At first it was just another virus, but as time went by, ignorance and uncertainty pervaded societies around the world, which suddenly became suspended, apprehensive, cautious and contained in isolation that dictated the distance from those who were closer to us. Touch, smelling, hugging and being with others were lost and there came new rules. The impossibility of physical contact with friends and family has been causing increasing unrest and discontent, something that we can easily understand with the naturalness of those who are Human and need others to live fully.
Collective isolation was forced upon us and warnings quickly echoed about the consequences of a necessary measure, certainly, but so disruptive for interpersonal relationships and our attitude towards others, that it generated great concern and unrest.
And in a period as troubled as the one we live in today, when Covid-19 interrupted or suspended mental health services in 93% of countries worldwide, as reported by SIC news, and at the same time there is an increase in the need for this type of health care, there is an urgent need to devise strategies and individually look for the best way to keep a healthy and strong mind (for example, going to Nature, since being in green spaces can mitigate unwanted effects of the pandemic mental health, as a recent study in Tokyo points out). Otherwise, we run the risk of succumbing to the adversities that face us in this “new normal”. Because, in fact, the pandemic has triggered fear and an automated emotional response in the face of an imminent threat which, if not properly eradicated - just as one seeks to do with the virus – can undoubtedly have devastating consequences.
If eating and sleeping are half the sustenance we need, as popular wisdom tells us, social interaction now emerges as the latest element of a triad essential for man's life.
The results of a study by researchers of the Massachusetts Institute of Technology (MIT) and of the Salk Institute suggest that our brains consider social interaction to be a basic need, just as our bodies need to eat properly to function. Published by the scientific journal Nature Neuroscience, the same study concluded that, after being in isolation for a certain period of time, the desire for social interactions is, in neurological terms, very similar to the desire to eat that we feel after fasting. I tried to understand the psychological impacts of an event as overwhelming to the dynamics of human relations as the pandemic we are currently facing, in an interview with Marco Torrado, Clinical Psychologist and Psychotherapist, with a Ph.D. in Human Development from FMUL, where he is Assistant Professor of Medical Psychology and Mental Health.
In your personal and professional opinion, how has the Covid-19 pandemic affected our minds?
Marco Torrado: The SARS-CoV-2 pandemic has affected our lives in a global way and extended to the various areas of mental functioning, having forced significant changes in the way we perceive the world and how we relate to others and ourselves. The impact that this pandemic has had on the occupational (school, academic, professional), social and family spheres is so evident that it has pushed us towards a permanent need to adapt to constant contextual variations, which are too fast and challenge our feeling of comfort and control over reality. It therefore represents a very significant drain on the psychic ability that each of us has to manage adversity and change. And, as we know, when the demands of the environment go beyond our cognitive and affective resources (i.e., our ability to think about what is happening) the vulnerability to getting sick increases. Of course, each individual, depending on constitutional characteristics, life history and the quality of environment (namely relational) may be more or less able to manage the impact of this pandemic internally.
Could the generalized fear that we feel today be responsible for some weaker physical conditions or specific illnesses?
Marco Torrado: Fear is a basic emotion and, as such, adaptive, without which it would be difficult for the human species to survive so many more or less threatening stimuli and events over millions of years. But what we experience with this pandemic is a sense of permanent fear and threat - be it the fear of contagion, of losing our job, of helplessness ... - promoting a continuous activation of this primitive fight/flight system that makes it difficult to balance and having the sufficient stability to maintain health in general. Of course, the pandemic promotes anxiety states that can be more or less significant due to the person's history, psychosocial situation and resources for the management of adversity, as well as previous aspects of personality. The impact of these negative emotional states experienced continuously is big: we have known it in clinical terms for a long time, and through research, particularly in psychosomatics, in a more recent way. In addition to the impact on psychological illness and the emergence, among others, of common mental disorders, the triggering of psychoneuroimmunological and inflammatory mechanisms based on negative emotions (e.g., anxious and depressive symptoms) can promote the weakening of existing physical conditions, namely cardiovascular diseases. All of this is always influenced by the greater or lesser support network of individuals, which naturally includes support, even if not in person, from family, friends and communities in general.
What are the main psychological factors aggravated by the current pandemic?
Marco Torrado: For the moment, what we know is described in some articles published in national and international journals in the area of mental health, with data that are still relatively little systematized, on the one hand; and, on the other hand, there is what we observe in the clinic's daily routine. I would say that the perception of greater emotional discomfort in people in general is almost unmistakable, the so commonly called distress that progressively hurts the ability to tolerate those that were previously small daily obstacles and now are quickly felt as profound threats. Because there is precisely a feeling of a deeper threat to integrity, promoted by a virus that, despite the imperative commitment of the scientific community, remains new among us and therefore still has few meanings that truly go beyond the potential 'little flu' (as some people still lightly name it!) and become the possibility of 'announced death'. I think the word ‘unpredictability’ is perhaps the one that best defines this dragging situation. We know that unpredictability is an existential condition and often at the core of the suffering that we often hear in consultations, such as the 'fear of dying'. In fact, this pandemic confronts us with this dimension in an even more crude way, which in some ways is reinforced by the media sensationalism that we observe daily. Mood changes, greater irritability, anxiety symptoms and feelings of greater insecurity are relatively common. Thoughts of ruin and hopelessness also stand out, especially when there are losses of people close to us due to COVID-19 and more frequent contact with morbidity, as in the case of health professionals.
How has your experience been in the last few months in your surgery, regarding the evidence of the worsening of these psychological factors? Are we able, at today's date, to assess the real psychological impact of the pandemic?
Marco Torrado: My psychological intervention practice in a hospital context and in private consultation alerts me predominantly to the very marked levels of anxiety in the people I support, as well as feelings of sadness and helplessness, which often reactivate previous emotionally difficult experiences. Psychotherapeutic practice requires a lot of subjectivity and the non-verbal dimension of the patient and the therapist, and the masks make our intervention very difficult, except when there is already a previous therapeutic alliance. Online approaches have helped and it is important to study them, namely the possibility of continuing clinical support without this obstacle to facial interpretation. With regard to the real impact in terms of psychological problems and psychiatric morbidity, I think that this will only be more evident in a while. It still seems to me that, in addition to the aspects I have already mentioned, there has been an increase in maladaptive emotional regulation strategies since the days of the full lockdown in March 2020. For example, in adolescents and young adults with whom I often work, I note an increase in the use of alcohol and other addictive substances in the management of contexts of social isolation, as well as an increase in the relationship with the online for purposes other than work or training. Online has become the possible tool for continuing the school and academic path of many young people and work for many families, mitigating inequalities and reduced opportunities, but also fertilizing areas of affective and anxious morbidity for those who, previously, already sought an online context at the expense of 'being with the other' physically. Similarly, the omnipresence of online and screens in children's lives, which was even more consensual during the first lockdown, predicts difficulties in self-regulation of behaviour and parental management and this is already clear in the type of complaints that arise. I think, therefore, that it will be in the medium term that we will better understand the real psychological and psychopathological consequences of the pandemic. Still, I think that there are also positive aspects in all this unpredictability. We have children who say they feel more relaxed with the daily 'forced' presence of their parents at home (who often became telecommuters or even lost their jobs) and more accompanied in their tasks, which is interesting, nonetheless, and resumes a broader discussion around the quality of social policies and support for parenting.
And what is your perception of the emotional state of our students? How have you felt them? Are they psychologically disturbed by the constraints inherent in the current pandemic? Or could the consequences be manifested in the future?
Marco Torrado: Above all, I feel diffuse tiredness in students, sometimes translated into greater apathy and sometimes less availability and motivation. I don't know if it is specific to the students, honestly, I think they genuinely try to adjust to the contingencies and from what I understand they even describe the mixed classroom regime (face-to-face and online) as much more satisfactory. One of the dimensions that concerns me is the weakening of social support that tends to happen and that, no matter how many groups on social networks there may be, do not replace the conviviality that we naturally seek to feel more secure and involved. And this is all the more true in young adults who, due to their developmental phase, seek to create new bonds and challenge themselves in new social roles without the current times allowing it in a more vivid and eventually less virtual way. As for the consequences, I think they may be more or less severe in the context of mental health due to a series of contextual and individual variables, but I am naturally concerned with the dragging of the high social and occupational constraints inherent in the pandemic, as well as this mutability (sometimes more confined, sometimes less) that increases the perception of lack of control over day-to-day and the future in the medium term and, potentially, the emergence of emotional malaise.
How or what strategies can be implemented in order to control/prevent psychological damage caused by the pandemic? What remains to be done (not only at individual level, but also in terms of political power)? And what is your assessment of the communication of the pandemic in our country and in the world so far?
Marco Torrado: These are complex questions, difficult to analyse and for which I have no closed answers. I think that a lot has been done by different institutional bodies, namely academies, professional associations and direct and indirect administration of the State in this field, although sometimes it seems that many different strategies without more comprehensive consultation tend to produce less substantial results than one would wish. Of course, public, private and social sector investment in mental health professionals, in particular psychologists, is crucial in a time like the one we are experiencing, whether in primary health care, hospital care, homes, and support lines, among others. Especially because I feel, at least in the hospital where I work, an important increase in requests for help.
However, in a broader perspective of health promotion, it is important to involve more scientific knowledge of Psychology in health communication, especially in a context when the promotion of responsible behaviours endowed with greater empathy for the others are so fundamental to contain the spread of this virus. We live in an age of almost unlimited information, or at times of disinformation disguised as information supposedly based on scientific evidence, which circulates freely on social networks and multiple fora. This can have a strong impact on the perception of the risk of contagion, which is highly changeable, and on concomitant protective behaviours, particularly among more vulnerable groups with lower levels of health literacy. Therefore, it is important to shape communication to multiple and different interlocutors and I think that there is a long (and complex) path to be taken, in this as in other morbidities, aiming at a greater observance of preventive behaviours.
Given the information that "social contact" is at the root of the increase in the number of cases, how do we manage a fundamental part of human existence - the close relationship - in times of pandemic, when we are asked to distance ourselves from the others? Dr Graça Freitas, in recent statements to the press, affirmed that "it is necessary to reduce contacts without stopping living", appealing to the Portuguese not to let their guard down despite the tiredness that is already quite evident. How do we manage distancing without breaking affections and emotional attachment to others?
Marco Torrado: The organization of our social behaviour is largely supported by community behaviour and the quest to belong. We are social beings and many more recent affective neurosciences studies have clearly emphasized the importance of social contact as a unique experience for human development since very early times. A virus that is transmitted between humans through contacts does in fact call into question a nuclear dimension of our existence, but naturally it requires our creative capacity to adapt and cultivate resilience resources. I would even say that the preservation of affective bonds and the maintenance of bonds has never been more important than now, even if digitally. Of course, our adaptability and resistance to the tension promoted by the pandemic is certainly not inexhaustible, but guaranteeing a relational proximity to significant people, even if not always in physical presence, is undoubtedly one of the most protective factors in relation to physical and mental illness.
What messages do you consider essential to transmit to society at a time as uncertain and disruptive as the one we are experiencing now?
Marco Torrado: I believe that we live in a moment of great disturbance and challenge regarding the beliefs that humanity, to a certain extent, has built that the human species is omnipotent and absolutely tolerates the unpredictability inherent in its existence. This pandemic, as well as possibly other past and perhaps future ones, confronts us with our fragility, like the need to return to an attitude of humbleness in the face of the unknown, as well as a continued commitment to the protection and development of people's health. It also seems relevant to me to evaluate what we are experiencing as something that, although disruptive, should be transitory due to the enormous effort of the scientific community to guarantee a vaccine or even possible drugs to mitigate this pandemic. However, we cannot fail to foresee potential consequences, more or less lasting, on the mental health of the populations. I believe in science and in the human and empathic relationship as a condition for this resilience. We will surely continue to be able to reinvent ourselves!