THE PANDEMIC, MENTAL HEALTH, AND THE GREAT OPPORTUNITY: A CONTRIBUTION BY DR. UBALDO SAGRIPANTI

La Ginestra (Wild Broom Or, The Flower of the Desert) by Giacomo Leopardi

Today is the 24-01-2021, the date is important in this communication as thousands of people die every day around the world due to COVID-19 and we will never truly know how many. Therefore, we also have a duty to look beyond and document this time in the most authentic and appropriate way for those who will come after. Narrative Medicine, in addition to being a current clinical tool, also represents the qualitative research method that could integrate the data that are emerging from quantitative statistical analyses carried out on different populations about mental health during the current Pandemic.

The Istituto Superiore di Sanità (ISS) alerts us that “During epidemic events there is an elevated risk of developing anxiety disorders, depression, self- and hetero-aggressive behaviours. (…) Various psychosocial risk factors such as economic stress, unemployment, bereavement, loss of role and job, and relationship breakdown also increase.” At the same time, Media and Internet combined together generate the phenomenon of “Infodemia”. The Treccani dictionary describes it as “circulation of an excessive amount of information, sometimes not screened with accuracy, leading to a difficult orientation on a particular issue for the complexity of identifying reliable sources.” The consequence is that of an interaction of stressful factors on different levels whose evolution is not currently predictable, but that certainly is already giving rise to a real Syndemic, of which, the component related to mental health, especially Depressive and Anxiety Disorders is expected to grow in the coming months.  The scientific world is currently proceeding with research projects based on the collection of evidence and data derived from standardized assessment methodologies combined with each other in order to define categories with the widest possible use of dimensions. This is indispensable and fundamental for a definition of the field, however, from the work produced in this regard may emerge aspects such as that highlighted by Nickell in 2004 during the SARS epidemic in which depression appeared in about 20% of the general population but its incidence among Toronto nurses rose to 45%. In a recent paper about the emotional responses and coping strategies of nurses during the COVID epidemic in China, additional issues emerged regarding the background, gender, and proximity to patients of the nurses studied.  Previous studies conducted during 2020 in different countries showed that healthcare workers were particularly susceptible to stress disorders due to psychological burden.  The highest incidence of psychological burden was identified in those who were female, nurses, at high risks of contracting COVID-19, low socioeconomic status, being forced into social isolation, and spending more time watching COVID-19 news. In addition, research is currently underway such as the International Multicenter Study that is investigating the impact of pandemic COVID-19 on the health of caregivers working in health care facilities or health centers around the world. The COVID-19 HEalth caRe wOrkErS (HEROES) study. 

Each study design seeks to document as accurately as possible aspects of participants’ lives that might play a role in, or otherwise be significantly associated with, risk factors, reactions, conditions, or behaviours correlated with depression or other disorders in terms of statistical diagnostic research.  Nevertheless, this kind of methodology does not involve collecting the experiences of people who have gone through this time, of which, no trace will remain in scientific reports.  Instruments that measure the amount of anxiety, anger, sadness, worry, feelings of fear and helplessness will be able to define descriptive categories; however, they will allow a little or none access to the qualities of the personal processes of the individuals that make them up. Nothing about the words, sounds, and images that unite or distinguish the people of this time, how much and how the qualities predict, state, or exclude possibilities of getting sick with depression or adapting to the stress that people experience.  This is true for the general and health care populations around the world. Excepting the World War time, Caregivers and Patients are experiencing a qualitatively unique and unprecedented doctor-patient relationship. However, for the first time in history, we may have the opportunity to simultaneously collect quantitative and qualitative data and shed light on cross-racial, cultural, socio-political, and religious aspects of the experience of Depression and other mental disorders.  

This pandemic, in addition to death, suffering and poverty, could give us a unique opportunity to compare parallel measures and experiences through the narratives of caregivers and patients from different countries of the world and then also on possible common factors of the doctor-patient relationship until now little studied.   Narrative Medicine combined with Evidence Based Medicine (EBM) could shed light on aspects of our nature, mental health and the relationship between it and Depression still not “scientifically” considered.  “The universe is written in mathematical language”says Galileo, but this truth coexists with that of Terence’s proposition “Homo sum, humani nihil a me alienum puto” in other words: nature, culture, environment and personal history are the variables that make up the complex system of Mental Health of each of us. However, about nature Heisenberg says: “Natural science (…) is not simply a description and explanation of nature, it is part of the mutual action between us and nature” from this evolution of scientific thought, John Wheeler will then say that derives a “participatory universe” whose mathematical structure is always present but no longer linear, thus showing its complexity. From here emerges the need for new models capable of understanding dimensions of human experience that until yesterday were considered metaphysical but, from Popper onwards, must be included in that participatory universe that has become scientifically indispensable for the study of what is human, and even more so, of Mental Health as a specific expression of our gender.  Narrative medicine with its tools of analysis and through the Natural Semantic Metalanguage can be the vehicle of the Great Opportunity of knowledge that the Pandemic offers us.   The latter, on the other hand, was also the motivation behind one of the greatest scientific adventures of all time, the one that led to the creation of a vaccine in just ten months through the participatory and synergistic collaboration of laboratories around the world. A “confederation” never realized before and yet already “felt” and almost foreshadowed by the story during another catastrophe: it was 1836, the cholera epidemic lashed Naples and Giacomo Leopardi on the slopes of Vesuvius, from Torre del Greco, a few months before dying wrote in the Broom:

l’umana compagnia,

tutti fra sé confederati estima 

gli uomini, e tutti abbraccia 

con vero amor, porgendo

valida e pronta ed aspettando aita

negli alterni perigli e nelle angosce

della guerra comune. (…)

I’d like to end with a little story about Pandemic and Mental Health: a few steps away from Leopardi’s house, in Recanati, at the back of the old hospital that also includes a Residential Rehabilitation Facility for Psychiatric Patients, there is a little garden. They created it last spring during the days of the first lockdown. According to ministerial security regulations, the facility’s residents could only meet with family and friends in a protected, possibly outdoor, location, but it wasn’t there yet, so they built it. In the middle of the little garden, Health Care Professionals and Patients together wanted to plant a broom and around it, painted on stones, reads:

tuoi cespi solitari intorno spargi,

odorata ginestra,

contenta dei deserti. 

Article by Dr. Ubaldo Sagripanti, Psychiatrist, ASUR Marche DSM AV3 – Civitanova Marche.

References

  • Emotional responses and coping strategies of nurses and nursingcollege students during COVID-19 outbreak Long Huang Fuming Xu Hairong Liu https://doi.org/10.1101/2020.03.05.20031898
  • Il Futuro è aperto, Popper K; Lorenz K. Rusconi Editore 1989 Il Tao della Fisica, F. Capra; Adelphi 1994      
  • Impatto della pandemia COVID-19 sulla salute degli operatori che lavorano in strutture sanitarie o centri per la salute.  The COVID-19 HEalth caRe wOrkErS (HEROES) study
  • La Ginestra o il fiore del deserto, G. Leopardi 1836 in C.Salinari, C. Ricci Storia della Letteratura Italiana; Ed Laterza 1979  
  • Medicina Narrativa, un punto di svolta per prendersi cura della della Depressione M.Balestrieri; P.Chesi; M.G. Marini; C.Mencacci; M. Migliorati; M.Pompili; L.reale; U.Sagripanti; S,Varia Effedi Ed.  Dec   2020 Rapporto ISS COVID-19 • n. 23/2020 
  • The psychological impact of COVID-19 on General Practitioners in Piedmont, Italy Lorys Castelli , et Al  .jad.2020.12.008  
  • The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public – A systematic review and meta-analysis Min Luo,a Lixia Guo,b Mingzhou Yu,c Wenying Jiang,d and Haiyan Wange,⁎ Psychiatry Res. 2020 Sep; 291: 113190. 
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