Coronavirus disease 2019 (covid-19): a guide for UK GPs

Cecil Helman, the late South African general practitioner and social anthropologist, wrote in his autobiography 'Suburban Shaman; Tales from medicine’s frontline ' that he did not mind if patients came to consult with him about their illnesses and explain the reasons as being viruses or spirits. He said that their concepts were a matter of semantics and both a virus and a spirit (djinn) represent the presence of something invading the body (1). What we see emerging around us now through a global narrative that impacts on our individual positioning in society, the home, and the self, is precisely the unravelling of the juxtaposition between the seen and the unseen that Helman was referring to.

We, in a biomedical and scientific paradigm, believe we can see viruses because of our equipment to permit our doing so; whereas there may equally be claims that spirits can be seen because of the way that bodies become possessed or that spiritual entities such as ancestors can create and control our bodily experiences. As it stands now, we know that there is a physiological phenomenon escalating globally. Our borders and boundaries of our lands and bodies have been transcended by an invisible force, COVID-19, and from the vantage point of our own seats in the world, through the media through academic findings (2), through patient lived experiences, and the ways that we make sense of them, COVID-19 is forming part of our belief-systems and socio-cultural understandings.

We are informed how to prepare, we are told how to prevent (3), we are updated with the rising number of confirmed cases as well as fatalities (4), but we only know COVID-19 through our trust in others, systems, and ways of evidencing. We are shifting and re-organising our world on a collective level in response to a symbol; to COVID-19. This symbol has united us in ways that show our frames of reference of the world are indeed semantic. COVID-19 is embodied and it does not matter whether its existence is understood be a virus or a spirit - regardless of our definition, we are all susceptible. We are all facing the trauma of the threat of potential death; this is our potential for union.

We know from analysing conflict and post-conflict transitions that such crises can pose as an opportunity for social transformation (5). We propose that in light of other collective traumas and humanitarian crises including climate change and the void of empathy of those who are traumatised from war and violence, COVID-19 needs a public mental health focus. As COVID-19 is the first major pandemic - or panic - for our generation, it is important that we seek the hidden opportunities for us to reflect and react as a global society. We are given the same symptom check-list and the same prevention strategies regardless of where we are living in the world, or our ethnic group, gender, age, or socio-economic group. There is an opportunity to bring people of all cultures together and reduce prejudice and stigma because of the global nature of COVID-19.

COVID-19 is challenging our position in the world because we realise our connectedness to those around us regardless of geographic distance, yet at the same time, we become deeply aware of our individuality because the illness will be a threat to our physical - and mental - well-being. We embody the same paradox that Helman wrote about; we are the landscape that our beliefs are inscribed upon. Our concepts, language, and understandings of our self and the world are merely semantics. We be-come our bodies through our experiences of illness. COIVD-19, then, is as much as challenge for how we are to frame it from a psychiatric perspective as it is symptomatic of a public health crisis. By merging public health with mental health, the ways that COVID-19 are changing the world could be for better rather than for worse. Our responsibility as mental health care professionals, including both clinicians and academics, is to ensure that our normativity about the ways we prescribe the meaning and representation of COVID-19 to our own selves and the world, enhances our mental health rather than leads to a deterioration of what we can transform individually and globally from this juncture onwards.

References:

1. Helman, C., 2014. Suburban shaman: tales from medicine's frontline. Hammersmith Books Limited.
2. Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID‐19 based on current evidence J Med Virol [Internet]. 2020 Mar 5;jmv.25722. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.25722
3. Department of Health and Social Care and Public Health England. Coronavirus (COVID-19): UK government response. 2020;
4. World Health Organisation. Novel Coronavirus (COVID-19) Situation. 2020; Available from: https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd
5. Yadav, P., 2016. Social transformation in post-conflict Nepal: A gender perspective. Routledge.