The B side of the COVID-19 pandemic: sealed cities, invisible psychological trauma

During the nearly two-month outbreak, a video went viral on social media.

As night fell, the residents of the sealed community pushed open the windows and shouted and shouted from the lit windows. The sound waves rise and fall, transmitting reflections between vertically lined buildings.

The meaning of shouting is either anger, or loneliness, boredom or even simple catharsis. And this scene has also become a microcosm of public sentiment under the epidemic.

The pandemic of infectious diseases brings not only a public health crisis, but also a psychosocial crisis.

According to the WHO, in the first year of the COVID-19 pandemic, the global incidence of anxiety and depression increased by a whopping 25%.

A study in The Lancet shows that in 2020 alone, the number of cases of major depressive disorder increased by 53 million worldwide, with more than 35 million of them being women.

The biggest victims are children and young people. For the huge group of teenagers, the two years shrouded by the epidemic occupy the most important stage of their growth. Their childhood and adolescence, which are required to stay at home and lack social activities and outdoor exercise, have a psychological impact on these young people far beyond our imagination.

The uncertainty of the pandemic, which has lasted for more than two years and will continue to continue, has enveloped people's lives in all directions, causing long-term and hidden psychological trauma.

Not only that, but while all people are anxious, some people are more anxious. If the psychological stress capacity of the Chinese people is regarded as a curve of normal distribution, then the vulnerable groups that are already on the left are even more shaky under the impact of the epidemic:

These include those who are on the verge of collapse but cannot be said to be underprivileged, medical workers with occupational exhaustion and stress disorders, adolescents with rising rates of self-injury and suicide, and patients who are already plagued by mental illnesses...

People on the brink of collapse

On April 8, the 10th day of the community being sealed, it was raining lightly outside, the rental house was not willing to turn on the lights, the dim corner of the dining table, Li Xiang, who had been idle at home, began to boast to his family with his eyes shining, saying that he had millions in his bank card, and he wanted to go back to his hometown in Jiangxi to get married and hold a banquet, buy a house, buy a car, buy a diamond ring...

"He must be hallucinating again", Li Xiang's mother was frightened, and his friends who often chatted with Li Xiang also felt this fear, li xiang must be something wrong.

On National Day last year, from her hometown in Jiangxi, Li Min, a single mother, moved to this rental house in Shanghai's Songjiang District to live with her son Li Xiang, who has been working for many years. Later, Li Xiang's younger brother also came to join his mother and brother, and he was ready to find a job in Shanghai, hoping that the brothers would help each other and take root in this strange city.

Mr. Lee was tall, emaciated, and a truck driver in a convoy who was responsible for transporting heavy loads to companies in nearby towns. At work, in addition to driving, he also had to help carry the heavy goods, and he was exhausted by the physical labor of getting up early and dark, and every time he came home from work late at night, he had hastily ate the dinner prepared by his mother and went to bed.

But there is hope for the future. This nearly 30-year-old bachelor is the economic pillar of the family, with an income of 8,000 to 10,000 yuan per month, which can support his mother and brother.

However, the pandemic has changed all that. The sealing control came suddenly, there was no pass, and the car could not be on the road, which cut off Li Xiang's source of income. There are tens of thousands of yuan of savings in hand, but to pay rent, to buy a family of three grain, only out of the project without income, this family of three can not support for long.

Time passed minute by minute, and Li thought that there was nothing to do at home, and the pressure was getting bigger and bigger.

Symptoms begin to emerge from an argument. Because he suddenly wanted to buy a new mobile phone, Li wanted to mix with Li Min, and then cried. Li wanted to feel that he had paid too much for his family and deserved a reward, but he was blocked by Li Min. Li Min believes that it is not too late to buy it when the seal is unsealed, and his son may just feel wronged, so he comforts a few words and gives up.

However, what no one expected was that after that quarrel, Li Xiang's situation took a sharp turn for the worse, and he began to constantly talk about going over the wall to go out to do things, how could not be stopped, Li Min began to be vaguely worried, she entrusted the neighborhood committee to ask a doctor to see the doctor. As a result, Lee wanted to be diagnosed with bipolar disorder.

After taking the medicine for a week, Li Xiang's situation was getting worse and worse, and even there was a scene of hallucinations in front of him, he wanted to go home to do a banquet, Li Min told him to wake up, "but he couldn't wake up."

"My son has always been very well-behaved and sensible, why did he suddenly get mentally ill?" Li Min did not understand.

In the view of Tang Wei, chief physician of the Department of Psychiatry at Wenzhou Corning Hospital, Li Xiang's case is typical, and he represents a group that is most easily overlooked.

Similar to Shanghai, Wenzhou also has a large migrant population. Since the outbreak of the epidemic, Tang Wei has received many patients who have worked outside the country.

He told Eight Point Jianwen, "These low-level workers living in urban villages, when the epidemic came, were sealed in a place that was not very familiar, could not go out, had no income, their pressure was the greatest, often on the verge of collapse, but they did not know where to find a psychologist and how to vent." ”

The vulnerability of this marginalized group can only be known when symptoms are present. Patients attended by Dr. Tang Wei often develop acute stress disorder and are brought to the hospital by family members or community workers.

Symptoms of acute stress disorder include noisiness, hallucinations, and delusions of victimization. If not treated in time, the condition can get worse and even hurt yourself or others.

Zhao Bin, a family doctor who works at a cabin hospital in Jing'an District, also met a girl with a fierce mood, Xiaomi, who was unwilling to do nucleic acid testing and refused to leave the cabin.

Xiaomi, in her twenties, came to Shanghai from the southern provinces to work, because of the new crown infection, the house she rented has been repossessed by the landlord, and the community in her hometown is unwilling to accept it. If the nucleic acid turns negative, she will be homeless.

"We had 3 doctors out to hold her down for nucleic acid," Zhao Bin said, "there is no way to channel." This is a matter of life, there is no place to make money, there is no place to live, if I channel her, am I not lying? Fairy tales are not enough to eat. ”

Watching the collapse of these patients, Zhao Bin sometimes thinks back to himself - the daily schedule starts at 6:30 in the morning and ends at 12 noon the next day, a total of 31.5 hours.

However, Zhao Bin knows very well that he is not the busiest. He told Eight O'Clock Jianwen: When Shanghai carried out large-scale grid screening of residents in the early stage of sealing and control, some colleagues left work at one or two o'clock in the morning and went to work at six or seven o'clock in the morning, day after day.

"This job is far beyond the limits of what the body can bear, and it is useless to do psychological counseling." Zhao Bin could only keep saying to himself, he couldn't collapse, he couldn't collapse.

Zhao Bin's Fang Cabin Hospital has more than 200 patients, and 3 medical staff are responsible for nucleic acid testing and other medical protection for everyone, once one medical staff leaves the post, it means that the remaining companions have to undertake more heavy work.

Qin Hai, a psychological counselor at the "Shanghai Medical Care and Anti-epidemic Care Psychological Hotline", told Eight Point Jianwen: "Generally speaking, doctors and nurses are very restrained, and they themselves will not come to ask for help if they have not yet reached the point of being out of control. When we asked for help, we must have reached the time when the doctors themselves could not resist, the situation was more serious, and they felt out of control. ”

In Qin Hai, among the phone calls they received, there were nurses who cried late at night, crying to psychological counselors about their guilt for their children. The nurse and her husband were both on duty at the hospital, leaving their children, who were in junior high school, at home alone. She felt that she had wanted to "quit her job" countless times, and countless times she had pulled herself back to continue caring for her patients.

The nurses in the psychiatric department would also call Qin Hai, and the nurse told Qin Hai that they now have 1 doctor and 3 nurses, taking care of 90 patients with mental disorders, "The mental pressure is too great, I can't stand it..."

wounds

The impact of infectious diseases such as the new crown pneumonia epidemic on human mental health will last at least 20 years or more – a view expressed by Lu Lin, president of the Sixth Hospital of Peking University and academician of the Chinese Academy of Engineering, on different occasions.

The World Health Organization's scientific bulletin also noted: "In the first year of the COVID-19 pandemic, the global prevalence of anxiety and depression increased significantly by 25%." However, even at this value, WHO Director-General Dr Tedros Adhanom Ghebreyesus said: "The information we now have about the impact of COVID-19 on mental health in the world is just the tip of the iceberg." ”。

"Anxiety and depression have changed throughout the epidemic, but in the early days of the epidemic, because there was not much understanding of the virus, whether it was medical workers or the general public, anxiety and fear dominated; as the epidemic has developed so far, everyone will be more depressed because of other social problems caused by the epidemic , such as unemployment and economic pressures ." Meng Fanqiang, a doctor at Beijing Anding Hospital, told Eight Point Jianwen.

In 2020, Meng Fanqiang supported the Beijing Xiaotangshan Designated Hospital to provide psychological support for the doctors and patients in it, and in the past two years, through his own outpatient clinic, the doctor has also continued to observe the emotional state of the patients.

Social loss, financial stress, panic and anxiety, loneliness and depression, the COVID-19 pandemic has left more and more people out of control. And for those at the center of the pandemic storm, the repeated superposition of imprints will eventually become a bloody wound in the spiritual world.

Going back in time to the Wuhan epidemic in 2020, many people remember a video of a girl running with a funeral car and crying "mom", and her mother died of new crown pneumonia.

The rapid spread of social media, one after another impactful image data in the Internet constantly exchanged and transmitted. Restlessness, sadness, anxiety, and fear hung over the city of Wuhan. This video has brought a huge psychological impact to many people, and the girl's encounter is a facet of the people who have suffered great mental trauma in the center of the epidemic storm.

To this day, Wuhan is still the city with the highest rate of mask wearing in the country, both outdoors and indoors. A psychological counselor in Wuhan described that the epidemic has destroyed the sense of security in the hearts of many Wuhan people, and masks have become a spiritual necessity for Wuhan people, symbolizing protection and safety.

In February last year, Lu Lin's team published a study in the nature sub-journal that compared with floods, major traumatic events (such as the 911 terrorist attacks), etc., the combined prevalence of post-traumatic stress disorder (PTSD) was the highest after the infectious disease pandemic, and in their study, this value was 22.6%, and almost one in 5 people.

These PTSDs are the externalization of mental wounds, one of the characteristics of which is: flashback. For patients, trauma-related scenes and content may be repeated and repeated in their minds like movies; on the other hand, patients will try to avoid events or scenes related to traumatic experiences in their lives, and even recall the details of the time like amnesia.

Under the long-term pain, fear and tension, if the relevant interventions are not taken correctly, some symptoms can cause people with PTSD to experience some serious problems in social or work situations and interpersonal relationships, which will seriously affect their normal life. As a result, in many cases, patients who suffer from PTSD are at higher risk of suicide.

After the end of the epidemic, the trauma concentrated on the local medical workers in Wuhan began to erupt in a concentrated manner, with a large number of nightmares and flashbacks, and the pictures of patients intubating and the sound of various electronic instruments constantly appeared in front of the eyes and echoed in the ears. One healthcare worker even walked into the hospital and his legs trembled uncontrollably.

A local medical worker during the Wuhan epidemic recalled to Eight Point Jianwen that shortly after the end of the epidemic in Wuhan, he had a very serious sleep disorder, he could only sleep for 3 to 4 hours a day, and his personality became irritable and fragile. Eating with friends often collapses suddenly because they inadvertently talk about some details of the previous anti-epidemic work, and cry uncontrollably in public. However, after two years, let her think back on the experience again, she just thought silently for a while, and said softly, "I don't remember." ”

Last February, a paper in a sub-journal of Nature described the excess mortality rate in Wuhan city and other parts of China in the three months following the outbreak in Wuhan in early 2020.

In those three months, the suicide-related mortality rate in Wuhan was 11.7 per million people, while the projected average mortality rate extrapolated from previous experience was only 7 per million people.

This means that in the three months of the outbreak, the death rate due to suicide has increased by more than 67% compared with the projected. The suicide-related mortality rate in other parts of Hubei Province except Wuhan (32.2 per million people) was also much higher than expected (19.9 per million people) (62%).

The more serious the epidemic, the more serious the psychological crisis will be. Although suicide is an extreme case of psychological crisis, it also shows from the side that this matches the understanding of the academic community.

However, Tong Yongsheng, chief physician of Huilongguan Hospital, said that for the vast majority of people under the epidemic, especially those who have not been seriously affected by the epidemic, the anxiety and depression caused by the epidemic are mostly transient.

But even so, Wang Yunyan, a counselor from Wuhan, believes that acknowledging the trauma and pain experienced by individuals is very important, "acknowledging means telling the sufferer that it is not your fault and that we have seen your experiences and encounters." ”

The next step is to accept and hold without evaluation, to catch the emotions of the sufferer and give them a sense of security. Traumatized people can also do things within their reach, such as becoming a volunteer to support those in need, not only connecting with others, but also enhancing personal value and creating a positive cycle.

Wang Yunyan felt: "The pain cannot disappear, but we must take the pain and see the light in the darkness." ”

Growing up in the midst of the pandemic

In an article, World Bank Vice President Indmeth Gill wrote: "Covid-19 has had three impacts: covid-19 is claiming millions of lives, people are suffering from job instability and poverty, and children and young people who are supposed to go to school are being asked to stay at home. ”

For more than two years of the pandemic, the biggest victims have been children and young people. For a large group of teenagers, the days of the epidemic occupy their most important stage of growth, and the psychological impact of this period on this group of people in the growth stage may be far beyond our imagination.

As early as 2020, UNICEF released a survey describing the experience of children during the epidemic, "Subverted Lives", which shows that during the epidemic, the number of calls received by the helpline about violence and abuse of children in their homes has soared, and some children have suffered from depression and even attempted suicide.

A survey of more than 5,000 high school students in the province by Wang Ting, an associate professor at Jiangxi University of Traditional Chinese Medicine, showed that the reporting rate of suicidal ideation in adolescents after the epidemic (38.88%) was almost half higher than that of middle school students in pre-epidemic studies (23.9%).

Although many experts have reminded that suicidal ideation is not the same as suicide, considering that suicide is the third leading cause of death for children and adolescents aged 10 to 14 years, these situations still deserve our attention.

Several psychiatrists from Beijing Anding Hospital and Wenzhou Kangning Hospital also told Eight Points That since the outbreak, the number of non-suicidal self-injurious self-injury and self-harm and suicidal adolescent patients they have received has increased significantly.

Whether it is Jiangxi, Beijing or Wenzhou, it is not the most serious area of the epidemic, in some areas that have to be closed for a long time because of the epidemic, children will be forced to isolate themselves from their familiar peers, and they need to be familiar with each other every day to not hide their shortcomings, but almost completely unable to communicate under the same roof, friction is almost inevitable.

In this case, if the child happens to be in puberty at this time, the parents are in menopause, and the friction caused by the two generations sharing a room together may leave a far-reaching rift in the intimate relationship of the family.

A psychological hotline operator and senior psychological counselor from the Shanghai Mental Health Center told Eight Point Jianwen that during the Shanghai lockdown, he often received calls for help from teenagers, and the youngest one was just over 10 years old.

"Some of the children who asked for help called alone, some relayed by their parents, and some accompanied by their parents. Some of them will complain about the war caused by online classes at home," the operator said, "when listening to online classes, children may be opportunistic, lazy, sleeping, playing games or losing regularity, some small actions will be magnified and highlighted in the family scene of sealing and control, and after being discovered by parents, there will often be contradictions." In addition to online classes, if multiple pressures in life are exerted on children, they carry too much, and they cannot find channels, so that they cannot release their emotions in time, and may choose self-harm and self-harm to express needs and dissatisfaction, and extreme children even hope to die. ”

In this regard, Dr. Wang Guanghai, a psychological counselor at the Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, analyzed to eight points of Jianwen: Because adolescents have poor control over emotions and impulsive behavior, adolescent depression will be somewhat different from adults, adults may just be depressed mood, but adolescents may show externalized aggressive behavior, irritability, tantrums, and even self-injury or suicidal behavior.

In addition to these fierce conflicts, it is also an indisputable fact that among the imprisoned adolescent population, the index of depression and anxiety has skyrocketed. At the beginning of 2020, Wang Jiwei, associate professor of the School of Public Health of Fudan University, and others conducted a survey of 7890 adolescents aged 12-18 in Wuhan, and found that during the period of home isolation, 21.7% of the study subjects reported anxiety and 24.6% of the study subjects reported depression.

Wang Guanghai mentioned that the team's research published in the authoritative medical journal Lancet proposes that irregular sleep, long screen use, insufficient physical activity, and epidemic-related concerns will increase the risk of mental health problems in children and adolescents.

In addition, during the epidemic, family financial difficulties, parental mental stress, and overly strict discipline are also not conducive to children's mental health and good adaptation. Wang Guanghai also appealed, "We should pay special attention to vulnerable children, especially those living in poor families, who are more likely to have mental health problems and need social support." ”

In addition to children from poor families having to bear more in this pandemic, special education children have almost become one of the most vulnerable groups in this pandemic.

A study from Hong Kong showed that during the pandemic, there are a number of psychiatric disorders that require special education, and children who need special education may experience interrupted rehabilitation and medication, which can lead to worsening symptoms and unpredictable effects on the child's future. In addition, "children with special educational needs, who rely entirely on parental supervision in the learning process, can significantly increase parental stress and ultimately affect their parents' mental health, which can lead to an increase in child abuse." ”

For how to maintain the mental health of adolescents during the epidemic, Du Yasong, director of the Department of Child and Adolescent Psychiatry at the Shanghai Mental Health Center, suggested: "Don't lose your sense of humor." He believes that during the sealing period, parents should guide their children more positively and create a relaxed and pleasant family atmosphere, "Sealing and control has also created some opportunities." For example, the absence of the father's role can return, and the time spent playing with the child increases. ”

Even so, however, for more children of this generation who have grown up in the pandemic, the impact of the lack of face-to-face social interaction with their peers is equally far-reaching.

Yao Guizhong, chief physician of the Department of Psychiatry of Peking University Sixth Hospital, pointed out to Eight Points Jianwen that people are social animals, "a very important purpose of going to school is to socialize, students cannot go to school due to the epidemic control, which may affect psychology in the short term, and in the long run, the lack of socialization process may be doomed to have a negative impact on adolescents' ability to communicate and adapt to society in the future." ”

This epidemic is almost destined to become a unique growth experience and collective memory of the post-00s and even the post-10s generations. In any case, in this turbulent world of black swans, whether the most vulnerable children are adequately protected is almost related to the future direction of the world.

Shi Chenjin and Yan Yucheng | writing

Li Shanshan | responsible editor

This article was first published on the WeChat public account "Eight Points Health" (ID: HealthInsight)

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