Mental Health, Isolation and Lockdowns

Brian Davey reflects on his past experience about the impact that self isolation is likely to have on the mental health of many people. It is not going to be easy – make sure that you stay in touch by phone or the internet. Show you have not forgotten elderly and vulnerable people….don’t feel you have to offer helpful advice if you don’t really know what would help – just listening attentively to what other people are going through and not invalidating their feelings will help.

Mental Health, Isolation and Lockdowns

Since an increasingly large number of people are self isolating voluntarily or in enforced “lockdowns” around the world it is importance to understand what that means for peoples’ mental health. The longer this crisis lasts, and the more people are obliged to isolate themselves, the greater the mental health impact across society will be.

I used to work in the UK voluntary sector mental health services as a “development worker” – developing projects and activities for people with mental health issues. I got into this role and job because in the late 1970s and 1980s I had mental health problems. This led me to think a lot about what was happening when I had mental health crises. I thought too about the mental health crises of others. Over time I arrived at an interpretation of mental health problems in which isolation, solitude, loneliness played an important part.

In the ordinary way of thinking people with mental health problems are typically on their own because of their mental health problems – but I began to think that it made as much sense, indeed more, to interpret things the other way round. In other words not that people are on their own because they are mad – but that they are mad because they are on their own. This was particularly true if they were in a state that I described as “confrontational isolation”. In other words where someone falls out with everyone in their social network. Even if one has not fallen out with everyone, to be isolated, and in a state of high negative emotion, is dangerous for mental health.

How difficult it is to be isolated day to day will depend a lot on how much resources we have in our environment. People who are homeless are most vulnerable of all and cannot self isolate.

Isolation undermines reality-checking so that fantasy thinking flourishes

If they are isolated people cannot easily “reality check” things that are important to them – like, for example, what other people are thinking, feeling and doing. For example, if you are on your own and you feel vulnerable it is easy to be paranoid and afraid and you have no way of knowing if you are in danger or not. Such a state of affairs inclines to emotionally charged fantasy. The point here is that without communication what is really going on with and for the other people in your life is inevitably a guess. They may have totally forgotten you. They may be coming to get you. They may be worried for you. You don’t know. You are in the dark. Isolation = vulnerability + uncertainty and you may endlessly speculate in hopeful or fearful thinking about what is going on.

That can make “lockdowns” so psychologically challenging. We have radio, TV and the internet. We have telephones. So we can still maintain media-ted contact with each other. Nevertheless isolation is emotionally tough.

Now add the fear that we, and loved ones, may get infected and may die. To remain sane we have to watch the news to stay in touch with what is happening – but what emotions occur when we go on twitter and see a convoy of ten Italian army heavy trucks carrying coffins to a crematorium?

The point here is that our thinking can get driven by powerful emotions while on our own when confronted by the awful reality of this pandemic. Thoughts that are fearful about the worst that might happen. Thoughts that are swept along by a powerful sense of our own helplessness.

Mental states that may flourish in emotionally charged isolation

Such mental states may then evoke (a) an inability to concentrate on meaningful activities, a state of distractedness and/or wandering off mentally into reassuring day dreams; (b) mental flashbacks about earlier events in life where one felt powerless and afraid because one did not understand what was going on and was too young to act (regression) (c) noticing the contents of one’s own mind as an internal monologue – powerfully charged with emotion (hearing voices – perhaps with different voices for different emotions and situations).

It is not just powerful fear that may drive our thoughts – anger and hope may too – but in ways that are unrealistic and unverifiable. The point about isolation is that one has neither the time nor the contacts and ability to check the truth of our own emotion driven thought processes.

For example it is quite natural in the time of the coronavirus to have strong political opinions about how the crisis has been and should be managed – indignation and anger may be fully justified if and when situations are mismanaged by officials or politicians.

BUT…how does one know why they do what they do – is it malevolence, is it incompetence, are they overwhelmed or have we misinterpreted them totally? Or have the politicians misinterpreted us. They speak about us panicking but is this so? We are accused of stripping the shelves bare of loo rolls but if you have a big family and there is to be two months lock down or longer is the problem that there are not enough loo rolls available on the shelves? Are we being kept in the dark so that we do not panic? If so maybe they are creating a panic because fears flourish where there is a lack of knowledge. Are “they” treating us like children as one public health expert has alleged. Are they assuming that they know best and condescending us like the patricians they regard themselves as being? Many of these questions are unanswerable from the information available but add to the confusion and is a source of anxiety and turmoil in its own right.

Paradoxically even our hope can sometimes be a problem. You may ask: how could hope be a problem? The poet T.S.Elliot writes in his poem East Coker

I said to my soul, be still, and wait without hope
For hope would be hope for the wrong thing; wait without love,
For love would be love of the wrong thing…

Some of us are hoping for a salvation in which we are the saviour – our vulnerability, our terror and powerlessness is too much to bear so in our day dreams we turn the powerlessness upside down and become a someone. We become fantastically important superstars…like Donald Trump who has the answer for everything and is doing an absolutely fantastic job…or making it up as he goes along and totally unable to be objective.

This is particularly because Trump and Johson is surrounded by institutions that are obsessed by retaining their power and credibility by being seen to make the “right decisions”. They also feel the need to redirect everyone’s fear, anger and indignation onto someone else to make sure that it is not directed at them – in a time of crisis there is competition for who is to play the role of scapegoat.

Scapegoating

Vulnerable people can become scapegoats too. Vulnerable people live lives where they are frequently ignored by petty officials and/or may be persecuted by them. The emotional state of neediness by vulnerable people may lead them to insistent claims for help and attention that others, who are themselves overwhelmed by the same crisis, find a distraction adding to the unbearable pressure. In the end the decision makers unload their anger and desperation with an attack on the needy people that will not leave them with any space. “Look we have operate a triage and you are in the third stream – will someone lock this person away.”

Mostly scapegoats are weak and vulnerable people. The anger and desperation generated by a crisis cannot usually be directed at people more powerful than yourself. That would be dangerous – they may remember and later take revenge. So powerful negative emotions are re-directed downwards and reasons are found to justify and rationalise the persecution. People find themselves doing ugly things. Then they must do those things again….and again…Then they cut themselves off from what they are doing. Then they start to enjoy what they are doing because it makes them feel powerful. It gives them a sense of agency in a time of chaos as they take away the agency of others. To justify doing it they demonise the one’s they are persecuting and tell themselves that their cruelty is for their own good, for the good of everyone.

Yet in this case vulnerable people are likely to be sources of infection because they do not have the means to protect themselves and in their extreme vulnerability are likely to become erratic, distracted at too many conflicting demands on them. This renders their lives unmanageable because they have no where of their own to keep themselves separate and manage personal hygiene.

These remarks extend to prisoners who are kept in conditions that are optimal for the spread of disease – including spreading it to prison warders and other staff.

Contrasting the isolated to the ‘well connected’

There is an irony here. While the most vulnerable in our society like homeless people and prisoners are unable to protect themselves by keeping themselves apart – this is also true, with this disease, of the ruling elite.

If you study how the elite keep and exercise their power it is not only by using the fabulous amount of money that they have, the “purchasing power”, it is also by using their “well connectedness”.

To be a part of the ruling elite you must be very intensively networked. A host of institutions exist to ensure that powerful people in one field – finance, energy, media, military and military industrial complex, manufacturing, academia – are able to easily connect, as needed, with other powerful people in others. In a global economy institutions exist in an international network.

The elite are at the other end of the spectrum from the people living in the hell of social isolation. They are highly connected – and not just through telephone wires and internet communications – they are connected in person. “Well connectedness” operates through and in political assemblies and parliaments, in committees, in clubs, in gala events and garden parties, at palaces, stately homes and elite hotels – as well as at Ascot, on television shows or though regular attendance at the World Economic Forum.

Of course the elite too can retreat to self isolation – indeed they can retreat to their private islands and to well stocked bunkers with wine cellars. That is if they can get there and their private jets are not stuck on the tarmac as has happened to some trying to get out of London. I do not know whether mental health problems would take quite the same form if isolated in an elite bunker – perhaps part of the terror might of being locked in.

Whatever…. most of the elite have already left it rather late, perhaps too late….and suddenly, belatedly they are discovering that the idea that “there is no such thing as society” does not work in the age of the coronavirus. There is a society after all. They are part of it and so are elderly, disabled and sick people. These might be their elderly parents or they might be the vulnerable person that infects a nurse that infects a health official that infects an adviser that infects a health minister….

So as not to be unbalanced about this – we should also noticed that a state of prolonged isolation sometimes is a blessing. It may give us a period absence of distraction in which to devote ourselves exclusively to things we always meant to do but never had time to before – to learn a new language, learn to draw or paint, write articles or even a book…
Isolation and lock downs as a time for creativity?

This idea was the basis of a book by Anthony Storr written in the mid 1990s that I read and reviewed many years ago. His book is called “Solitude” (HarperCollins 1994) but its original title was “The School of Genius” and his aim in writing it was to challenge the implicit assumption, so common in therapy, that success in relationships is the only key to happiness.

Creativity and achievement can also provide satisfaction in life – and creativity often requires isolation from the distraction entailed in close human involvement. Storr shows that the capacity to be alone is valuable in a variety of circumstances – when it helps people to get in touch with their deepest feelings, in coming to terms with grief and loss; in sorting out their ideas and in the changing of attitudes. In a series of short biographies of artists, musicians, authors, philosophers, he shows that without long periods of isolation their achievements could scarcely have been possible. In many of these biographies there is a repeated pattern of miserable, lonely and/or persecuted childhoods of people who then made no intimate human relationship (but who were often regarded with affection by friends, not to mention the audiences of their work). It was through their work that these people found their salvation, repaired some of the hurt, found satisfaction in their achievement and creativity.

Enforced isolation and sensory deprivation

But solitude is not always to be regarded positively. Storr’s chapter on “Enforced Isolation” is prefaced by a quote from Francis Bacon. “The worse solitude is to be destitute of sincere friendship”. In this chapter he analyses the effects of solitude in conditions of solitary confinement, the psychological torture of political dissidents, sensory deprivation and the like. In these cases the mental breakdowns that result are no different, though Storr does not say it, from the symptoms of schizophrenia – namely hallucinations, confusion, extreme anxiety, a lack of care about personal appearance and habits. That is what is so appalling about the treatment of Julian Assange and Chelsea Manning when they exposed war crimes by the elite – there has clearly been an attempt to psychologically break them by extended and brutal solitary confinement with no chance for them to express themselves.

There are some circumstances where solitude may be a wonderful chance but, for many people it is not going to be like that in the lock down facing us. For many people isolation and sensory deprivation might become the stuff of everyday life – sensorily deprived because they have no money, sensorily deprived because they have no work, sensorily deprived because they live stacked in rectangular environments of grey concrete, peeled paint and glass and surrounded by grass; sensorily deprived because they are no longer able to get the distraction of going out to visit their friends and neighbours in a pub.

A crisis of isolation AND destitution

Earlier I wrote about how people may survive through their creativity in writing or painting or with their computer – but a lot of people are probably not going to have the chance for getting on with what they have always wanted to do without distractions. The nagging worry that prevents them getting on with other things, will be about how they are going to make ends meet as jobs and pensions disappear and the value of lifetime savings melts down. Can one really be creative as one is worried about how to earn a living or where is the next meal is coming from? We are really only in the beginning of this crisis yet and the lockdown may go on for a long time while the economy deteriorates with deep impacts on everyone.

What I am writing about is isolation AND impending or actual destitution. There is a convention in the mental health field, because it is organised as a speciality for the health and social services, that people develop mental health problems and thus cannot look after themselves and thus need a medical and social intervention. This is an artificial way of thinking about things that arises from a professional and institutional division of labour. It isolates a psychiatric problem as “the” problem and it assume that the other problems follow from the psychiatric one.

A better way of thinking about the situation like this is that people are going through a life crisis. Ideally this is a transition from one kind of lifestyle that was unsustainable to another (which will hopefully then be sustainable). Multiple dimensions of life are collapsing and all the changes have be coped with at the same time – crisis of habitat, occupation or studies, income and debts, personal and work relationships and routines. Managing all these together will likely cause chaos, absent mindedness and distractedness in life practicalities. All of these things are and will create profound insecurity, anxiety and emotional turmoil. However these distressing mental and emotional states are not “the” cause of what is wrong but one part of a huge problem.

This is a lot clearer in a collective crisis like this one than if it were happening to one person but the essential issues are the same. There is the need for a new “package” of life routines and elements that is sustainable before mental and emotional turmoil will stabilise.

It does not make sense to see this as a mental health crisis “causing” the other issues. Those people who isolate “panic” as “the” cause of current events because they judge that others are “overreacting” are not seeing things in a useful perspective. Of course people are panicking! In fact one of the problems has been the complacency of the elite which is only waking up now to how serious this is and have allowed the infection to spread to a catastrophic level.

This is explained in my book Credo in chapter 31 where I anticipated a situation like this. Chapter 31 is titled “Life Management, Stability and Life Transitions” see

http://www.credoeconomics.com/wp-content/uploads/2017/02/credo.pdf
Also http://strategyforlosers.blogspot.com/2008/04/de-growth-economy-and-lifestyles.html and http://www.bgmi.us/web/bdavey/Breakdowns.htm
See also my review of Anthony Storr’s book at http://www.bgmi.us/web/bdavey/Solitude.htm

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