection that was crucial during nine weeks of quarantine.
“My role during this period,” Dr. Smaller said, “has been to provide an emotional outlet to vent, to be listened to, and to be a responsive witness to this traumatic event in her and her family’s life. As news of the virus spreading in the US reached Ms. A., she said, ‘Now, we must worry about all of you.’”
Finding creative ways to connect
In a recent New Yorker article (March 12, 2020) Robin Wright writes, “Across the globe, a coronavirus culture is emerging, spontaneously and creatively, to deal with public fear, restrictions on daily life, and the tedious isolation of quarantine.”
In China and Iran, where hundreds of millions of people are in some form of lockdown, creative responses to promote connection have included:
- Nightclubs do “cloud clubbing” where viewers watch D.J. sets on streaming platforms and send in messages to be read live.
- “Home Karaoke Station” features famous singers taking requests, engaging with viewers, and performing while self-quarantined in their homes.
- Gyms offer workout classes online.
- The Chinese app WeChat created a group where one can find lovers while under lockdown.
- In Iran, doctors and nurses participated in a coronavirus dance challenge, posting videos of themselves dancing to lively music in full suits of personal protective equipment.
- A third-grade teacher in Khuzestan Province went viral on Twitter when she improvised to keep her classes going online after schools closed nationwide. Stuck at home, she used the side of her refrigerator as a whiteboard and with a blue marker, gave geometry lessons.
During this time of great stress, anxiety, and fear, protecting the most vulnerable of our population makes it imperative to physically distance ourselves from friends and loved ones. The key to maintaining psychological health while doing so is maintaining regular routines and finding creative ways to connect with others. This is the task at hand until the crisis is over.
Sue Kolod, Ph.D., is co-chair of the Committee on Public Information of the American Psychoanalytic Association and co-editor of the blog, Psychoanalysis Unplugged.