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3 Apr, 2020 06:29

Fear may kill – psychiatrist 

The Covid-19 pandemic is humanity's biggest test in decades, and for every individual's mental health too. We look at fear – one of our most basic emotions, that’s currently ruling many lives – together with Jacek Debiec, psychiatrist and neuroscientist at the University of Michigan.

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Sophie Shevardnadze: So, Jacek Debiec, psychiatrist, neuroscientist, with us today to discuss the fear factor during the global pandemic. Jacek, I want to start with a little parable I've heard recently. So Plague meets a pilgrim on the road and asks him, “Where are you going?” And the pilgrim says, "Well, I'm heading to the holy city of Mecca. What about you?" Then Plague goes, "Well, I'm going to Baghdad and I'm going to kill 5000 people." So both meet again in a year. And the pilgrim says to Plague, "You know, you said you were going to kill five thousand people in Baghdad. But in fact, you've killed fifty-five thousand people." And Plague responds, "No, I told you, the truth - I've killed those 5000 people. The rest died of fear." So I thought it was very relevant in what's going on today. Tell me, is our fear of this coronavirus pandemics bad enough that it can actually kill us?

Jacek Debiec: Well, first, thank you for having me. Yes. Fear is a powerful weapon. Fear may be a deadly weapon and fear may kill. And it may kill in many ways. When we're thinking about fear there are many layers to fear that we are experiencing. One thing, probably most obvious, is what we feel and how we think. We think about the threat, we think about safety, searching for safety. But that's the part that is more cognitive or on the levels of our feelings, but there are also other layers. Another one is they're all physiological responses. You know, when your heart is pounding, your blood pressure is increased in order to pump more blood, more oxygen, more nutrients to your muscles. And that enables you to either fight or to run away. At this physiological levels, you know, you think about increased blood pressure, some people may die of a heart attack. And actually there are some studies, some reports that, say, in Africa, when people were attacked by lions, some of them were actually getting heart attack during this assault. So possibly they could die of heart attack, not only because the beast will ... 

SS: Well, I know they say when someone commits suicide jumping from a skyscraper, he is not even going to know when he reaches the floor because he's going to have a heart attack right before that.

JD: Right. So that's one thing. But another thing is that you mentioning dying by suicide, that fear may push us to behave in a certain way. We may kind of run away and fall down a cliff, or fear may trigger aggression, which is also a survival response. And somebody else may die because the person is so frightened and they attribute their cause of the fear to somebody else. 

SS: I want to talk a little more, though, on a physiological level, if you don't mind. We're going to go through all that in detail, but first, stress, I know, is a very powerful tool. It can destroy one's health, right? Doctors say 50 per cent of our health problems come from stress. And I can imagine how psychosomatics work: you convince yourself that you're sick and indeed, you just start feeling the symptoms and even though you're physically healthy. So if I keep, for instance, my hands clean, wash them all the time, but I keep panicking a lot with this, would this make me susceptible to COVID-19 more? How does it work? I mean, would my immune system literally be suppressed or go down if I panic and fear getting infected with COVID-19? 

JD: Prolonged fear maylower or may affect your immune response because prolonged fears means prolonged stress, means that the levels of your stress hormones go up.And prolonged increase or prolonged elevation of your stress hormones in your body definitely affect your immune response. So we don't have fear to live in fear. We have fear to look for safety, to secure our safety and the safety of our kin. And that's the whole difficulty, that's the whole problem that when there's a mismatch between responses and the environment, we may be at risk of living in fear without really using this whole energy that fear gives us.

SS: So under stress, from what I understand, the brain centre that is responsible for fear and anxiety is most active while the rational part of our brain actually becomes more sluggish. Right? So does that mean that during bad times, our reason gives the reigns to our emotions? 

JD: Yes, absolutely. Well, first of all, usually ... I mean, I'm speaking again from this evolutionary perspective, the threats were pretty predictable. And that's why the responses were pretty simple, really. A few major responses. One is to freeze. So you just don't move. You don't want to draw attention of the predator. You run away. So "freeze", "flight" or you fight. It's pretty simple. Now the environment is more sophisticated. It's not enough. There is no washing your hands hardwired in your brain. You just need to hardwire it. You need to have this response acquired or learnt. What is really important, because in a situation of fear or stress, we cannot process nuances, details so well, everything becomes simplified. So what is really important is to rehearse the procedures, rehearse responses. And this is what first responders do. People who are firefighters or medical personnel, uniformed services. They just practice the procedures, they practice responses and rehearse them when they are not frightened. So the responses may be or they become almost automatic. 

SS: So all we're saying is that, yes, during bad times, emotions take over and we're not able to think rationally.Would that explain why people are rushing into grocery stores and just stocking up so much pasta and buckwheat and rice and toilet paper? And you know that this is way too much. It's not for three months. It's probably for three years. But you still keep hoarding. Does that explain...? I'm just wondering, is there any way to change these basic workings of our stressed brains? 

JD: Well, you know, it is hard because, as you said, it's irrational, it's emotional. And if you're informed, "wWell, get some supplies for two or three weeks", then, you know, a part of your mind will still think“Well, what if it takes longer?So what if I get supplies for additional three weeks?”. So this is kind of hard to stop this type of thinking because you want to increase your safety, increase your chances of survival. Now, what is really helpful in situations like this is when you're getting full information and information is, you know, whatever there is, it's transparent. The communication has to be simple. And I'm now talking about the communication by the authorities, by people who have knowledge or who are in the position of coordinating these emergency actions. So if you know, "Yes, please get supplies for two weeks” then “We will secure that there will be another delivery to local stores"... 

SS: So I feel like in this fear factor, good and bad roles are played by the media. Because I mean, we couldn't imagine being without the information, and media worldwide are now working their socks off to give the public all possible information about COVID-19. I mean, knowledge is power, but on the other hand, hearing all the time about it is making me even more scared. So, I'm sort of like deciding I'm going to watch news once a day because it's not possible. What's your take? Is having media coverage a curse or a blessing in this kind of situation? 

JD: Well, you know, you're a media person, so you know this reality better than I do. But I would just start with a question: do media have their internal guidelines, how to report in the case of a disaster or emergency? This is a question, to your knowledge, do the media have this kind of guidelines? 

SS: I don't know that anyone could have a guideline on a virus, how to report on that we don't really know much about. But I mean, the only guideline we have is trying to work not from the office, but from home. And that's what we're doing. But everything else is just guided by our own fears and questions that we are faced with. Right now, media are like everyone else. 

JD: Well, but let's imagine, you know, probably in many institutions, people have fire drills. You know, once in a while there's a fire drill. So people know which way they should exit the building, where they should wait outside of the building. There are procedures. And I think communication is also such a powerful tool and powerful dimension of our life that it does make sense to have clear procedures, how we communicate. First, you need to know that communications should be simple and should be consistent. If you're searching for different sources of information, then there could be contradiction. And on one side, there is, I would say, the great advantage that people have freedom in searching for different sources of information. But when we are dealing with a disaster of that kind of dimension, I mean, I would say that the media should act responsibly. So some information should be verified before they are shared with the public. 

SS: You're talking about fake news right now, because fake news in general has become a huge problem in recent years, but especially in times of global pandemic. This is something that sort of becomes ten times more inflated in terms of importance while it shouldn't be done ever. 

JD: Well, you know, I would say I wouldn't blame media for everything, because by blaming media for everything, we are just kind of attributing like a superpower to the media. But there is a challenge for each individual to really choose their sources of information and these things we should probably learn from the from our childhood, how to look for information, how to verify this information. 

SS: Can I ask you something? I completely understand about verifying your information, sticking to the true sort of journalistic guidelines that should be working, whether it's pandemic or not. I'm talking about the overall rule of the worldwide media, no matter what country, is that what brings ratings are bad news. Whatever bleeds brings more ratings. Like, if you look at the media coverage worldwideI mean, I have not seen one report, story, feature on a person who has already gotten well, gotten infected and then gotten well. All I see is people getting sick, people dying. And I feel almost like the regular media logic feeds into this collective hysteria. 

JD: Well, to some extent, yes, probably. I mean, again, it depends what the motivation is. If the motivation is to increase your audience so definitely sharing information that is scary may increase your audience. Why? Because under threat, our attention is biased to scary information. We want to know about threat more. So we will be even actively searching for this information. What else happened? How many people died? Who else got sick? What are other health risk factors that predispose you to a bad outcome if you get infected by the virus? So we have this natural bias. But you know, this is kind of the question for media people. Are we acting now to increase our ratings or increase our audience, or we want to give our time to experts that will inform people how to process information or what information is relevant? 

SS: How to process is a very important part you just mentioned because when you're under very heavy stress, how do you tell a rumour from a real fact? 

JD: You may have difficulty. You may have difficulty, definitely. I mean you can do it if you trained yourself before to do it, which means, if you were a really conscious media consumer, conscious news consumer. So if you learned before, you have a certain set of sources of information and you want to verify that. So you want to know what to do . . . It is hard to learn it when you're under stress. So I agree with you that if you are under stress, then it's easy to be rational but it's also easy to manipulate people who are under the influence of intense emotions. 

SS: So as a psychiatrist, could you advise, would it be better in this time of global pandemic when everyone's under stress, everyone's fearful, media coverage is extensive, but mostly it's scary... I mean, when you turn on TV, it's real, it's there, but it's scary. Would you advise to isolate ourselves from the media? Maybe not watch TV and go on Facebook feeds and YouTube feeds all the time? 

JD: You know, with news it’s like with food. You need to have some news. You need to have some information. I think the total isolation won't be helpful because you will not learn about washing your hands or you will not learn about what the safe distance is. The question is more like how to choose the sources of your information and how much of this information you need. I do think that for most people, definitely for many people it does make sense to limit this flow of information, just to focus more mostly on reliable sources of information and, I would say, experts like health experts that are trained and that have knowledge. If somebody is just getting a lot of news exposure, but there is no expert source, then I would probably say that this person may be at risk of not making the best choices. 

SS: So talking from a psychiatric point of view one more time, we humans are such social animals . . . How does being isolated from one another for such a long time, undefined period actually, affect our psyche?

JD: Well, I would say any change may cause distress. There are some people who are used to be isolated, they may not be so much affected by this situation because there's no significant change in their routine. However, for most people who are so connected, it might be a source of stress and definitely it is highly advised to maintain connections. I observe that many people now, when they are in isolation and stay at their homes, reach out to their family members or to their friends that they haven't been in touch with. So there are also some positive aspects of that. People know that we need to keep a distance, but we need to stay connected. And so I think that many people naturally do it without any guidance, without any advice, because you find safety in your connections. I would say, probably most people will cope with that, will find a way to stay connected and technology could be helpful here. For some people, that could be more stressful. So then I would recommend trying to think about . . . you know, maybe this is a good idea to schedule some phone calls or some time online, especially for children who don't go to the schools. You know, there could be some playtime over Skype or Zoom—or any other application to have things scheduled. People may have some book clubs, you know, and share experiences. I do believe in our adaptive skills and the kind of survival skills—that people find a way to connect. 

SS: I completely agree about always being able to adapt no matter the circumstances . . . And you're right that we've found new ways to speak to people that we haven't spoken in ages. And that's a good thing, I suppose, about being isolated and having a lot of free time on your hands. But this thing will be overone day or another. Some say two months, some say six months. It's going to be over, right? We're going to come out of it. And then how are we going to be with each other? That's the big question. Do you feel like we are going to be slightly more introverted with every day of isolating distance? Even those who are extroverts? I'm an extrovert. I love to go out. I'm very social, but I've adapted in this isolation and I'm not sure how I'm going to be once I can go out and be social like I used to be. Do you think we're going to be more extroverted after this thing is over, or will we be more caring, less selfish than we are today? What are your prognoses? That's what I want to know, I suppose. 

JD: Well, it depends really. I think probably you outlined possible scenarios. This is how experiences change us. [When] there is something stressful, it can support our growth. Like, when you think that you're an extrovert and [wonder] will you be an introvert? . . . You probably won't change your personality. But now, if in this time that you're staying in confinement, in isolation, you can kind of use it to explore yourself better, then you may share other aspects of yourself with other people. So that could be a positive thing. I do think that many people will be affected, some seriously, because this pandemic really does not affect each of us in the same way. I am now more concerned, more worried about first responders, the frontline healthcare workers, because they are working under extreme stress. You know, their chance of exposure to the virus is higher. But at the same time, they are under stress when they come home because they don't want to pass the virus to their family. So something that should be kind of comfort for you and safety is not [that]. I have many colleagues who work in the E.R. in hospitals that move out from their homes to protect their families, and I think that these people have a double load. So again, I think, probably what you're saying, it's exactly what's gonna happen . . . For some people it may mean growth, but for some other people, it may mean a long-term, I would say, burden or maybe some injuries, emotional injuries, wounds. 

SS: Jacek, thank you so much for this wonderful insight. We wish you all the best of luck and stay safe, stay healthy and hopefully, we'll talk again at better times. 

JD: My pleasure. Stay safe too. 

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