Covid 19 - From fear to emotional distress, reducing the risk of post-traumatic stress disorder

by Claude de Scorraille
March 27, 2020

My previous intervention focused on how to deal with emotional distress during the confinement phase linked to covid 19.

My purpose was to identify from the main stress factors at play the emotions that can arise: fear, anger and pain in the perspective of setting a framework to promote their regulation.

I now suggest that you go further in understanding emotional distress with a view to neutralizing the psychological consequences that threaten us in the post-crisis period, in particular post-traumatic stress disorder.

From fear to emotional distress

For Nardone, fear is a perception that immediately triggers an emotion and this emotion that accompanies the perception will provoke a psychophysiological reaction. We have on the one hand the perception-emotion on the other a psychophysiological reaction, the body is impacted and from there the anxiety emerges and is maintained if the regulatory mechanisms are disturbed.

From anxiety to panic disorder

When anxiety persists and reaches a certain threshold, it can itself become the cause of fear. A circular loop then sets in between fear as a perception and anxiety as a psycho-physiological reaction.

Anxiety pushes us to fight, keeps us alert to deal with perceived fear. But if we have difficulty cohabiting with anxiety - it is indeed unpleasant to bear it when its level is high - we will try to curb it by control or avoidance behavior and, in the event of failure, the disorders panics appear.

From anxiety to impotence

When a person feels anxious, it will be different, what makes him suffer and therefore puts him in distress is produced by the state of malaise that he perceives and which is translated in this person by a cognitive and emotional position negative in relation to his ability to cope with future events.

She has the certainty that things will go wrong and that she does not have and will have no control to deal with them in a satisfactory way.

It is as if she were condemned to a terrible destiny from which she could not escape. She is frozen in a posture of oppressive expectation of the drama that she dreads and on which she has a feeling of powerlessness.

She saw herself as helpless and that ended up being very depressing.

To sum up, anxiety pushes us to fight, keeps us alert, but if we feel condemned and unarmed we feel anxious.

The duration of confinement

The stigmatization of certain populations

The risk of post-traumatic stress

The nursing profession.

One of the peculiarities of the carer's job is to show self-sacrifice in the name of care, devotion is a characteristic of the job and encourages the carer to commit himself very often beyond his limits. This characteristic is further reinforced by the ovations we give them, by collectively saluting their commitment every evening, by considering them as heroes. I am not saying that we must stop showing our support for their efforts, I am warning of the risk of not sufficiently taking into account an emotional distress that advances in a veiled way where shame can come to take the relay fear and accentuate anguish in a sneaky and lasting way.

Become a rival of oneself, the engine of shame

Shame is a moral emotion, which is related to honor.
We feel shame when we do not live up to our own standards or those that are expected by others or that are defined by the culture. In the current situation, it can be difficult for these actors to be perceived as both heroes and dangerous people in that they are likely to contaminate us.
The major risk for a carer is that alongside his efforts, the success he encounters in his ability to test himself leads him to become a rival of himself.
This is precisely one of the motors of shame.
Coriolanus, an illustrious hero of Roman antiquity, is described by Plutarch in this way: “The man endowed with a strong and generous soul draws from the first honors he receives a new ardor to deserve more… He would be ashamed to betray his glory, by not surpassing it by greater deeds”. The problem arises when the caregiver begins to feel signals of loss of control and nothing he does helps to correct them.
The carer then feels like a failure and ashamed of being so because if he can no longer hold on, now or later, steeped in shame, he will tend to experience it as a personal failure that will impact his identity and his self-esteem. He will say to himself “I am not worthy of being loved”, “I am pathetic for being so fragile”.

Getting bogged down in shame by maintaining secrecy

the secret contributes to the emergence of shame over time.
We are silent to protect ourselves, we are silent to protect ourselves from the undesirable consequences that could result from a revelation. To speak is to take the risk of being rejected and this prospect is appalling. Not only is the shameful person ashamed but he is also ashamed of being ashamed and this is what encourages him all the more to hide himself in secrecy. To counteract the deleterious effect of shame, it is important to provide psychological support to these personnel to teach them to do something for themselves and not just for others.

children

The risk of post-traumatic syndrome does not only concern health professionals. Anyone can be subject to it. Children are also affected by this risk. Many children find it difficult to make sense of the situation, they may also fear for their parents.

The paradox of over-protection

Sometimes the child's manifesting fear can become so infuriating that it causes the adult to contradict their words and drive the child away from the feared object.
An overly protective behavior of adults then finds itself in contradiction with what they had preached until then, when they said “there is nothing to be afraid of!”.
In other words, the adult adopts a contradictory communication since he verbally denies the fear and then adopts a protective behavior which behavior non-verbally confirms the existence of the fear.
This form of communication is a double bind that creates other uncertainties since the message transmitted indirectly confirms to the child that there is indeed something to be afraid of.
The child in these conditions struggles to be reassured and measures his inability to reassure himself. Giving children the opportunity to express their concerns is a solution that will allow them to go through the painful emotions that overwhelm them, as for adults. 

The principle of resilience

More generally, what can stimulate resilience right now is being able to get out of a test that would be too strong.
When we live an experience and its emotional charge is too intense, we can react to cut ourselves off from our sensations (fear, anger, pain, shame) by a process of dissociation because living with these emotions is insurmountable for us. .
Many professionals are in this situation, journalists, gendarmes, police officers, firefighters, but also transporters, delivery people and of course all those who work in shops, or elsewhere, those who work valiantly and without being considered as carrying out an activity of public and health utility in view of the circumstances. Sometimes they find themselves stuck in a reality as if they were caught in a game where confronting the real world is worth zero but avoiding confronting it is worth double the trouble. We then find ourselves trapped in an impasse where whatever we avoid or confront is a game in which we lose whatever we do. We then end up experiencing endless pain that can last regardless of the context, whether it presents a real threat or whether it is no longer the case.

To stimulate the resources of resilience, it is important to be able to coexist with the vulnerability that accompanies the lived experience. Because it is by being able to be vulnerable that one is able to be strong. Accepting vulnerability allows us to put in place the actions we need. Those that are immediately possible and accessible, even if they seem insufficient to us.

I would like to end with the words of one of my patients who confided to me that she had realized that when she was feeling bad, what kept her in her discomfort was to listen to her and not to be listening. And that made all the difference...

THANKS !