When lockdown ends, euphoria for some, fear for others

The writer is professor of psychological medicine at the institute of psychiatry, King’s College London

It is said that the initial messaging from the UK government about the pandemic (“Stay Home, Protect the NHS, Save Lives”) was one of the most successful health campaigns, ever. It told us what to do, why, and how. By and large we did, almost entirely without coercion. Altruism was also at the forefront: 750,000 people volunteered to help the NHS.

Today, as Britain approaches the end of lockdown, the messages floating around are different and more explicitly based around fear. Some believe that everyone will suffer from “post-lockdown traumatic stress disorder”, “post-Covid stress disorder” or “reverse culture shock”. Such language may well flow from genuine concern about what happens when lockdown ends. But they are also partly due to changes in government messaging during the pandemic.

First, we were told to “stay alert”. It may be reasonable to be alert to a person next to you on the bus who looks feverish, coughs and tells you they have no sense of taste and smell. But how often was anyone that near you, anyway? Then, as the UK entered the second coronavirus wave, the creation of fear was more explicit. Act as if you have the virus and assume everyone else does, we were told. As a result, the most ordinary human interactions could become fraught with danger. I made the mistake of misjudging the space between myself and another pedestrian and still remember the look of horror in his eyes as our elbows touched. The philosopher Thomas Hobbes described what happens when every person becomes a threat to another. “In such condition, there is no place for Industry; because the fruit thereof is uncertain . . . [and] worst of all, continual fear.”

For many, life at the moment is one of “continual fear”. Perhaps, as Sam sang in Casablanca, “a kiss is just a kiss” — but only in our social bubble. And even though most of the time a cough is just that, few of us are able to remain phlegmatic — I chose the word deliberately — when it happens nearby. So the UCL studies led by Daisy Fancourt that showed a rise in anxiety after lockdown are no surprise. Anxiety and depression in young people were already climbing before Covid-19 struck; they have since accelerated.

Pandemics are a triple whammy when it comes to fear. They create fear by their very nature. Governments then often act to increase that fear to encourage our co-operation with virus control measures. (In the UK, the collective memory of the last pandemic was the relatively benign swine flu, so last March the government’s scientific advisory group SAGE could still talk about the need to increase perceived threat levels among the complacent.) But the worst is that enforced social distancing removes one of the best ways we have of reducing anxiety, our social networks.

Yet if increasing fear is all too easy, whether deliberately or not, reducing it is harder. As we see the light at the end of the tunnel, some will gleefully go to the pub, the restaurant or, in my case, Chelsea football club, as soon as it is legal. Probably more of us will emerge like the Prisoners’ Chorus in Fidelio, stumbling slowly, almost unwillingly, from our prison cells into daylight.

Now I can just hear some people saying “all this is obvious”. Fearfulness is understandable, a normal reaction to unprecedented circumstances and there’s no need to see someone like me. “We will get by as we always have, once the rules permit”, they may add, “via families, friends and colleagues”. (Although not necessarily in that order.) But others would have us believe that our emergence from lockdown will be far more than that. It may, in fact, require a whole new medical diagnosis.

The problem is we already have too many diagnoses. The Diagnostic and Statistical Manual, the so called “Psychiatric Bible”, has steadily increased the number of diagnoses from 128 in its 1952 edition, to 348 in 2013. This fifth edition may look smaller but only because it is printed on thinner paper.

Diagnosis can be important: post-traumatic stress disorder is a serious condition for which proven interventions exist. But terms such as “re-entry syndrome” risk medicalising normal emotions. It inflates diagnoses and, as finance ministers often remind us, inflation requires disinflation. Here that may mean overlooking people with genuine disorders, including those caused by Covid-19, such as healthcare workers, who would benefit from treatment but may get lost in a morass of “re-entry syndrome”.

We should do our best to avoid medicalising the normal, expanding the boundaries of the pathological or creating disorders where there are none. Marcel Proust’s observation carries a pertinent warning for our times. “For each illness that doctors cure with medicine, they provoke 10 in healthy people by inoculating them with the virus that is a thousand times more powerful than any microbe: the idea that one is ill.”