The Chart of Humanities: the pillars of the bio-psycho-social-spiritual model to humanise isolation and care during COVID-19 outbreak

We are aware of the World Health Organization‘s definition of health: complete physical, mental and social well-being and not just the absence of disease. This definition is utopian, as written on many texts because it denies what the nature of the human being subjected to quite precise laws is: being born, growing up, being adult, growing old and dying.

Now, we experience the COVID-19 pandemic. Therefore, perhaps many of us will not even be given a chance to grow old. Rather than on health (from the Latin salvus, now so topical), we can focus on the meaning of a more profound concept: the flow of our existence. And here, next to the three standard components of the definition of health – bodily, mental and social – a fourth one follows, that is the spiritual-existential dimension.

There are questions related to spirituality and its practice, to the sense of wonder and amazement and the centring on balance with an awareness of what happens inside and outside of oneself (translation of the word mindfulness, often abused). Besides them, the meaning-making is a crucial variable, which can explain why we make certain choices, why we accept or reject the events and how all this resounds on our physical and psychic whole.

Our mind, in most cases, is by its very nature “narrative”, that is to say, in search of meaning: it works to discover cause-effect relations. The word “why” belongs to the sixty-four universal meaning terms of human language (Goddard and Wierzbicka 2014). In essence, this means that in all the world populations, this word exists as evidence of our cognitive and logical programming to search for the meaning of facts and events, wherever they happen.

Let’s see how many explanations we are trying to give the word COVID-19: from the biological leap to the escape from the laboratory, to the conspiracy theories, regardless of the actual natural truth; there are also other perhaps of thought. And still, we observe the apologists of COVID-19 writing on less consumption, less pollution, slower rhythms, close people, where Homo Sapiens is a little less at the centre of attention: the virus becomes almost a friend. Without judging, these are the existential values of those who think like that. Others believe that the virus is the invisible enemy to fight with all our knowledge, that it is bringing colossal damage because it kills human lives both in a physical sense (it kills them) and in a metaphorical sense (it breaks projects, plans and dreams). Other values within this vision: there is no right or wrong. Then there are the equilibrists who try to unite the conflicting views, doing a miraculous operation of alchemy.

Without meaning, we are in chaos, at the mercy of events, including possible illness, or traumatic event, such as forced isolation that breaks into the previous balance of health. It is through the attribution of meaning that we become resilient and able to plan (Marini 2018).

We make progress with a purpose, which may be the most ancient one, innate to our essence; but the dynamic flow – because life flows, like everything flows, πάντα ρει – also leads to change the purpose of what we think, live and feel. Also, “change” is a word with universal meaning, to indicate the need for dynamism. In essence, it is impossible to stand still, motionless, because things change as we change in every moment. We can never get wet in the same water of the river (Herodotus again), and this now applies to our showers or bathtubs.

Let’s go on and close to meaning, let’s venture an almost tiring word to pronounce and write, perhaps because it is so beautiful that it is nearly a taboo: happiness. Let’s start from where our culture is founded, from ancient Greek thought and in particular from Herodotus, the philosopher of the πάντα ρει is also the first to coin the term eudaimonia, to be inhabited by a good demon. What does the demon have to do with it? Aristotle explains it better, and Carl Gustav Jung will take it up in his psychoanalysis: the good demon is the one who helps us to find purpose and meaning in our existence. It is not easy to find him: following the thought of Aristotle, Jung and another psychoanalytic excellence, James Hillman, the good demon hides behind the continuous bombardments and daily stimuli, manipulations, labyrinths of conditioning imposed by ourselves because we are borrowed from others. It is very difficult to find him, while we witness the numbers of victims (WHO has asked not to call them victims, but I can’t use any other term while writing), the states affected, the obvious differences between those who have a welfare state and those who instead live in a system without welfare…

And yet, we can feel the demon, and we could translate it with a term a little more contemporary and with a Christian dimension, the Talent. Only if we follow our Talent will we be able to hope for eudaimonia, so that our life can find its purpose even when we are isolated at home.

I have collected the narratives of disabled people living in the almost complete impossibility of moving their bodies, who have conquered more eudaimonia than many normalized individuals: it seems a paradox. The question Why me this disease? was asked by everyone, but the answers then and now make the difference. If one moves from one’s guilt or assigned to others to enter a more exploratory dimension, What can I learn from this new condition?, then perception changes. On two fundamental aspects, it is almost impossible to make discounts. The first is the management of great physical pain, which if present alters the ability to react, and the second is not to be left alone but to be accompanied.

And what can we do our own and learn from this situation of forced isolation while outside the epidemic spreads?

Maybe the biological model, related to body and corporeity, psychological model, connected to emotions and feelings (and let’s not be surprised if we change mood more than usual in this time of uncertainty), social model (the relationships I have, now to be cultivated at a distance, how beautiful they are, how much can I do to make them pleasant, and from who do I have to protect myself? ), the social model when people “go crazy” for sure. And then the spiritual part, which is confused with religion, but that’s not it; it involves our values, our priorities, our purpose anyway and regardless of this situation, our hope, our inner space to reflect, meditate and create.

In English, the term heal has to do with the root holy. The word whole is also related to heal; and wealth is also related to health.

In short, health is a wealth, a gift and as such must be preserved, even if at this moment isolated: here the first-person voices of experts of the Humanities for Health who have left us the testimony of their guiding pillars in the times of COVID-19.

The mind and the emotion dance, by Stephen Legari

Enhancing the relationships with the Earth, by June Boyce-Tillman

Rediscovering relationships and music, by Neil Vickers

Using our time to look more in depth, by Jonathan McFarland

Physically distant, but socially a lot closer, by Giskin Day

Give yourself the opportunity to be and not only to do things, by Susana Magalhães

We long for the return to be physically present for one another, by Carol-Ann Farkas

Below, my guiding pillars according to the bio-psycho-socio-spiritual model:

Domestic context – Biological model

Try to keep the biorhythm that your body wishes: it is normal that in time of changes and grief, the body can overreact, so it is fundamental to accomplish the need of body rest. Do yoga to distress body and concentrate on the breath: in anxiety and fear time, the breath is shortened and muscles are tense, therefore it is important to do daily practice to relax the body and prolong the breath, also to increase vital capacity.

Psychological model

Stay updated only at certain times in the day from social and tv channel. Infodemia is terrible, and is creating addiction… auto controlling the use of the social network is important for our mental wellbeing. Stay rational, when someone else either in a chat is in panic, empathize however with rational cognitive empathy.  And acknowledge as possible one very self mood fluctuations. It is rational, the situation has totally changed.

Social model

Be in contact with the others, especially the most vulnerable people (but protect yourself). take care of your dearests.  Leave chats where there is too much anger (a day of anger is allowed, but keep far from the continuous fighting- it si not the proper time, and it is not human at this moment when we have to spread Humanitas). Try to negotiate and cool down conflicts. Prepare the legacy… in all meanings. When going shopping grocery, protect very well ourselves with what you have, keep the 2 meters distance, but try to be kind with the people you meet even in the body gestures. If you see people too close, tell them that is for their safeguard that they should be more distant and for the safeguard of the others. But no shouting and screaming.

Spiritual model 

Give priorities to your lives. We lived up to now in an accelerated word and this is the time for rethinking priorities and values. Make a plan for ones’ life both n the staying at home, and for the end of the pandemic. Enjoy the little daily things, create room for space for yourselves for meditating, writing, reading, praying… doing what we like: dancing , chanting… even – for women -wearing high heel and lipstick at home…

Hospital context – Biological model

I leave to the possible doctors here, but of course, anaesthesia and sedation – as said – is the best form of humanisation. Think what you wish to do with your body, whether you wish to be submitted into a trial, or not…

Psychological model

Fix the kind of behaviour, if one’s conditions are not so critical, we wish to have with the healthcare personnel. They are rationally our heroes. If one’s conditions are not so critical, think about how you can calm yourselves in such a critical stressful environment.

Social model

Bring with oneself, if allowed a tablet (prepare it in advance), or cellular that you can leave  to the hospital: this will be the way to stay in touch with your beloved, especially at the moment of the reawake. Alone does not mean lonely. We feel too lonely but not necessarily alone: one can endure this moment in the hospital alone,  and think that behind the protective masks, gloves and covering clothes there are human beings helping and taking care of you.

Spiritual model

Prepare ourselves according to our values and beliefs. It may happen everything, Alea is huge. Think to the next generations. Think to better humanity. Think that one’s has done great things on this earth, loving, being loved.

Maria Giulia Marini

Epidemiologist and counselor in transactional analysis, thirty years of professional life in health care. I have a classic humanistic background, including the knowledge of Ancient Greek and Latin, which opened me to study languages and arts, becoming an Art Coach. I followed afterward scientific academic studies, in clinical pharmacology with an academic specialization in Epidemiology (University of Milan and Pavia). Past international experiences at the Harvard Medical School and in a pharma company at Mainz in Germany. Currently Director of Innovation in the Health Care Area of Fondazione ISTUD a center for educational and social and health care research. I'm serving as president of EUNAMES- European Narrative Medicine Society, on the board of Italian Society of Narrative Medicine, a tenured professor of Narrative Medicine at La Sapienza, Roma, and teaching narrative medicine in other universities and institutions at a national and international level. In 2016 I was a referee for the World Health Organization- Europen for “Narrative Method of Research in Public Health.” Writer of the books; “Narrative medicine: Bridging the gap between Evidence-Based care and Medical Humanities,” and "Languages of care in Narrative Medicine" edited with Springer, and since 2021 main editor for Springer of the new series "New Paradigms in Health Care."

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