The worldwide pandemic over COVID-19, and the heavy-handed government
response to it, has generated a wide range of reaction among patients.
As a family physician and a psychiatrist, we have seen some patients
adapting well. On the other hand, many feel anxious over the thought of
getting the illness or experience other negative emotional responses
resulting from the lockdown. Invasive public policy intervention always
comes with a host of unanticipated consequences.
Politicians initially gave into their usual impulses to reassure
rather than inform, calling for “business as usual,” and “nothing to see
here.” But it quickly became evident that the disease spread fast and
could be life-threatening in a minority of cases. In response, federal
and state entities called for “social distancing, “hand and surface
washing, and “hands off the face,” all of which seemed reasonable. Then,
as the news media sensationalized their coverage, public officials
became anxious and fell back on their all-time favorite method of
problem-solving: risk management. Emergency statutes and orders have
mandated masks, closings, and in some states, curfews.
Governors are deeming which businesses and services are to be
considered essential or not. Some of our neighbors are mandated to work,
despite the risk, while others are now unemployed or are forced to stay
home and lose income. Other consequences of mandatory “stay at home”
measures and deferred medical care include mental health and substance
use disorders, other illnesses, and domestic violence. And of course,
the economic damage caused by the lockdowns will also degrade patients’
ability to obtain medical care in the future.
In our practices, we are seeing patients make health compromises that
might increase their susceptibility to the viral scourge. Some have
become so anxious or depressed, due to fear stoked by the media, that
they are unable to work. One potty-trained four-year-old patient had a
curious manifestation. In the last month, as her entire routine changed,
she had daily unpredictable urination, or incontinence: probably a
disorder driven by all of the media blitz, adult anxiety, and related
disruption.
Physicians, guided by the principle of “do no harm,” are always on
the alert to side effects and unexpected reactions to their
interventions. Physicians are expected to take responsibility for the
“iatrogenic” harms they cause.
The side effects of government intervention might be dubbed
“solonogenic” (after the historic Greek lawgiver), although
accountability in a political context does not reach the standard of the
medical model. Economist and philosopher Thomas Sowell put it this way:
“It is hard to imagine a more stupid or more dangerous way of making
decisions than by putting those decisions in the hands of people who pay
no price for being wrong.” Patients beware: Politicians are not your
doctors!
As a family physician and a psychiatrist with more than fifty years,
collectively, of clinical experience, we are not the only ones to
observe that the current intervention in the name of public health is so
invasive and far-reaching that it has caused considerable amount of
preventable mental illness in adults and children alike. Our colleagues
are, no doubt, also spending considerable time treating patients’ mental
health symptoms stemming from the government-caused crisis.
It is imperative to recognize these solonogenic harms so they can be
treated properly by clinicians. It may not be possible to remove the
mental irritant of public health orders right now, but their effects can
be mitigated if we distance our minds from the parts of the guidance
that irritate.
We propose the name “lockdown panic syndrome,” in order to highlight
the public health intervention as the etiology of the mental disorder.
Put simply, this syndrome consists of anxiety about the coronavirus and
confinement at home that leads to paralysis rather than productive
problem-solving. In some cases, it even results in loss of sphincter
control — a rather transparent metaphor for the general problem we face.
It is inherently anxiety-provoking and fatiguing to have one’s own
judgment about managing the risks of everyday life preempted by the
micro-risk-managing directives of public officials who are remote and
unaccountable.
As physicians, we grapple with the same mental challenges as our
patients. It is anxiety-provoking to be faced with the possibility of
punishment if one does not practice medicine according to government
edict, particularly when the authors of those directives are
nonclinicians, remote, unaccountable, and concerned with the well-being
of populations rather than individuals. Physicians beware: public
officials will not be responsible for the clinical outcomes resulting
from your compliance with their guidance!
How can lockdown panic syndrome be treated? Encourage patients to
take back control over their own daily lives as much as they safely can.
Tell patients that their own judgment about protecting themselves will
be sound once they have vetted their information carefully and sought
individualized guidance from their personal physicians. Patients can
also be supported in taking the initiative to rebuild their own lives on
their own terms, in safe and realistic ways, rather than waiting for
the go-ahead from public officials.
Physicians can heal themselves by staying in charge of their own
clinical decisions. As always, doctors interpret the scientific
literature in the context of their own unique practice experiences.
Individualize treatment plans to the needs and values of each patient.
Physicians will feel less anxious, and their morale will improve when
they remind themselves that they are servants of their patients, not the
state.
Public officials and the media could stop lockdown panic syndrome in
its tracks by allowing physicians to treat the clinical problems created
by COVID-19, and empowering patients to use their individual judgment
and take responsibility for themselves and their families.
Unfortunately, it may be too much to ask public officials to shelve
their partisan agendas, but the rest of us, practicing physicians and
patients, can partner together to make America a healthy nation again,
mentally, physically, and perhaps we can learn to put politics in places
less central in our minds.
Craig M. Wax is a family physician. Robert Emmons is a psychiatrist.
Lockdown panic syndrome, and how to fix it
