With COVID-19 we are dealing with an invisible stressor and the potentially traumatic threat of death to ourselves and our loved ones. Both of these are creating widespread feelings of anxiety and depression, and may in the long run, if we get the hundreds of thousands of deaths as potentially predicted, cause a new kind of post-traumatic stress in some, and complicated grieving in others. I’ve been involved in two similar-type traumatic stressors: one, the Chernobyl power plant explosion, a technological disaster spewing radioactive particles over a vast area of land, and the other involving nonstate terrorist actors killing some, while threatening to kill all, that may have lessons to teach us about how to psychologically cope better on an individual and national level with COVID-19. What can we learn from other similar stressors to brace and get through this one?
Terrorists – We Can Kill You Anywhere, at Any Time. The global COVID-19 threat is completely different, yet not totally unlike, than terrorists who, after successfully carrying out one spectacular attack or a campaign of attacks that are widely nationally or internationally broadcast, spread fear and anxiety throughout entire societies. It’s not rational, really; terrorists who in reality only killed dozens somehow manage to convince entire populations that they can be killed at anytime, anywhere, and thus make us all fear.
What we learned with the terrorist threat is that the news media, particularly during and right after an attack, is deeply important – that it’s crucial to have broadcasters who don’t sensationalize and whip up the fear any more than is necessary to take wise precautions and leaders and spokespersons who instill trust and calm throughout the nation. We need to be able to turn to credible leaders to pass true and trustworthy information so that the population follows their instructions and doesn’t begin to doubt and look for their own, often misguided, sources of information. We already have seen this with the couple who recently ingested a substance that President Trump touted as a potential cure for COVID-19, yet the form they took killed one of them.
Likewise, it’s important for parents to realize that children are also viewing the news as well and are too young to make sense of it and are frightened by it. For instance, after 9/11, even children in Italy were reporting nightmares of planes crashing into their apartment buildings after viewing the planes of 9/11 hitting the twin towers in New York too many times, with too many heightened emotions. Similarly, I recently heard about one 3-year-old child who, after hearing too much scary COVID-19 news, began to ask his mother, “Are there viruses here in our home too?” Sometimes it’s good to shut off the news when small children are around. These days, with Twitter also giving adults endless and frightening news, adults too may need to exercise self-discipline and not overload their emotional capacities.
Chernobyl: The Invisible Stressor of Radiation Poisoning
The Chernobyl disaster also gives us lessons about facing an invisible stressor, much like the COVID-19 virus that can’t be seen by the naked eye, but can be lethal nonetheless. While many are frustrated by the lack of COVID-19 testing, all of us are inundated with the news of its highly contagious nature leading many to speculate about what may be in their futures if they too become infected. For instance, a mother in Europe told me her son had bronchitis and due to the restrictions had to have the doctor come to them. She relayed how the healthcare workers arrived fully suited to test her young toddler. While he tested negative, she could only imagine what might have happened if he tested positive. Would they have separated him from his mother and taken him to the hospital alone?
How many deaths will occur with family members unable to be at their loved ones’ bedsides, unable to say goodbye? It haunts all of us when a loved one begins to cough or complain of any symptoms resembling those of COVID-19.
This is not unlike our experiences in 1997, when my husband was posted as U.S. Ambassador in Belarus, the former Soviet Union country hit hardest by the Chernobyl disaster, with most of the radioactive fallout landing on Belarusian territory. We had three young children with us and were naturally concerned about their being exposed. I wasn’t the only one worried. It was 11 years after the disaster but the “Chernobyl necklaces” – scars crossing the throats of children who had developed thyroid cancer – were sobering reminders of the dangers that may still lurk in the food, soil and air. Mothers were terrified when their children sneezed or fell ill, fearing the worst – that they had been radiated and now had cancer. It’s not unlike COVID-19 today with everyone wondering what they might touch, walk upon, or breathe that could bring the toxic death virus inside their bodies and homes. It’s not irrational to have fears as we watch the fatality numbers growing and the predictions that hundreds of thousands may die.
In Belarus, the Chernobyl liquidators, brave men and women who had gone to shut down the nuclear reactor, some even working on the rooftop to build a giant sarcophagus to contain it, asked me to study their post-traumatic responses years after having been exposed to radiation, as some of their comrades had died of radiation poisoning afterwards. They all feared early deaths, cancers and some even had partners who didn’t want to risk having children for fear of potential birth defects due to radiation mutations.
Studying their responses, I and others learned that the Chernobyl liquidators had all the classic symptoms of post-traumatic stress disorder [PTSD]. They had faced an event that threatened all of their lives, had learned of others dying horrific deaths in wards shuttered from public visits, and they as a result suffered extreme fear, anxiety and depression, and a sense of heightened arousal in their bodies. They suffered nightmares and found it difficult to sleep. They tried hard to avoid thinking or talking about the disaster, but often felt they could not and then resorted to drinking and other maladaptive methods of trying to calm themselves.
But the one thing they didn’t suffer were flashbacks of the event. That was because they had faced an invisible stressor, something unlike other traumas, where the threat to life involves a painfully and overwhelmingly visible traumatic stressor, which is remembered over and over again after the event. Many PTSD survivors refer to these post-traumatic flashbacks, which repeatedly intrude into their everyday thoughts, as being like full-sensory films, in which they painfully relive the traumatic event with the sights, smells, sounds, tastes and sensations of the traumatic event still all intact – to be relived again in every gory detail.
There were no such traumatic flashbacks for the Chernobyl liquidators because their trauma was informational, and the stressor was invisible. Most had only learned later of the grave dangers they had undergone while being exposed to this invisible stressor of radiation. It is the same now for COVID-19 exposure. While as a collective society we are all exposed to the COVID-19 crisis, none of us know as individuals, until we fall ill, if we have been exposed and may die of it. But that doesn’t stop our minds from conjuring up ill-fated futures with which to torture us. In the case of the Chernobyl liquidators, they experienced what I began to refer to as flash-forwards – traumatic images that played in their minds of falling ill with cancer, of dying early, or of being rejected by others, and these robbed them of their joy and caused them the same deep distress often seen in PTSD. In fact, I believe they had PTSD from the Chernobyl event, but with this one feature specifically different – the horror playing in their minds was not of a past event, but of a poisoned future.
So how can we as a collective society, and individually, deal with the stress and anxiety and potential trauma of COVID-19? First is to realize the stress and traumas may raise cortisol levels in our bodies and that we can do things to antagonize that. One is engaging in attachment behaviors that release oxytocin in our brains and bodies, a hormone that naturally antagonizes cortisol and lowers it. That’s why you see toddlers who are exploring their worlds, when frightened, turning back to their parents for a reassuring gaze or vocalization, or even running back for a hug, to let them know the fear is not overwhelming and that they can carry on. It’s a natural stress inhibitor to engage in attachment behaviors. Okay, so we can’t hug and touch anymore, except in our immediate families, but a phone call, reaching out to others and knowing you are not facing this alone, and some laughter can be very strong medicine to keep stress levels in check, as can diverting your attention from the stressor by absorbing yourself in things that bring joy or take your thoughts elsewhere. Likewise, exercise is good.
While we don’t want to dwell on the negative, we also need to face that some of us will lose loved ones, which is why we all must take social distancing seriously and try to minimize the number of losses. For those who do suffer losses, we can expect to see complicated grieving. We may not be able to be at the bedside or even enter the hospitals where our loved ones are treated, or be able to hold funerals and burials for some. This will inhibit grieving and we will have to find other ways to hold delayed memorials and to grieve with rituals that differ from those relied upon in the past.
But we also need to put our fears into perspective. When 9/11 happened, I was in Brussels and held stress debriefings for expats who feared for family members back home, about flights and about the next attack, which al-Qaeda had announced would be at NATO headquarters in Brussels in October. Government officials suddenly went to militarized workplaces, passing armed guards and tanks on their way into their offices and heard about real and fake anthrax arriving into many of the U.S. embassies around the world. They became terrified and started ruminating about their fears.
I told them to put it into perspective and asked how many had driven to the meeting we were holding? How many had partaken of the snacks served? Who dared to sit under the chandelier that might fall down and kill them if it dislodged from its hook in the ceiling? There are many ways to die and we generally block them all out. COVID-19 is making us acutely aware in these uncertain times of our own, and our loved ones’, mortality. Aside from giving us a terrifying glimpse of our potential grim futures, it might also be a good thing.
Realizing that those around you, those you work with, those you interact with on a daily basis, your family members and even the strangers you pass never to see again are all mortal has the potential to instill deep terror inside. It also has the potential to make you a better human being, one filled with compassion and love for your fellow human traveler. We are all here only for a short time and this can be a time when we take the extra steps to be kind to one another and show love for all. COVID-19 is a pandemic of epic proportions but if we all refuse to give into fear and choose to respond with love and care it can also be a blessing in disguise.