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Mental Health in quarantine: self-care and care as a collective practice

The changes in economic, social and emotional life caused by the Covid-19 pandemic are profound. It is not an exaggeration to say that our generation, or a significant part of it, will definitely be marked by the experience of living an acute epidemiological risk, of seriously fearing the lives of their most vulnerable relatives, of adhering to an unprecedented social isolation. The consequent voices from the field of Science, Health and Public Health, loaded with social responsibility and technical rigor, become, more than ever, a guiding and even appeasing element for our broken routines. In this scenario, it is quite positive that intellectuals and mental health professionals are willing to go public to talk about the need for self-care practices at a time when isolation, the breakdown of routine and expectations already established for the future generate widespread anguish and anxiety. The suspension of life organizers at this time is not just a matter of routine breaking, however. It is important to stick to this, so as not to fall into the error of seeking individual solutions to problems of a collective order. At the same time that anguish is generated by the lack of daily markers that organize daily life, such as leaving home every day, having coffee there, returning home at a certain time, we cannot understand this process in isolation. The deterioration in the general state of mental health of the population comes not only from the breakdown of routine and isolation, but above all from material uncertainty, deep financial insecurity, and information chaos. Material uncertainty is not a new determinant in the life of the Brazilian population, mostly poor, black and underemployed. But these uncertainties and insecurities deepen acutely with the pandemic, a circumstance that has arrived very suddenly for the majority of the population.

An article published by the Lancet Magazine on February 26 addresses the psychological effects of quarantine. The Lancet is a British journal of reference in the field of medicine, and one of the oldest scientific journals in the world. The article reviews 24 previous studies that researched the subject on the occasions of SARS, H1NI1, Ebola, and other relatively recent epidemics. It is interesting to discuss here some of its results, in light of the understanding that the way one lives, works, gets sick and cures is mainly determined by the position of individuals in class society, and that the response to illnesses suffered individually or collectively involves questioning this economic system. Class society is also structured by racism and patriarchy. One of the first conclusions of the article is that, during and after quarantine, “symptoms” arise related to so-called post-traumatic stress, which can include fear, anger, grief, torpor, confusion, anxiety-induced insomnia, and compulsive behaviors (such as constantly washing one’s hands, and starting to avoid agglomerations for a long time). This effect would not be uniform: people who had already suffered from previous psychic illnesses, and health professionals, would be more vulnerable. There would also be stressors that could worsen the effects during quarantine: long duration of isolation, frustration and boredom, inadequate information and inadequate supplies. The obvious is that the central task of maintaining the mental health of quarantined people is to ensure that they have access to income, food and financial security, and correct information.

When we, professionals of the health area, talk about the relationship between stress and lack of money, or even stress and chronic poverty, we do not always pay attention to the depth of what we are talking about. It is not a one-off stress, which manifests itself acutely. Nor is it simply the fruit of desire frustration, which we must all learn to deal with. It is a place of permanent suffering, which is independent of one’s actions, work capacity, or even one’s psychic resources. It is a place of permanent precariousness that should not exist, and only exists because we are in an economic structure founded on exploitation and inequality, in which a slice of society must necessarily live in bad conditions, so that an absolute minority can concentrate wealth. The suffering caused by being in this place is not punctual, and “stress” may not be the best word to describe it. Feelings such as anger, fear, confusion, torpor, caused by insecurity and economic injustice, lead to compromised ability to live and plan life fully, to see oneself as a social and historical subject, to make long-term projects and plans, to understand one’s own working and creative capacities and to take full advantage of them. In short, economic injustice and financial insecurity, concern about what to eat tomorrow not only leads to occasional stress, but causes permanent mental health damage for a large part of the population.

The pandemic caused by Covid-19 accentuates these processes, and reveals how the way we organize life, work and production globally is not capable of responding to a pandemic that could compromise the lives of millions. Why is a debate about a decent minimum income so controversial in a context that it is absolutely necessary to decrease social circulation? Why has a local epidemic turned into a pandemic so quickly? Why are the psychological effects of quarantine, which can be diminished by collectively oriented measures, not considered a priority for governments? It is not enough to guide people who reorganize their routine and have self-care practices such as meditation, physical exercises and reading, although this is important. There is no possibility of reducing the damage to mental health without, as the article puts it, a financial guarantee, and a guarantee of clear and quick information.

This other element put forward by the article, the guarantee of clear and quick information, is also compromised by an unequal and exploratory structure. Part of the population does not have access to either clear information or formal education to understand and appropriate this information. In Brazil’s case, the federal government, especially in its most ideologically reactionary core, acts to confuse and distort. President Jair Bolsonaro even said it was a “flu,” distorted public health officials’ statements, and spread untruths about medicines that would cure Covid-19. His well-paid army of message applications keeps shooting up false or distorted news in an attempt to protect the government’s image during the crisis. Crisis from which this government obviously has no interest in protecting the Brazilian population and its well being. The states of fear, confusion, panic and torpor that manifest themselves in an individual manner are directly related to this. Especially for the elderly, or people with little access to so-called digital literacy, more likely to believe in the most varied news and inadequate information.

The government’s negligence and mismatch also clashes with another element brought by the article: the question of the duration of quarantine. According to the authors, to reduce the damage to mental health, short quarantines should be sought, the maximum posśivel respecting epidemiological recommendations. The extension of this period should also be avoided at any cost. It is better to clearly guide the population to a three-week quarantine, for example, than to impose one of 10 days and extend it for another week. The government is reluctant to guide a full quarantine of adequate duration, and the disharmony between the presidency and state and municipal governments only delays the isolation that must be done, causing even more doubts in the population. The lack of tests, a reflection of the dismantling of the SUS, especially the Health Surveillance, not only generates underreporting, but causes the need to extend the quarantine time, because there is no mapping of which are and where the infected circulate.

Frustration and boredom in quarantine are also pointed out as stressors, and measures that can decrease anxiety and increase communication, such as universal access to quality Internet, are protective of mental health. These measures go through personal redefinitions but mainly by social structure, it is important to remember. It is interesting to reflect on a contradiction posed by the global capitalist structure: the large urban agglomerations, the megalopolis, in which millions of people live together, a majority in densities of precarious housing, by potentializing the capacity of contagion of the coronavirus, causes more distance between us. The irrationality of megalopolis is revealed. At the same time that it gathers us, it pushes us away. If there is something possible to be generalized as universal in humanity, it is that we are social and interpersonal. We make ourselves from the other, we are because we are in relation. Our approach in large urban agglomerations, however, is in favor of an illogical and unsustainable capital that creates inequalities, anguish, isolation and health risks.

One last element brought by the article gives us a good hint of the direction we can take: according to the authors, although it was not possible to carry out a study that compared in isolation the difference in mental health between those who entered into quarantine on a mandatory basis and those who entered voluntarily, several publications showed that the symptoms of stress, anxiety, anger and fear associated with quarantine were reduced when people knew that their attitude was significant to preserve the life of pŕoximo, especially the most vulnerable. Stress was also reduced when this effort was socially reinforced, with the media and public authorities publicly thanking those in quarantine. This conclusion gives us the principle of some answers: until the Brazilian government and part of the media recognize and publicly value those who are in quarantine, the anguish for part of the population will not be mitigated. It also tells us that the goal of self-care practices – reducing levels of anguish, stress, anxiety – is also achieved when it is known that its action preserves the lives of others. It is important that we continually remind ourselves of this. It also points out to us that the answer to part of the anguish is not just self-care. Exercising active solidarity, such as through collective care campaigns, financial campaigns, food collection campaigns, understanding how capitalism and its crises diminish the value of peripheral lives, is important. It is also to recognize that the answer lies centrally in thickening the social broth of resistance to the “top floor,” represented by the Bolsonaro government and megamillionaire businessmen who continually impose on the people an economic and social program that places the profits of some above the lives of the majority. Neoliberalism is not only an economic reorganization of the productive forces in order to intensify exploitation of the workers: it is also a form of sociability that induces individualism and affectively chaotic states. Many have pointed out that the Covid-19 crisis may leave as a legacy different ways of relating socially, with care, solidarity and collectivity being taken as more central values. It is essential that the questioning of the global economic order that generates individualism and injustice be part of this possible change in the ways of caring for oneself and others.

References

Magellan B. New coronavirus: the need for a response from the people.

Gonçalves, NP; Alves, L; Martins, J; Minowa, E; Pennachioni, N; Couto, V. Coronavirus: The failure of the capitalist system and the radical defense of SUS

Brooks, SK; Webster, RK; Smith, LE; Woodland, L; Wessely, S; Greenberg, N; Rubin, GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020, 395.

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