Thinking Clearly During COVID-19: Thoughts on Fear, Stress, and Mental Illness

In his classic 1918 essay, Mourning and Melancholia, Sigmund Freud examined the difference between mourning-a natural and non-pathological process-and melancholia, what we would now call major depression or depressive disorder. Although the feelings of grief, sadness, and temporary disruptions in functioning (disturbed sleep, appetite, and concentration) experienced when we lose someone close to us or something we highly value, look very much like clinical depression, they arc towards return to our usual functioning. In clinical depression or melancholia, the disturbances are of course, more intense, prolonged. and continue to interfere with the ability to function over a longer time (are sometimes associated with thoughts or impulses to self-harm) and often with depression there is no obvious loss or precipitant.

Illness or adaptive behaviors?
I’ve been thinking of this distinction recently in light of the challenges we are all facing in managing our fear, worry, stress, isolation, and for many of us potential and real loss as we face the COVID-19 pandemic. There has been much written and said about the dire mental health impact of the pandemic. The feelings are real, natural, and sensible as well as disturbing and adaptive-similar to the feelings we experience during mourning. And, while they may increase our risk of exacerbations or new onset of mental illness, we should be careful not to label these natural feelings as themselves pathological or signs of mental illness.

Let’s consider an analogy. Imagine you are carrying a heavy package up a hill on a hot day. As you are walking along you may notice that you are breathing more heavily than usual, you might be sweating, your heart is likely beating faster and as you continue, your arms may start to ache. Is carrying this package harming your health? At this point, it would seem reasonable to suggest you are fine. Your body is reacting the way it ought to in order to compensate for the load you are carrying. Of course, if you have a history of heart problems or are dehydrated, or if you have arthritis in your knees, carrying this package can lead to or exacerbate a physical problem.

So, while the burdens we are all bearing right now are disturbing and might put us at higher risk for a mental health problem than is usual, we should not confuse our completely typical and normal feelings with illness. At the same time, it is sensible that we should remain alert enough for signs of a more concerning or pathological response to our burden (ie, severe, unrelenting anxiety and/or sadness, inability to cope or concentrate, sleep and/or find pleasure in anything at all, or thoughts or impulses of self-harm or harm to others).

Transference
In addition to the importance of distinguishing illness from typical adaptive response, there is another valuable and relevant psychological lesson to be gleaned from the work of Sigmund Freud. One of Freud’s core (and rather remarkable) observations was that the people he treated in psychoanalysis would begin to relate to the analyst in ways and patterns that were similar to the ways they had interacted with parents and other important figures from their early lives. He called this phenomenon “transference.”

The idea is that we all repeat our relationship patterns, our assumptions about people and situations; and the more vague, ambiguous, and stressful a situation is, the more we fill in the gaps of our understanding with old patterns. In his Pulitzer prize winning book The Denial of Death, the social anthropologist Ernest Becker extended Freud’s idea of transference. He argued that we all carry the roots of our childhood psychological development with us and central to those childhood feelings are our inevitable feelings of fear and helplessness that every child feels. Becker claims that when we are faced with frightening situations, and especially one’s where we feel out of control and in which we may be in serious danger, it is natural and nearly inevitable to wish for a parental figure-a hero- to protect and save us. This is dangerous because when this occurs we may suspend or partly suspend our adult intellectual capacity to reason and think independently. This is how propaganda works and at its extreme how people can be brainwashed: when people fear for their life, they will grasp onto whoever might be in a position to keep them safe or help them-even if it is the person who might also harm them.

During the pandemic crisis, people fear for their safety and we are faced with a situation in which there is a lot of uncertainty about what is happening-both the exact nature of the risk and how to minimize it. This is precisely the type of situation during which the kind of transference-driven dependency Becker described, can emerge. It is easy to be confused, manipulated, or taken advantage of when we are fearful and feeling helpless.

While the current pandemic increases our risk of being manipulated or misled, the world of social media and the current tense and uncertain political environment amplify our uncertainty and can leave us grasping for anything and anyone who seems to have an answer. When we become aware of this natural human vulnerability, we can be on guard for people who might be trying to manipulate or take advantage. When there is so much unknown, we should be suspicious of anyone who claims to have too much certainty, to have “the solution,” especially if they tell you they’ll share it with you for the right price. At times like this, humility is core to truthful and valuable information.

Where does this leave us? We should accept that the past few weeks and the coming weeks will be difficult and that difficulty will apparently continue for a while, but people are working on science and evidence-driven responses and strategies. We should try to continue thinking carefully and critically about what we hear and read, we should do what we can to make sensible decisions about our safety and health and that of those around us, and most important, we should do what we can to stay connected as well as we can to those who provide us positive and real emotional support and do what we can to relieve our distress and the distress of those around us.

Hopefully we can all stay safe and healthy and help each other carry this burden. We can come out of these experiences more aware of ourselves and more sensitive and deeply connected.

Disclosures:

Dr Schwartz is Clinical Associate Professor of Psychiatry, NYU School of Medicine and Chief Medical Officer, The Jed Foundation (JED), New York, NY. He reports no conflicts of interest concerning the subject matter of this article.