"I could not sleep normally for 14 days after returning from Germany to Turkey, and despite the cancellation of the conference that I went to attend and following the safety rules, I used to prepare days and monitor my case for fear of the symptoms of my infection appearing, and even after this period has passed I feel that I cannot exercise my life as well I was before my departure. "
(RSC, BA student in Turkey, speaking for "Meydan")
"I haven't seen my children for three weeks, and I can no longer sleep, because I am constantly trying to absorb all of this."
(Dr. Neelam von in her interview with the USA Today newspaper about her work in caring for people with the emerging coronavirus (COVID-19)) (1)
A torrent of news, events, facts, analyzes, forecasts and rumors accompanied the Corona Virus Pandemic (Covid-19) pandemic since the outbreak began in the countries of the world, the escalation of injuries and deaths and in light of the recommendations made by the leading international health institutions, and the laws and formal procedures that affected all groups of society, The effects of this global emergency on the effects of all sectors of countries, this pandemic not only represents a danger to the health of the body, but also mental health, and this risk is not limited to those who contracted the disease or who is treated or who recovered from it, but includes all Population without exception, m The degree of this risk varies according to several factors.
To understand the negative effects of the current situation resulting from the pandemic on the mental health of people in their societies, and to know how to deal with it, and to highlight the most important advice and recommendations provided by psychiatrists to protect mental health in this circumstance, "Meydan" conducted an interview with Dr. Marwa Hamdan, a doctor specializing in child and adolescent psychiatry research at King's College London, asked these questions.
Maidan: If we want to talk about the fact that people in any country were divided into workers in the health sector, people inside the quarantine, and people who are obligated to stay in their homes, what are the negative effects of the spread of the pandemic on the mental health of these groups?
The world is currently witnessing a pandemic that was classified by the World Health Organization as a "pandemic", and this pandemic has negative effects on mental health, which affect almost all groups of society. Some of these effects are the increase in rates of anxiety and fear, and panic attacks, and the matter may develop in some to the emergence Symptoms similar to PTSD symptoms, cases of frustration and depression have also been recorded in the public, and a number of studies have shown an increase in the rates of suicide attempts, and an increase in the appearance of physical symptoms of psychological origin or what is known as "Somatoform Symptoms" ).
The appearance of these symptoms is due to factors, most notably the lack of clarity of vision regarding the course of this pandemic. Generally.
If we want to divide society into the categories that I mentioned, then anyone of these groups can be exposed to the negative effects that we talked about, such as anxiety, depression and PTSD, but there are specific groups that are more likely than others to develop certain types of mental disorders, such as the health workers category, They are the first frontline to deal with the affected cases, and they are exposed daily to see these cases, which makes them more vulnerable to post-traumatic stress disorder, so they are subjected to repeated trauma, not only due to dealing with new cases or when watching their colleagues become infected, but also as a result of general For others related to the work environment itself, and in these situations, according to some research, job combustion rates among health workers increase due to long hours work or the lack of personal protective equipment that reduces the possibility of transmission to them, and the lack of supplies adds an additional load on them, and this They also raise their levels of anxiety and fear for themselves and the fear of endangering the lives of loved ones and their family members if they cause the infection to be transmitted to them.
As for the general category of those who are obligated to stay in their homes, this situation increases the prevalence of boredom between them clearly, and it is sufficient to browse a few social networking sites to see the spread of a state of great resentment resulting from staying in homes, and this of course affects negatively on mental health, It cannot be underestimated, as it reflects a state of isolation and emptiness that in turn leads to the emergence of psychological symptoms that we have referred to, such as anxiety, stress, depression, and even tantrums that can also be repeated without a clear incentive for them.
In addition, the constant warning and mention of the importance of preventing the spread of infection by repeatedly washing and sterilizing hands produces a kind of obsession in some people, and exposes them to recurring ideas known as "intrusive thoughts", and it converts ideas related to hygiene into obsessive about the extent of surface cleanness, for example, Thus, constant exposure to anxiety and excessive frequency of these actions.
As for people who are forced to enter quarantine centers, we can say that they are more vulnerable to feeling isolated and their negative effects on psychological equilibrium. The separation from the family atmosphere or the usual social support exposes the individual to psychological pressure that may cause symptoms such as panic and anxiety, in addition to this category also being exposed to stigma Accompanying this epidemic and the resulting feeling of shame or guilt, and this leads to an increased risk of fear and depression than other members of society, and although this pandemic is inherently a disease like other diseases, the people living in quarantine are the most groups For fear that they and their families will be stigmatized.
Maidan: Is any of these negative effects likely to develop into mental illness in these people?
The incidence of mental illness cannot be attributed to one reason. Mental diseases are inherently caused by multiple environmental and genetic factors, but we can confirm that the prevailing general state of fear led to an increase in anxiety disorder rates - although they were not classified as mental illness - and also deteriorated The condition of people who previously suffer from mental illnesses, this means that people who currently have mental disorders are more vulnerable than others to the development of these disorders they have, as the case accompanying the pandemic can be a catalyst to increase the severity of existing symptoms or even their emergence under these conditions.
However, the increase in suicide rates is considered a real risk indicator that alerts the existence of an emergency situation that calls for urgent intervention and also foreshadows the existence of a real psychological disorder, whether present or undiscovered, and although there are countries that did not record this increase as Palestine, for example, research and news sources talked about recording and linking this increase Of the Coronary Virus Virus Virus (COVID-19) pandemic, and although we treat every case as having its specificity and medical history, the conditions of isolation that these people may currently experience, or their loss of loved ones as a result of this pandemic, may cause severe symptoms requiring medical intervention and presentation Support To myself to them.
There is a watershed between the natural practice of washing hands and disinfecting surfaces and the pathological practices that appear to their owners
It is also worth noting here what is known as "Obsessive Compulsive Disorder" known as "OCD", and those who suffer from it suffer from obsessive-compulsive disorder that persistently pursues them and compels them to perform certain actions in order to get rid of these obsessions, and one of the most famous examples of these obsessions. Among those suffering from this disorder are those related to hygiene, which compel the individual to wash his hands or clean the place around him and sterilize him in an exaggerated and satisfactory manner. Readers may now have questions such as: I make sure to clean my hands as a result of my fear of the epidemic and suspect that the surfaces around me are not sterile enough, so does this mean that I have this disorder?
But although this link is logical, there is a watershed between the natural practice of washing hands and disinfecting surfaces and the pathological practices that appear on their owners. For example, people with this disorder repeat repeated cleaning practices and using sterile materials to the degree that causes skin exfoliation or disease problems, added to This is because those practices can be described and considered satisfactory if it causes the owner to be impeded from exercising his life and functions in a natural and sound way, that is, the amount of the impact of these behaviors on a person's life and his daily functioning is the criterion used in distinguishing natural behaviors from Psychological disorders that require intervention from a doctor or counselor, whether it comes from the obsessive symptoms of germs or even anxiety or frustration or even depression.
I would also like to point out here that any person who is exposed to the loss of someone he loved as a result of this pandemic will be at risk of developing PTSD, and in the event that his grief period has increased for a long time and has turned into symptoms of pathological depression, then you should go for medical advice.
Maidan: What are the factors that can cause the mentioned negative effects to be more severe?
There are several factors that control the scene now and can cause the severity of the negative effects mentioned above.
* The emergency facing the world today, the blurring of its scene and future expectations around it, and the resulting increased levels of anxiety and fear among people, the world is facing a pandemic that kills more lives daily, and there is no effective treatment that has been proven until now, and what is received from the news about the need for at least a year Until the manufacture of an effective vaccine, and it is difficult until the moment to anticipate the end of this pandemic and our ability to contain the disease, and whether the pandemic is a seasonal infection that will end by the summer or is there another wave awaiting us, all this is in the field of foggy scenery that can increase the incidence of panic and general anxiety.
* If we deal with the health sector, and specifically the category of its employees, Gaza regions, for example, lack an adequate amount of medical equipment, ranging from simple methods of protection such as masks and special types recommended for use or protective clothing for doctors to ventilators and the beds of patients in intensive care departments capable of Absorbing the large numbers of injured people in the event of an epidemic, the acute shortage of these equipment and tools puts health workers under double psychological pressure not because of the fear of infection or being transferred to their families, but also because of the fear of scenarios that could W if increased pressure on hospitals and the concomitant emotional stress and burning job among workers in the health sector.
* Another factor that contributes to the increase in the severity of the mentioned effects, which is the absence of societal awareness, specifically with regard to the practice of social stigma or failure to adhere to the correct quarantine laws due to the auxiliary role in the spread of the epidemic, thus exacerbating the psychological effects associated with it as a result of deaths or increased number of cases Death.
* Also the loss of psychological support and communication with the family, which contributes to the deterioration of the psychological side of the injured or persons in quarantine, and we have heard about people who died due to illness and did not have the opportunity to obtain a last meeting with their loved ones. The psychological support provided by the environment, whether in the workplace or even at home is very important, not only for people in quarantine, but also for health workers, it has been observed high rates of mental disorders among these groups, especially among those who did not receive psychological support In their field of work, some of you may have heard about the story that recently spread through social and irrigation media by one of the doctors who witnessed many deaths and said that he felt as never before that he needed to see a psychiatrist.
Maidan: During her interview with Maidan, M. H., PhD student in Turkey: “It is not the first time that I hide from death. I spent five years in a situation similar to isolation at home when I was in Syria. My fear now is concentrated in losing my source of income and not getting infected.” A large number of The residents of the Arab region have spent many years in areas that have been subjected to violence, killing and displacement, and there are those who still live in these conditions. Can we say that the loss of the source of financial income is the greatest fear of these people in this period compared to others who did not experience similar conditions? And why?
First I will clarify something related to Maslow's theory of needs, a psychological theory presented by the scientist “Abraham Maslow” to explain the hierarchy of human motivational needs in life according to a hierarchy, in which basic physiological needs such as food and drink come at the base of this pyramid, followed by the need for security and safety, including that Health security.
According to this theory, we will find that it is self-evident for a person who does not have the necessary money to provide for his basic needs of food and drink, or for a person who will be prevented from staying at home or quarantine from earning a living his day, that the security of this sustenance becomes an urgent need that may exceed in its importance among these people their fear of infection Or the epidemic itself, and although there is some criticism of this theory in the positioning of things in the pyramid, I am referring to it here to clarify an important point, which is that while safety measures call for staying at home, officials must provide solutions to those who will be affected by the loss of their livelihood , Before carrying out quarantine or Demanding to stay in homes, so we saw at the beginning of the crisis when official invitations to stay in the house were published that there were voices that were launched to indicate this problem, and to talk about the negative impact that the loss of the source of income has on the mental health of these people, an effect that may outweigh the risk of the possibility of catching or Transmission of infection, we have a potential versus an imperative.
It was also pointed out here that even in natural cases, it was logically observed when talking about environmental factors that contribute to a person suffering from a mental illness such as depression, for example, the person’s disease history started with a painful accident or a loss of his job, and we are currently living in a global epidemic situation, which imposes the necessity of securing a source Income or material support for those affected by staying at home without work, neglecting this aspect will cause deterioration of the disturbances and psychological symptoms resulting from the loss of the source of income.
Maidan: Health care systems in several countries in the Arab region do not have the ability to provide the necessary support in the field of mental health currently due to several factors, the most prominent of which are limited resources, so how can people within the aforementioned categories cope with the negative effects of the current situation left by the pandemic on their mental health? Are there specific strategies, reliable knowledge sources, projects or counseling services programs in the field of mental health, and examples of this?
Of course if we mention that there are negative effects, we must mention the recommended strategies for dealing with these effects, and here I will refer to what was recently published by the Yale University Psychiatry Department, as its specialists made several recommendations to counter these effects, the most prominent of which are:
* The necessity of maintaining a healthy degree of social communication with friends and family, especially among people who remain in quarantine, at a time when it is recommended to commit to a kind of social separation and stay at home, the university specialists stressed the importance of a circle of social communication, which in turn constitutes a basic and working supporter Important in maintaining the mental health of people in general.
Let's talk about this angle in some detail, given the rules of home stone, it focuses on not leaving the house except to purchase basic needs or to carry out sporting activities that are allowed daily or to work if it cannot be completed from the home, that is, it aims to reduce the presence of gatherings as possible To stop the spread of the virus, and even if it is necessary to leave the home, it must be kept to leave a distance of two meters separating people outside their homes, which is known as social divergence, that is, the necessary communication is allowed, as we are social beings that are absolutely impossible to prevent communication between them, and it is also advised to make periodic meetings remotely (across the Internet) from time to time between the family members who do not share the same home to maintain a healthy level of social communication which we have referred, and this is in the circle of compliance with the rules of domestic stone and protects at the same time from falling into absolute isolation negatively affect the health of people psychological.
As for people who have symptoms of infection, such as a high temperature, for example, they are forced to adhere to a stricter stone, and they are prohibited from leaving the stone places at all until a specified period of time has passed based on the persistence or disappearance of symptoms or the presence of another person in their surroundings, for example at home, who suffers from Symptoms of infection as well, so these people are advised to keep in touch with their families and friends remotely, and those responsible have to provide them with the basic needs to ensure that they do not mix with others.
Maintaining a daily routine that is stable and flexible also gives the person a sense of control and the ability to take control.
* Specialists also warned of the frequent circulation of pandemic news, the frequent dealing with disturbing news causes a significant increase in stress rates and the severity of the negative effects resulting on the psychological health of people, and noted the possibility of contenting themselves with reading the pandemic news only once or twice daily, while checking the accuracy of the sources that get people Including on this news, and here I would like to refer to official reliable sources such as the World Health Organization, or accredited research journals, and medical professionals, and stress the importance of permanently avoiding rumors or unreliable sources, especially those that publish information The social networking sites without clarifying its sources, and warn of the rumor mongers related to the conspiracy theory, and it has too many such aspects of the virus that causes the epidemic is biologically plant virus and that the whole thing is biological warfare, or the spread of the virus link technological characteristic "5G".
* Maintaining a daily routine that is characterized by some stability and flexibility as well, the availability of these two characteristics gives the person a feeling of control and the ability to control matters in light of the instability and lack of clarity in this pandemic, as an important part of the original psychological effects caused by a sudden change in the routine of life in The person before the pandemic spread and after its spread and the imposition of home quarantine.
* It is also recommended to follow a daily exercise routine at home, as this helps to improve the mood of people and reduce their stress and anxiety rates, and to maintain a daily morning wake-up routine, and regular sleep times, that improves the mood in general, with the importance of exposing the place of sleep to the sun to help the person To wake up regularly, as well as the health benefits of an order.
* Another important issue is that quarantine or commitment to stay in the home does not mean not having a regular period to leave the house, but when necessary, countries have devoted several hours a day in which people in the quarantine are allowed to go out to exercise and buy the necessary supplies or medicine and also go to work What cannot be done remotely, as leaving even for short periods is beneficial and necessary for mental health, but within the framework of adhering to the recommended health rules such as commitment to social divergence, avoiding gathering, and cleaning hands.
As I explained earlier, allowing people to leave the home is an issue that applies to those who did not show symptoms of infection, but those who have symptoms appear obliged to remain in quarantine and never leave.
* Finally, people are advised to seek psychological counseling when feeling any effects that warrant concern, and although the capabilities available in several Arab countries do not meet the needs of the population in this aspect, there are initiatives and services that seek to meet this need as much as possible, we mention, for example, in Palestine, specifically in Gaza , The free guidelines through which the "Gaza Mental Health Program" provides free psychological counseling services over the phone, and in Jordan, "You do not want you, we are with you" initiative implemented by the "International Medical Authority" in cooperation with a group of psychiatrists to provide psychological support sessions remotely During the pandemic period, Internationally, in Britain, for example, a free psychological counseling line was provided to support health workers, and on the Internet there are websites that provide tips for maintaining mental health, such as Young Minds.
In addition to the previous advice, I would like to point out the importance of raising awareness in our societies about the societal stigma experienced by people looking for or receiving psychological support, or even speaking in this aspect, it is "not a shame" to obtain psychological counseling, and we must protect ourselves Of great pressure, it is natural to feel disturbed in such unusual situations, it is normal to sometimes feel bored or lazy or even mood changes, it is natural to feel fear of infection, what you are asked here is to try to follow the advice that we have mentioned, and go for On medical advice if they are a Severe symptoms.
Maidan: Will the pandemic reinforce the spread of the phenomenon of fear of strangers (Xenphobia), or will it cause hostile behavior for people of racial or religious minorities or even those who have contracted or recovered from the disease?
It is no secret to anyone that such practices have been monitored in a number of countries, including Arab countries. Simple follow-up to social media sites will show aspects of bullying on the Chinese, for example, and this is certainly an unhealthy phenomenon, but rather it is hostile to the principle of openness to and acceptance of the other, so it is advisable to obtain information From its reliable sources, and it is used before publishing publications that show content that is bullying a specific culture. Racism is an always reprehensible character, so that some studies have proven that the negative psychological impact resulting from such practices is not only limited to the bullied, but also to the bullied.
Maidan: In a post on Facebook, the young Omar, the grandson of one of the people who were declared infected with the Coronavirus (COVID-19) in Gaza, said: “My grandfather went to the quarantine as recommended, we learned the day before yesterday that his test result is positive, We were very worried about him, but the biggest worry was when we saw the way people circulated the news of a serious injury. They posted his picture everywhere on Facebook, mocked him, bullied him all day and night "2. Do people who are classified as "persons infected with" Covid-19 "or" people treated with "Covid-19" or "people recovering from" Covid-19 "face stigma or bullying even after ensuring that they are not infected or cured of the disease ? How can they and their families cope with this situation?
Personally, I followed all this, and read the posts that talked about the first two cases diagnosed in Gaza, I was very misfortune by bullying them, which spread on social networking sites, and it became worse for me to publish personal information about the injured to the public, and the blunt manner that some pages conveyed on social media sites, so information exchange For patients, it is permitted according to specific and specific frameworks, such as the risk of transmission of infection to the medical staff who dealt with the case before it was discovered, and here the medical staff is informed in a professional manner, but the publication of the patient's private information through social media is contrary to professional ethics Unfortunately, as a result of the lack of societal awareness, and it reinforces the false idea dealing with the disease as a stigma, it is good that there are individual initiatives taken by public figures when they spread the news of their HIV infection to reinforce a counter-idea which is that it is quite natural for the infection to be transmitted For anyone and there is no need to treat the disease as a stigma, in addition to being an illustration of the experience and symptoms that they experienced.
As for the question about how the families of the injured deal with this matter, it is an important question, as the responsibility here does not rest with the families of the injured, but rather it is the responsibility of an entire community, so I advise in such cases not to deal with bullies in general, and in the first place not to practice bullying And, I consider that such a publication has a role in dealing with the occurring bullying, it shed light on the phenomenon, gaining sympathy with the young man's grandfather, and spreading some awareness about the issue, and with regard to people who have been or are being bullied, there are features that social networking sites allow to report bullies, given that The content they post is Wei are abusive, and as for what causes these people to be bullied, it negatively affects their psychological health, and this effect appears in the form of panic attacks, for example, or persistent symptoms that include feelings of frustration, despair, and thoughts about death and suicide, or the constant anxiety that hinders them from accomplishing their daily actions in the form What is required is advised, and in this case they are advised to seek psychological counseling, and this is not limited to those who have been bullied in this circumstance, but even in various other circumstances, obtaining psychological support and counseling in these cases helps them in enhancing their mental health and protecting them from the consequences of bullying and enables them to To deal with other similar situations.
Maidan: In countries where the curfew was imposed, violent reactions from some people have been observed, such as causing chaos and riots at places where bread and food are sold. Can a curfew measure cause a greater negative impact on mental health than would the official calls for a commitment to stay at home?
Theoretically, this is true. The phrase “curfew” raises a degree of panic that explains the occurrence of such acts and accidents, and causes citizens to purchase huge quantities of food supplies or consumer needs in anticipation of the inability to go out to buy these needs in such a situation, and therefore they seek To protect themselves from being exposed to this, as the curfew includes strict measures, during which people may be exposed to exceptional circumstances that cause a high rate of anxiety and tension among them who are already arising from the current situation, particularly among people who are vulnerable to a possible psychological disorder.
Maidan: Are there any general advice you can give to people who closely monitor developments in the current pandemic?
I advise everyone to obtain information from its reliable sources, and to stop publishing rumors or publications supporting the conspiracy theory. It is unfortunate to see those with a high educational level do so. False information increases rates of anxiety and stress, and I hope that everyone will be careful in choosing the sources of information and not dealing with all What is published on social media as confirmed and correct information unless confirmed by the source of the information, and I confirm once again that there is no effective treatment to eliminate the virus, and everything that is published is still under study and study.