Confinement: “You have to get out of your shell and keep ties” – News Geneva: Geneva news



Panteleimon Giannakopulos is a professor of psychiatry at the University of Geneva. After having directed the HUG department for ten years in his field, he has been in charge of the medical management of the Curabilis prison establishment since December 2015. The surge of the new coronavirus on the Geneva population inspires him with observations and reflections which may prove to be useful for everyone to get through this crisis as well as possible, to support containment and to prepare, the virus passed, for an existence probably different from what it was before the pandemic.

What is the mental state of the Geneva population at the moment?

It is very variable, because we are only at the beginning of confinement. Apart from the applause for the health personnel, we are not yet witnessing collective reactions. By observing closely, we see individual strategies emerge to deal with a radical change in our lifestyles.

What are these personal strategies?

We can cite four: people, say, conformists, follow the rules laid down to the letter; they are less focused on individual freedom, much more on collective duty. Anxious personalities, on the other hand, have reactions of acute stress, strongly fear contamination and spend their time trying to protect themselves; among them there is a weakening of the social role. Another category is made up of people who introduce nuances, such as “we have seen others”, “we may be doing too much”, etc. They tend to trivialize the rules while following them to some extent. And then a minority of people refractory to the laws revolt against what is a deprivation of liberty and break the prohibitions.

Are these people going to be more and more numerous?

We can fear it. We observe this in each chronic crisis because the problem is not so much the measures that we take as their duration. From a psychological point of view, the Federal Council has done very very well to keep the confinement at its current level. If the lid of the steam pot is closed too tightly, for too long, anomaly and transgression can be observed. Anxiety overflows, aggressiveness gains ground.

Are we witnessing domestic violence, for example?

Cases of domestic and urban violence are clearly noted. Confinement forces people to an exercise in introspection and restraint with which we are very unfamiliar. It can highlight relationships, conflicting at the bottom, which become explosive in a vacuum. When you put people in a situation of “rats locked in a mousetrap” inevitably deviations occur which, before, were neutralized by the possibility of escape. There is no other outlet than the mobile phone and the internet, and they have their limits. A very strict system can last for a short time, because people are afraid for their health: with the confrontation with the death toll, you get a large membership, but over time, it may unravel.

Is this already quantifiable at Curabilis?

Not yet, even if we have difficult acute cases linked to the health crisis. In the chain of care, we know that psychiatric pathologies manifest themselves with a delay effect of two to three weeks. We are preparing for it, as we expect the demand for psychiatric help to rise sharply if the confinement is to last beyond April 19, the date advanced by the Federal Council.

What must be done in this crisis so as not to sink?

We should keep activities that bind us socially. The question of work is fundamental, because the notion of duty is very precious for the human being: there are things that we must do. And it’s important to be there for others. Staying at home, creating a bunker and thinking only of saving yourself, this weakens.

Online aperitifs and other internet meetings, is it a good last resort?

Whatever the way, it is a question of making it so that the “5 people” does not become 0. It is necessary to leave its shell and individual references. And focus on what is still allowed! There are a multitude of things that can still be done.

Maintaining rituals – getting up as usual, getting dressed, working, eating and going to bed at the same time – is it saving?

Very clearly yes. In times of stress, ritualization channels anxiety. We must put obligations: our universe must not be limited to our bed and the fight not to be contaminated.

The caregivers are applauded every night. Will people who have a strong commitment to others do better psychically?

For sure. Those and on a completely different level, those who have a religious belief. To remain withdrawn is to risk psychic exhaustion.

Can we easily return to normal life after such a global crisis?

In my opinion, there will be a major societal change. This pandemic calls into question all the benefits of globalization: your neighbor, who lives thousands of kilometers away, can cause your death. It’s new. The day when our lives are no longer in danger, we will have to lead a deep, complex and painful questioning. The risk would be the confinement of nations. When we state the truth that “it is not the virus that moves but people”, we question the free movement of people. The palpable risk is to erect boundaries again, in our heads and in reality.

A war with no visible enemy

Emmanuel Macron compared the fight against the coronavirus to a war. Can the impact of this pandemic be compared, psychologically, to that of a war?

Yes and no. The fundamental difference is the absence of a visible enemy that we are fighting against. The great advantage of war – if I may say so – on the psychic level, is that it leaves a human being with a unifying characteristic: his ability to project the bad outwards. The bad guys are the others. And when the enemy is visible, we also accept losses more easily. In this Covid-19 pandemic, the situation is more pernicious and dangerous for mental balance: the enemy is invisible, he can attack you everywhere when you leave your home. Psychologically, these are exhausting situations when they are prolonged because they force us to manage in parallel the need for solidarity and the obligation of confinement, solidarity and loneliness.

This new coronavirus mows the most vulnerable – children apart. It is special.

Yes, it attacks the weakest: the sick and the elderly. It is completely contrary to the values ​​of our culture, which was built to protect them. We are not at all in the logic of natural selection and these losses are very difficult to live in European culture.

Are we living the most difficult period of the epidemic here?

We must be clear: no. The most complicated period, that of the depressed experience, is if we see that the efforts made do not obtain the expected response quickly. If in ten days, there is a flattening of the curve of infected people thanks to confinement, this will boost alertness. If, on the other hand, we don’t succeed, we could have a depressive reaction: “What’s the use?” However, we can prepare for it by maintaining the social bond, and remain just as vigilant afterwards.

Is it right to put forward end of crisis dates? Doesn’t this increase anxiety?

The problem lies in the principle of hope and disillusionment. We live with our eyes riveted on a regression of the epidemic, at the same time the news is raining, the figures are worrying. We oscillate between the hope that it will stop and the fear that it will be an endless story. And to save ourselves, we give up our individual freedoms for months.

States reacted to this in different ways. What are the consequences of these policies on the psyche of individuals?

You have countries like Holland or Sweden and to some extent previously Great Britain who have bet on collective immunity. It’s another way of looking at society. In this case, you risk considerable human loss, but you better preserve the social fabric and individual freedoms. In confinement, you protect human lives immediately, but at the cost of restrictions which, over time, affect well-being. In this equation the essential variable is time.

Can we easily return to normal life after such a global crisis?

In my opinion, there will be a major societal change. This pandemic calls into question all the gains made in recent years after globalization. Your neighbor, who may live thousands of miles away, can cause your death. It’s new. For a long time, it was science fiction … It no longer is. The day when our lives are no longer in danger, we will have to conduct a deep, complex and painful questioning. Our basic paradigms will change. The risk would be the confinement of nations. When we state the truth that “it is not the virus that moves but people”, we question the idea of ​​the free movement of people, the world without visible borders. The palpable risk is to erect boundaries again, in our heads and in reality.

To see things in a positive light, will we be, after this pandemic, more united to fight together, against global warming or for a concerted migration policy for example?

As long as you calm people’s anxiety about contamination in the broad sense, yes, that’s even the bet. Action plans should be kept ready in case a new common enemy arises, which involves structured thinking that anticipates times of global crisis and not decisions made in panic. It will be necessary if we do not want to go back sixty years.

Created: 26.03.2020, 07h13


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