from London, United Kingdom
With the California wildfires continuing, residents had come to live under very extreme conditions, including heat waves, frequent blackouts, and the on-going pandemic. Described by the Californian Department of Forestry and Fire Protection as the most devastating fire season, the latter provides further evidence to the claim that climate change is real and it is happening right now. Furthermore, it also sheds light on another important aspect, which is the limit of human resilience to disasters.
The combination of the wildfire emergency with the pandemic one is particularly devastating because local authorities are required to respond to them with opposite strategies. Whilst the guidelines to prevent the virus encourage people to stay home, wildfires require them to evacuate and gather together in specific shelters. In addition to this aspect, some of the effects of wildfires, such as low air quality, are also responsible for exacerbating the spreading of the virus. A recent Harvard study, therefore, demonstrates that long-term exposure to air pollution significantly increases the risk of COVID-19 death. As a result, several psychiatrists are hypothesising that the psychological scars left by pandemic- combined with other disastrous situations such as the one in California- may seriously harness the mental well-being of communities, representing a problem at the individual but also social levels.
This article analyses the effects among the global population of a stress en masse in terms of collective trauma- a concept widely covered in war and genocide studies. The aim is to shed light on the strong connection between politics and global mental health as highly intertwined fields that continuously inform each other.
The psychology of a pandemic
In his 2019 latest published book, Steven Taylor has analysed the psychological aspects of a pandemic. He argues that the latter represent fundamental factors that not only trigger emotional distress and social disruption but also inevitably influence the spread of the virus. Simply put, psychological factors can explain forms of ‘popular disobedience’ to the proposed hygiene programs aimed at reducing the spread of the virus. They also play a role for understanding those behavioural patterns, including xenophobia and excessive fear, that develop when people are threatened with a global menace. Finally, they offer an understanding to the way people cope with loss in very uncertain times.
The COVID-19 pandemic has increased distress among the world’s population. The intensity of the virus combined with particular political, economic and health systems have caused some countries to suffer to different extents the drawbacks of the pandemic. Whilst the background of COVID-19 keeps affecting everyone’s mental and physical well-being, people continue to deal with additional crises and disasters. Post-Traumatic Stress Disorder (PTSD) researcher Joe Ruzek has argued that a victim’s risk of developing post-disaster trauma largely depends on their previous history of mental health issues. With the accumulation of trauma in a lifetime, Ruzek predicts that the likelihood of developing signs of (PTSD) significantly increase. It becomes therefore important for a state to provide psychological support to communities dealing with great distress for ethical reasons but also to avoid economic and social burdens.
Collective trauma in war literature
The concepts of collective trauma and generational trauma have recently become subject of investigation for international relations and war literature. Indeed, the notion of psychological trauma consists of “a type of damage that violates the familiar ideas and expectations about the world of an individual or society, plunging them into a state of extreme confusion and uncertainty” (Aydin 2017: 127). An extreme example can be genocide where the killing of a multitude of people- not necessarily linked by the same ethnic, national or religious traits- is often too difficult to grapple into one’s understanding. With the reduction of the individual to a single dimension- used to justify the genocide- the victims are denied of their individuality and history. This can trigger a trauma that trespasses through generations because by denying one’s person’s past, their future is compromised accordingly (Aydin, 2017).
When it comes to a pandemic, the narration of a collective trauma is slightly different, and it must be. The importance of adopting an alternative discourse is an essential strategy aimed at overcoming xenophobic repercussions and conspiracy beliefs whilst providing effective responses to the specific pandemic emergency. Even though levels of suffering caused by a genocide are way more serious, the pandemic presents several risk factors for PTSD. These include, “sudden death, life-changing events, large-scale social ruptures and chronic stressors” (The Economist, 2020).
COVID-19 and mental health
Researchers have identified three types of psychological trauma in a pandemic. The first one concerns those who directly experience the virus. The second one involves those who witness patients suffering from it. This category includes family members and friends but also aid workers who represent one of the most psychologically affected categories for COVID-19. In Spain, for instance, a study based on the experience of 1,422 health workers has found that 56.6% of them present PTSD symptoms, 58.6% anxiety’s symptoms, and 46% depressive disorder. Finally, the third category affects those experiencing stigmatization and the realistic or unrealistic fear of infection (Xiao et al., 2020).
However, the categorization overlooks the fact that some communities and/or social groups have received less assistance during these last few months. Even though during a pandemic everyone becomes a potential victim, some individuals- due to the intersectionality of dimensions such as class, gender and sex- can suffer, to a wider extent, of the virus’s negative effects. As a result, the risk of developing mental health disorders among such groups further increases.
Structural inequalities during a pandemic
In the US, for instance, the non-partisan APM Research Lab shows that African Americans have died of COVID-19 at almost three times the rate of white people. This may be attributed to unequal socio-economic conditions- determining citizens’ access to the healthcare system- that have been exacerbated during the pandemic. In this regard, it is also important to mention the global surge in domestic violence– a consequence of self-isolation measures and confinement at home. With the increased demand, institutions that are supposed to protect women from Intimate Partner Violence (IPV), already weak and underfunded, are falling short from assisting victims (Bettinger-Lopez and Bro, 2020).
Pre-existing literature had already pointed out to the higher propensity for these two groups to develop mental health diseases, including PTSD, depression, anxiety, substance abuse and thoughts of suicide. A systematic review and meta-analysis has found that, outside the pandemic, women experiencing IPV are seven times more likely than men to develop PTSD, 2.7 times depression, four times anxiety, and drug and alcohol abuse six times. At the same time, research also shows that the legacy of slavery in the US has left an intergenerational cultural trauma among African Americans, leading to higher psychological stress and PTSD. In relation to the latter, scientific evidence points out that high levels of accumulated trauma increase the likelihood of developing negative health outcomes (high blood pressure and diabetes) and suicidal thoughts.
Having to deal with COVID-19’s secondary traumas (isolation, economic instability, and human losses), marginalised communities find themselves in the position to deal with increasing complex situations- already aggravated by historical traumatic experiences.
Conflict-affected low and middle-income countries in the era of COVID-19
The global health crisis also presents extremely compounding levels of risk for people living in, as well as those displaced from low to middle income countries (LMICs) (Bentley et al., 2020). There is a high chance therefore that people living in these countries are already experiencing humanitarian emergencies which inevitably affect, on the one hand, individual countries’ healthcare systems, and, on the other hand, population vulnerabilities in terms of “public mental health and psychosocial picture” (Ibid, 2020: 261).
In a context like the Somalian one, researchers have investigated the effectiveness of “local to global” approaches which consider the intersection of the different concerns to which the population is subject. In other terms, they argue that community-based interventions that integrate faith principles are more effective at tackling ongoing collective traumas as well as understanding the risks involved with the global health emergency.
The example of Somalia is indicative in this case because the country has suffered famines, waves of displacement, a civil war and natural disasters. The high rates of mental illness, with one in three Somalis affected by some form of psychological disorder, makes the country one of the conflict zones with the highest prevalence of mental disorder in the world (WHO). Within this context, the lack of mental health assistance centres only contributes to further instability, creating a spiral in which the violence and the killings are also the consequence of unaddressed mental health problems (Mumin, 2018).
Faith and local culture-based approaches
During the COVID-19 pandemic, given the infrastructure limitation, resource limitations and displacement, Somali communities in-country and abroad have strongly relied on collective values, including faith in Islam and social support with one another. In practice, this has translated into community efforts to protect the most vulnerable to the virus, such as elderly people, individuals with chronic health conditions and those coming from poorer socioeconomic backgrounds. As a result, faith in Islam has provided Somali communities with effective tools to cope with the stressor collective effects of COVID-19.
This example is also evidence to the importance of faith perspectives and local culture to mental health, suggesting that healing in certain communities is strongly linked to values that not always are recognized by Western mental health services. An interesting insight, in this regard, comes from the Stanford anthropologist Tanya Luhrmann who has investigated the role of local culture in understanding schizophrenia. Results from interviews conducted with 60 individuals from the US, Ghana and India reveal that Americans registered only negative experiences with their voices whilst Africans and Indians had predominantly positive ones. Her final findings suggest that experiences of ‘hearing voices’ are strongly shaped by the way specific cultures envisage with social norms, with people outside the West imagining the self as defined through relationships.
Conclusion
Acknowledging the role of local culture in shaping mental illness opens up to alternative clinical paths to treat people with schizophrenia. At the same time, it is also plausible to think that treating mental illness, in general, requires an understanding of the environments in which individuals live.
In the context of a global pandemic, for Somalis, Islamic faith and collectivist values have served as “coping pathways in response to longstanding collective trauma and the acute stressors presented by COVID-19”. In the aftermath of a catastrophe, people tend to cope better when they perceive strong social support, thus strong communities are generally more likely to organise in times of crisis.
The process through which communities become ‘strong’ is specific to their values and history. However, there are universal elements, such a good leadership and the establishment of mutual aid-networks, that can foster unity and solidarity among people whilst alleviating the effects of the collective trauma. On the contrary, when the aforementioned conditions are lacking, people are left to deal with a harsh reality. This can foster “self-centered prepping behaviour” which is positively linked with conspiracy belief about the Coronavirus disease, and uncover racialised responses to fear which will disproportionately affect marginalised groups.
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Autore dell’articolo*: Ginevra Canessa, laureata in Politics and International Relations, BA (Hons), University of Kent (Regno Unito). Studentessa presso la London School of Economics per un Master (MSc) in Human Rights. Addetta alle questioni di Global Gender Justice del Think Tank.
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