This opinion piece by Benjamin Herbstman, MD, MHS and Holly Blatman, MD was first published on April 7, 2020 in The Boston Globe.
The potential consequences of noncompliance are being outweighed by the human desire to find comfort from loneliness and feelings of helplessness by gathering in groups.
Given the current wartime reality in health care facilities battling COVID-19, it can be difficult to understand why all of us are not taking social distancing and stay-at-home measures more seriously. New York Governor Andrew Cuomo recently called group gatherings in Central Park “insensitive . . . arrogant . . . [and] self-destructive,” channeling his anger and frustration at seemingly uncaring citizens. But while anger and blame are understandable reactions to people who are not heeding the public health call, they don’t help us understand or change individual behavior — or make it more likely for people to follow the restrictions that we all need to follow in order to safeguard thousands or even millions of lives.
In our work as psychiatrists and psychoanalysts, we often observe people employing psychological defenses such as denial, avoidance, dissociation, splitting off of consciousness, and compartmentalization in order to make an unbearable reality more manageable. This can occur on an individual level and also on a society-wide level and is a common response to trauma. That is exactly what is happening here: Even though many of us are not yet physically sick with COVID-19, we are experiencing trauma as individuals and as a nation, and it is this emotional trauma that is behind many instances of noncompliance.
We have seen such a society-wide trauma before in the aftermath of Sept. 11, 2001, when 7.5 percent of New York City residents were diagnosed with Post-Traumatic Stress Disorder. But Sept. 11 was a violent trauma experienced collectively by a nation in one day. Citizens not only watched the attack unfold on television but also witnessed its aftermath for months and years in the rubble of Ground Zero. All New Yorkers felt equally threatened, and gathering in groups was both harmless and, indeed, therapeutic.
By contrast, COVID-19 is a largely invisible threat that each person is experiencing differently, depending on their job, the prevalence of disease where they live, the patchwork of local response, resources available in their community, and whether the virus has impacted the health of someone they know and love. What’s more, unlike the attacks of Sept. 11, many important aspects of this trauma are occurring out of public view — from the spread of the microscopic-sized viral particles themselves to the terror of health care workers updating their wills and advance directives as they get ready for war-like hospital deployments.
In other words, we are living in alternate realities. This lack of a shared experience makes it hard for people who are not affected by the virus to comprehend the potential consequences of their actions. It also makes it difficult for those people who are directly dealing with the virus to understand why others are not heeding restrictions that will undoubtedly save lives.
Based on our clinical experience, we believe that instead of turning to anger and blame, it is more useful, as individuals and a society, to approach the situation with compassion and psychological understanding. We say this not because flouting restrictions should be accepted, but because an empathic approach — one that helps people consider their behaviors in the context of emotional trauma — will enable them to better process reality and choose to mitigate danger by following lifesaving public health advice.
For the people on the front lines of the pandemic, the social restrictions are essential and any violation is intolerable. But for people not on the front lines, the potential consequences of noncompliance are being outweighed by the human desire to find comfort from loneliness and feelings of helplessness by gathering in groups.
It is understandable that the psychological defense mechanisms of denial, avoidance, dissociation, splitting off of consciousness, and compartmentalization would be mobilized. These mechanisms are unconscious attempts to maintain calm and equilibrium in times of danger, but they diminish one’s ability to accurately assess present risk and react in a fully rational manner. They explain how even a caring and thoughtful person could attend a group outing in the park or on Boston Common despite the certainty that it will contribute to viral spread, unmanageable numbers of patients in hospitals, and increased mortality.
So, what can we all do with these insights? When you find yourself talking with someone who is about to go on an unnecessary errand, to a dinner party, or on a weekend with friends, consider these ideas: Empathize with their wish to find comfort with friends and have a life that feels normal again; ask how they weigh the risks of going out — to themselves, their family, and those most vulnerable; share what you know about the risk of viral spread and how it relates to going out; and remind them of the critical situation in hospitals.
The life and death of patients and health care workers depends on helping everyone stick to the stay-at-home rules. In our experience, an inquisitive, noncritical attitude, plus accurate information, best enables people to make good decisions.
Benjamin Herbstman MD, MHS is a psychoanalyst on the faculty at the Boston Psychoanalytic Society and Institute. He is a Lecturer, part-time, at Harvard Medical School, and Assistant Psychiatrist at McLean Hospital, and has a private practice in Cambridge, MA.
Holly Blatman, MD is a psychoanalyst on the faculty at the Boston Psychoanalytic Society and Institute. She is a child, adolescent and adult psychiatrist in private practice in Cambridge, MA.
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