The next pandemic, following closely on COVID-19, may be mental illness. So indicates Megan Brooks in Medscape Emergency Medicine (April 2020).
In the same vein, Dr Tony Bartone, Professor Ian Hickie, and Professor Patrick McGorry in their conjoint AMA statement (7thof May) predicted that there would be a likely 25% increase in suicides resulting from the corona pandemic. This would surpass the mortality rate of the virus itself.
The prediction accords with past experience. For instance, after the Ash Wednesday and Black Saturday bushfires suicides increased by approximately a quarter.
Suicides are the most visible mental health consequences of disasters. We think, symbolically, of stockbrokers jumping out of windows in the 1929 stock market crash.
Suicides are just the tip of the iceberg of mental health impairment following disasters. But when we consider the submerged four-fifths of mental suffering, we reach a conceptual hiatus.
This played itself out for me in the 1983 Ash Wednesday bushfires when I led a mental health team to fire-affected Mt Macedon.There we witnessed mental distress, explosions in GP and outpatients attendances, and a wellspring of painful emotions. Yet the psychiatric bureaucracy, on the basis of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM) maintained that there was no significant increase in psychiatric illnesses.
And truly, there was no increase in schizophrenia, little in clinical depression. People were not in a conventional sense psychiatrically ill or ‘mad’. They did not need psychiatric hospitalisation.
Yet we know intuitively that the recent Black Summer bushfires, the pandemic, the bereavements, threats to life, losses, unemployment, financial hardship, loneliness, social and cultural deprivations, and severe disruptions of our lives do carry huge psychological costs.
We must abandon the DSM paradigm for one that embraces and explains the widespread distress in natural disasters and other traumatic situations.
Hippocrates, the founder of scientific medicine presaged the required perspective two and a half thousand years ago. He said, ‘It is changes that are chiefly responsible for diseases, especially the greatest changes..’ Fast forward to the 1900s. We can replace Hippocrates’s ‘changes’ with ‘stress’, and ‘greatest changes’ with ‘trauma.’
Indeed stress and trauma researchers from various fields: bereavements, combat, Holocaust, and indeed disaster survivors etc., all agreed that it was the severity and quality of physical, psychological, and social stresses and traumas that determined the consequent severity and quality of physical, of psychological, and social symptoms and illnesses (some of which were DSM psychiatric disorders).
Within this perspective one could add fruitful dimensions to understanding. How did children, families, groups, nations respond to stresses and traumas? Did specific circumstances and certain responses lead to particular disorders? What moral and spiritual consequences resulted from the stresses and traumas?
With regard to particular responses to certain circumstances, research indicated that bereavement and loss often led to sadness and depression. Anger and terror emanating from fight and flight responses could lead to post-traumatic stress disorder (PTSD). Rupture of attachment bonds often led to feeling helpless and abandoned. Hopelessness and despair could lead to suicide. On the physical side, they could lead to immune system depression and subsequent infections and cancers.
Moral and spiritual disturbances are ubiquitous in stresses and traumas. For instance, failure to save someone can lead to existential guilt and shame. On the other hand, perceived failures of others regarding oneself can lead to hatred and aggression. Loss of agency and prestige can lead to demoralisation; and so on.
Yes, in this viral pandemic there will be a pandemic of mental health disorders, of which suicide and major psychiatric disorders will be but the tip of the iceberg. We must recognize the bulk of the iceberg with its complex interweaving biological, psychological, social, moral, and spiritual wounds.
Recognitions of specific stresses and traumas that produce specific types of biological, psychological, social, and moral wounds helps healing of the whole human and of whole communities.
Paul Valent cofounded the Australasian Society for Traumatic Stress Studies and has written widely on stress, trauma, and violence.