Post COVID-19 Collectivism and lockdown

Alkistis Saramandi

Alkistis Saramandi

Author

Collectivist Society Pandemic Covid

Have We Become a Collectivist Society Because of COVID-19?

Over the past few weeks people around the world have gradually been asked, and then forced to put a halt to their daily routines as what was considered to be ‘just a flu’, also known as coronavirus (COVID-19), has turned into a global crisis, a pandemic.

The weeks and months that have passed as well as the weeks and months we are about to experience will undoubtedly be some of the most challenging times we will experience in our lifetime. Suddenly, the individualistic society most of the Western culture has been used to live in, is urged and forced to stop – people are encouraged to avoid public spaces, they are working from home and homeschooling their children.

At the same time, healthcare professionals, scientists, supermarket and pharmacy staff, lorry drivers, and all other employees and professionals who have for so long been underpaid and overlooked are being forced to work under unprecedented conditions, and to carry out heroic work to now, save our lives.

But what is actually happening? How can we cope and adjust during this time, from the mental health perspective? What are the effects of this forced, physical ‘social’ distancing on our well-being – avoiding social encounters without emotionally and socially distancing ourselves from our loved ones? 

Becoming a collectivist scoiety

We have started going grocery shopping for our sick and vulnerable neighbours; while artists, fitness gurus, and influencers post free content on their social media accounts to entertain everyone staying at home (such as painting, dance classes, workouts, etc.). Also, retired NHS staff are signing-up to join the front line and thousands of final year medicine students graduated earlier to help the overwhelmed healthcare system.

Simultaneously, delivery services, supermarket staff, and bin men, among others are selflessly working to ensure we can all have the essentials at home. While, for most of us, our task is to restructure our routine and to adjust to staying and ‘functioning’ from home. We now realise that to survive this pandemic we need to practice resilience, and become a collectivist community – emphasise on the needs and goals of the group rather than our own.

Collectivist Society Pandemic Covid

The need to control in times of uncertainty

The lockdown measures have triggered an unparalleled sense of anxiety and stress. Suddenly we need to make decisions with uncertain outcomes. The decisions – both the social and the economic – we make on a daily basis are highly influenced by our emotions. Despite our efforts to take control over our emotions, what happens when we are overtaken by the unknown, and by fear?

With a deadly virus roaming around, a virus that knows no borders, social class, and background, we feel powerless, and overwhelmed. Now, uncertainty is a major factor of our decision-making; We dream of and plan for the future, without actually knowing when the lockdown will end, or when the vaccine will be found, how many people will be infected and how many will die.

Studies have shown that unless we engage in cognitive reappraisal, risk aversion increases and is more likely to increase alongside anxiety. We also waver between the ‘exploration and exploitation’, the kind of ‘Should I stay or should I go?’ mentality. When making a decision we need to weigh the benefits of exploring a potentially more profitable option, or exploiting a pre-existing, but usually more sub-optimal one.

The decision is ultimately affected by different components such as how familiar we are with the environment, and the value we expect from the known source we can exploit against the cost of becoming vulnerable and risking a costly exploration.

The behavioural and brain sciences are yet to uncover the exact mechanisms of either option, but we know that during this extraordinary time most of us will experience some anxiety partly caused by the uncertainty either decision is accompanied by. We feel an unequivocal need to ‘control’, to ‘manage’ all these feelings and emotions which have penetrated our bodies and minds during this time of global chaos. 

How should one cope with this? Over the past few weeks, numerous articles on how to cope with anxiety and uncertainty have been published and shared. And the commonest ‘take home message’? – ‘try to maintain a routine and keep busy’.

By keeping a relatively ‘normal’ routine we allow our brains to feel they’re taking control, we let our bodies adjust to the temporary, yet taxing and challenging normality.

‘I miss hugs and hanging out with my people’

 

As humans, we are surrounded by social interactions, physical or virtual. We use different means for different sorts of interactions, but touch has undeniably been the most frequently used and most reliable non-verbal mean of communication. Different fields of psychology have explained the importance of touch – skin-on-skin contact has tremendous developmental benefits.

Touch is also present in our social interactions, as it has been found to be the preferred channel for expression of emotions, including social support. And, while we have learned to resort to hugs to soothe one another, to show our presence when a loved one is in physical and/or emotional pain, we are now urged to minimise, or actually completely avoid such interactions to prevent transmission of the virus. How is one taught to cope then?

People that previously felt lonely and isolated are now aching even more. People used to retreating to their social circle to share their worries are now at home. Even when at home, we try and avoid interactions with those in the same household. But is this social, or physical distancing? How has this term affected our perspective during this isolation period? 

While physically distancing – for an unknown amount of time – can be temporarily tackled by staying in touch emotionally and socially (over the phone and with engagement on social media) those already in isolation and lonely suffer a little more. Being alone in daily life for a prolonged period of time contributes to the development of depressive traits. Long-term social withdrawal and increased loneliness lead to increased negative affect.

While this forced stay-at-home measure is necessary to defeat this contagious virus, we could practise self-care and monitor our well-being. Adopting a healthier lifestyle, such as healthy diet, a balanced sleep hygiene, physical exercise, reduced screen time, is paramount in order to control the effects of this abruptly-altered daily life and (mis)information bombardment. 

This is a difficult time, and the way each one of us copes is different. Let’s take this time as an opportunity to rebuild our habits, to invest in our relationships and consider the benefits of moving towards a more compassionate, considerate, and sustainable community.

The Impact of Isolation on OCD

Alkistis Saramandi

Alkistis Saramandi

Author

Obsessive-Compulsive Disorder (OCD) is a mental health disorder in which a person has recurring thoughts [obsessions] leading to certain, repeated behaviours [compulsions]. The exact, underlying mechanisms leading to this debilitating condition remain unknown. Please take a moment to read this article and help researchers understand the multiple factors contributing to different mental health disorders.

Opens the door. 

Gets out of the house. 

Locks the door. 

Steps outside. 

For some it does not end there. 

Opens the door. 

Gets out of the house. 

Locks the door. 

Steps outside.

Return home.

Unlock the door.

Lock the door.

Steps outside.

Return home.

Unlock the door.

Lock the door.

Some will repeat these steps over and over again. They know they have locked the door, but they have recurring thoughts [obsessions] leading them to certain behaviours [compulsions] they are urged to repeat over and over again.

Gets back home. 

Runs to the bathroom. 

Washes hands. 

Goes to the living room 

Runs back to the bathroom 

[To] Wash their hands again, and again, and again

These are two of the many compulsions observed in individuals with Obsessive Compulsive Disorder (OCD).

According to the International OCD Foundation, around 1 in 100 adults is diagnosed with OCD. It is a common, chronic and long-lasting disorder characterised by obsessions and compulsions. Obsessions are often divided into four categories: fear of germs or contamination, unwanted forbidden or taboo thoughts involving religion, harm or sex, aggressive thoughts towards others or self, and having things symmetrical or in a perfect order whilst compulsions include excessive cleaning and/or handwashing, and compulsive counting, among others.

While many of us enjoy things being ordered in a certain way these behaviours are ordinary until they start interfering with and affecting one’s quality of life, functioning, and relationships. The debilitating symptoms of the disorder make it a disabling condition, especially now, during the pandemic, that behaviours and actions OCD sufferers are encouraged to control and minimise are behaviours and actions preventing the spread of a virus and contributing to personal and societal protection.

While the exact mechanisms leading to the OCD phenotype remain unclear, functional imaging has revealed that hyperactivity in four brain areas – the orbitofrontal cortex, the anterior cingulate cortex, the thalamus, and the striatum – may be associated with the observed actions and behaviours resulting from the individual’s obsessions and compulsions. All aforementioned brain areas are involved in functions such as decision-making, impulse control, response inhibition, morality, reinforcement, motivation, and reward perception, among others.
Misregulation or impairments – functional (in the relationship between brain activity and mental functions), or structural (in brain areas associated with a particular cognition or behaviour) – are likely to disturb the brain’s programmed actions and connections and result in suboptimal responses. Inevitably research is of notable importance – understanding the pathophysiology of disorders will, in turn, aid the prevention, detection, treatment and prognosis of crippling conditions.

OCD Mental Health Control Behaviour

To this day the management of OCD has been based on pharmacological and/or psychological therapies. Going down the pharmacological treatment route, the most common choice is the use of Serotonin Reuptake Inhibitors (SRIs) or Selective SRIs (SSRIs). Several randomised control trials (RCTs) have evaluated the efficacy of such pharmacological options and observed that modifications and increases in the balance of serotonin levels – a neurotransmitter involved in regulating function and influencing emotions, mood, memory, and sleep – may soothe some of the enfeebling and enervating OCD symptoms.

Others may opt for psychological treatments – usually Cognitive Behaviour Therapy (CBT), or Exposure and Response Prevention (ERP) therapy. CBT uses three main principles when it comes to managing OCD symptoms. The first one is based on perspective learning theory – neutral stimuli can become negatively reinforced compulsions via classical conditioning. Patients are thus encouraged to practice escape/avoidance behaviours which eliminate any cues prior to development of habituation.

The second allows individuals with OCD to understand that obsessions are often the result of otherwise typical intrusive images or thoughts which become misinterpreted in what we could call a vicious circle of underlying character flaws or predictive of subsequent catastrophes; individual responsibility in preventing harm may be interpreted as the need to develop certain rituals and behavioural responses in a quest of reducing anxiety, seeking safety, minimising harm or, even responsibility.

Finally, CBT is based on the notion that OCD obsessions and compulsions may be associated with individual intolerance of uncertainty (an inability to endure to aversive responses resulting from a perceived lack of salient cues, and maintained by the associated perception of uncertainty), less confidence in accuracy of memory, and an extraordinary importance in controlling thoughts.

OCD Mental Health Control Behaviour

Individuals with diagnosed OCD will often partake in ERP therapy which enables them to tackle maladaptive beliefs, e.g. ‘I will contract an illness by using public toilets’ by exposing them to the stimulus that evokes such obsessive thoughts and motivating them to refrain from engagement in compulsions. Although exposure to the triggering stimulus will naturally provoke anxiety at first, stimulus habituation will aid the anxiety to subside with negative associations also abating over time.

Systematic reviews and meta-analyses have shown that both pharmacological and psychological therapies – and often a combination of the two – are beneficial, however several measurements and mechanisms remain poorly understood. Questions such as ‘Will client C adhere to treatment?’, ‘Which factors influence OCD treatment outcome?’, ‘What is the OCD pathophysiology?’ among many others remain unanswered and the need to facilitate research is great.

Although experts from different fields joined forces a long time ago in a quest of answers, without public engagement there will be great delays in understanding diseases, developing therapies, preventing and managing symptoms, and personalising treatment. Especially now, with the world fighting a deadly virus and people being asked to practice rituals otherwise deemed as obsessive – ‘Wash your hands’, ‘Don’t touch your face’, ‘Sanitise surfaces before you sit down’ – some of us may feel that it is excessive, some of us may feel more prepared, and for some this has prompted harrowing anxiety. And questions rise – Were patients that had completed ERP or CBT sessions more prepared to cope, or do they feel profoundly overwhelmed – especially if their obsessions are contamination-related? What about patients relying on SRIs or SSRIs – is their medication still helping them?

The need to expedite mental health research is cardinal. We need to fight any associated stigma, develop treatments tailored to individual needs, observe and tackle any effects significant life events may have on disorder symptomatology in order to both prevent but also manage debilitating conditions. Research advance starts with us – from our desire to spare a few minutes to complete a questionnaire, to participating in a clinical trial – the options are endless and the benefits to society are significant. Start today – have a look at some of the available research opportunities, choose a topic that interests you and make a difference.

 

References

Knopp, J., Knowles, S., Bee, P., Lovell, K., & Bower, P.

(2013). A systematic review of predictors and moderators of response to psychological therapies in OCD: Do we have enough empirical evidence to target treatment?. Clinical psychology review, 33(8), 1067-1081.

NIMH

Obsessive-Compulsive Disorder. (2020). Retrieved 12 May 2020, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

Ponniah, K., Magiati, I., & Hollon, S. D.

(2013). An update on the efficacy of psychological treatments for obsessive–compulsive disorder in adults. Journal of obsessive-compulsive and related disorders, 2(2), 207-218.

Seibell, P. J., & Hollander, E.

(2014). Management of obsessive-compulsive disorder. F1000prime reports, 6.

Skapinakis, P., Caldwell, D. M., Hollingworth, W., Bryden, P., Fineberg, N. A., Salkovskis, P., … & Lewis, G.

(2016). Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 3(8), 730-739.

 

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