With the onset of the COVID-19 pandemic, one of the strategic commitments of the state in dealing with the crisis was to provide care for the mental health of the population. To that end, psychological support helplines were set up in the Psychiatric Clinic. In an interview with "Res Publica", the director of the clinic, Stojan Bajraktarov, explained that our people are not accustomed to isolation. They are used to closeness and it is normal that the new way of life is difficult for them. He pointed out that in certain groups there is a primitive defense mechanism, i.e. denial of the virus. They do not adhere to the precautionary measures and do not stop to think that they are selfish towards their loved ones. According to him, it is a minority and most citizens disapprove of their own behavior, which instills hope for collective mental health.
What were the effects of the isolation and the quarantine measures, i.e. social distancing in the state of emergency, as opposed to the physical distancing that we now must implement in practice?
Every social crisis, including the current coronavirus pandemic, has negative consequences on the mental health of the individual and the collective. Reactions and psychological coping with similar crises have been depicted in literature and seen throughout history, we can see such examples in the Iliad, the siege of Troy, the plague pandemic, or during the global economic crises. Through these examples we can learn historical lessons, anticipate what lies ahead, and prepare for a possible crisis of our mental health. It was during quarantine that Shakespeare wrote King Lear, Newton developed the law of universal gravitation, and Munch and Boccaccio were particularly prolific.
Hardly anyone remained unfazed by this crisis, given that we all had to make behavioral changes. We have changed the way we behave and function on a daily basis, and we expect that style to last for at least a few more years. Of course, there are examples when, due to personal characteristics and stress-triggering factors in individuals, their individual capacity for appropriate response to the crisis is limited. Help should be provided for those individuals. Collective mental health is affected by several important factors. Among them are: our Mediterranean mindset, our genetically predisposed temperament, the habits of close socialization in our micro-environment, our traditional values, close family relations, and the habits of building close relationships at work, in the neighborhood or relations built by similar interests in various social or cultural activities.
What can be surmised from the psychological support helplines of the Psychiatric Clinic? What are the most common reasons why citizens call?
Right after the onset of the crisis, people could not accept or adapt to health precautionary measures and there was an increase primarily in emotional and behavioral problems. A friend, who is a very positive and sociable person, after two weeks of isolation, said that he had changed his mind about the term "mental health", adding that from now on he would respect it, even though he previously thought it was just a phrase that rings hollow.
Citizens' reactions were expected, given that we are an outgoing people, who are quite socially active, with habits for building close interpersonal relationships. Therefore, the measures were very difficult for certain groups of citizens. That was why the capabilities of the health system in dealing with the crisis were limited.
In general, we as a people are not in the habit of isolating ourselves, instead we are accustomed to empathy and helping our loved ones. As a nation, we are temperamental and extrovert. We have a tradition of close contacts, we like to hug, kiss, be in physical contact, and now we miss that physical closeness. But over time, we learn as we go that we can restructure ourselves. We are adapting to the crisis and to the new ways of socializing and behaving on a daily level.
The current epidemiological reports are a reflection of the present behavior of the population in Macedonia in the new normal. What is the state of mental health of the nation?
We live in a time of many risks and challenges to our mental health, which have been present for a while now, having only intensified with the pandemic. The epidemiological situation is also a result of the activation of a primitive defense mechanism in certain collectives. That is denial, i.e., "if my standpoint is that there is no coronavirus, then I have nothing to fear." It is a selfish attitude, because if you do not implement the measures yourself, you put others at risk. They do not stop to think that most often they endanger their closest ones.
This irresponsible behavior correlates with the crises of national mental health, of societal values, of morality, which seem to have been in a phase of transformation for a long time. If we associate this with national mental health, we would conclude that the selfishness of people who do not respect the measures and do not accept their responsibility in relation to collective health, prevails over a sense of collective responsibility and over all positive correlations such as humanity, empathy, altruism... Nevertheless, I think that they are a minority. The majority of citizens have a critical attitude and developed abilities for insight into their own behavior, which instills hope that we can have a cautiously optimistic outlook on the prosperity of our mental health collectively.
How much will the pandemic change humankind? Is the behavior of the nation in relation to some world trends?
We have been discussing with our colleagues in several European countries that mental health at the collective level has common international characteristics. In the initial period, the instinct for survival prevailed. It's as if we've all engaged all our psychological capacities to deal with the risks to our health. The collective urge to survive and defend against this existential danger has been activated. The number of people dealing with mental illness seeking help from mental health services has dropped significantly in the first two months of the pandemic, but has risen significantly this month. During this period, many people are asking for advice on the psychological support helplines, which indicates a positive trend in terms of improving knowledge and public opinion on mental health or readiness to solve psychological problems with a professional. This indicates that the stigma of mental disorders has decreased, which will certainly result in improved mental health, and is in line with trends, especially in developed countries.
It is obvious that we have changed in every aspect of our living, the focus of life is being redefined. It is important to work on re-examining oneself and reformulating one’s priorities. We are most likely to value more what is at stake, such as our own health. Many people I know seem to have reconnected with forgotten family values during this crisis. There is greater interest in cooking, gardening, family nature walks, etc.
This crisis has definitely proven once again that humans are very adaptable creatures and that the entire social system is undergoing a rapid transformation under the influence of a general threat.
Which values have declined and what segment of ourselves has come to light?
I have a feeling that the pandemic has accelerated the catharsis of the mental health crisis, but I hope that it will result in a period of positive transformation and development of a positive, humane, intellectual collective spirit and mindset. Not only during the pandemic, but also throughout the long transition, there have been attempts of brute force to overpower reason. There have been deliberate attempts to provoke the awakening of an aggressive urge in a certain suitable population, who, not knowing how to deal with the challenge of intolerance of their own individuality, take on the role of Faustus and sell their souls to the so-called ruler.
Gustave Le Bon writes that authoritarianism attracts such individuals into crowds and the opinions, ideas and beliefs thrust onto them are accepted or rejected in their entirety, without critical consideration.
That is the essence of both nationalism and Nazism, and of all the authoritarianisms that are present in many countries, or represent significant movements in well-known democracies. This is the story of Palpatine and the Star Wars Empire, or Sauron and the Orcs in The Lord of the Rings. Even in such periods, the same Faustus-like individuals blindly believe in the "power/ruler", and perceive goodness and humanity more as a weakness than as a social imperative. The upside of the story is that throughout history, as well as in novels and movies, good always wins. Let’s hope that we will be fortunate enough for this mental health crisis to unfold in a similar way and that after this period of mass abreaction, sociological and moral purification will follow.
Social media have become the only place for social contacts. What have you learnt from them? What role did they play?
Despite their huge success, social media have been a symbol of the destructive side of modern technological development. However, during this period, they’ve played an extremely positive role in maintaining social relations, which were and still are at high risk due to preventive measures. During the quarantine period, social media played a key role in terms of psychological coping with social isolation, loneliness, lack of contact, especially among the youth. Their positive aspect came to the fore, especially in terms of information sharing, options for education and entertainment and they served as a great tool for upkeeping morale.
What about the mental health of the children, who no longer attend school and have replaced "live" socializing with online games and TV. At what point should we be concerned about them and how can we help them?
I would say that children, young people, and particularly adolescents, are special critical groups, according to the manifested problems in the functioning in the past period. Physical distancing has also caused social distancing and young people are finding it particularly difficult to cope with that. This is understandable, given that the expression and processing of age-specific urges are now suppressed by the severity of the challenge posed by the pandemic. The lack of a structured work day and all the positive effects of the educational process truly are a challenge, as is the limitation of opportunities for playing sports and for other social activities. The effect of these processes on mental health primarily depends on the characteristics that the young person has acquired during their upbringing in the family environment, primarily from their parents.
It seems that most of the youth, in the initial period, were strongly committed to following recommendations, but as the pandemic went on, their fears weakened. This may have led to a reduction in their perception of imminent danger and to a lax attitude in terms of adhering to measures. This, by all means, is understandable, because restraining their physical and social activity can have quite a negative effect on their health. They should certainly be a priority in all subsequent measures, especially if this situation is prolonged. It is necessary to restructure and organize quality teaching, to organize measures for promotion of mental health and prevention of mental health issues, for them to become knowledgable in this area and to improve the capacity of parents and teachers to deal with their needs.
How can we help ourselves now and in the following period, knowing that we will continue to fear for our own health, for a possible infection with COVID-19 and the uncertainty of keeping our jobs?
Henry David Thoreau gives us one piece of advice - "simplify, simplify". I think that if we are ready to accept the simplest advice, which is repeated almost daily by the WHO, we will manage to help ourselves and our loved ones. By adhering to the measures, we can significantly influence the spread of the infection, pay attention to ourselves, consistently be physically active. Adherence to the simplest measures, which are constantly repeated by our health authorities and the WHO, which are: wear a mask, maintain distance and keep good hygiene, should become our lifestyle, in order to deal with the situation more safely. We should also prioritize quality sleep, good nutrition, keeping the rhythm of daily activities, and above all, maintaining regular social contacts with all our loved ones. Predictions of a possible economic crisis may cause fear among the majority of the population, but that should serve as a warning to prepare on time.
And as one of my dear friends says, we should primarily socialize with people we like, those that are pleasant to be around, who have a positive effect on our mood and our mental health.
Journalist: Ana Zafirova
Photographer: Tomislav Georgiev
