This page contains a shortlisted entry by Elias Diamantis for the RCPsych Future Archives Competition.
Reflection of a Liaison Psychiatrist on 2020 and 2021
I remember joking about people eating bats from Wuhan wet markets in February 2020, when the rumbling news and chatter about “coronavirus” began. I don’t remember the exact joke and it probably wasn’t that funny. My wife and I went to the Philippines for 2 weeks that month, narrowly avoiding the travel restrictions. While walking around Bohol, groups of chattering little kids would scamper away from us with their hands over their mouths, presumably warned of breathing near foreigners. I didn’t honestly think we’d be seeing similarly bizarre behaviour when we got back to the UK. I also saw “COVID-19” for the first time on a Filipino television, sat in a café by the Sagada rice-terraces. I saw clips of Chinese authorities barring sick people from hospitals and thanked God that wouldn’t happen in England.
Upon my return, I was informed of a variety of changes to my work as a Liaison Psychiatrist. We would now default to assessing people by telephone. The liaison psychiatry team were considered “super-spreaders” so instead of sitting alongside someone in psychological crisis, we became a voice (for some yet another voice) in their ear. I was half-way through my psychodynamic case as a trainee and moved to telephone and then video-consultation. Can you really expect a therapist to embody the comforting embrace of the eternally loving parent they never had via that slightly askew eye contact of Microsoft Teams? (Other videoconferencing tools were available) At one point my client carried digital-me, mid therapy, right into her bedroom for privacy, shattering several walls of the therapeutic frame.
Thankfully, if the risks justified it, we were still able to do “in-person” assessments, though thoroughly gowned, masked and visored. I then began to see (as opposed to hear about) the lifecrushing effect of the lockdown on some people. A self-employed builder took an overdose after being told he didn’t qualify for furlough, having no idea how he would support his partner and family. An elderly schizophrenic lady lost every single one of her cafés – she would normally visit a different one each day of the week – and all three of the churches that she’d attend on Sundays closed their doors. A troubled young man had just started to find some meaning in the cut and thrust of his Engineering degree before being sent home to a single bed flat to live an isolated and online existence. These are just a few examples of kinds of presentations I saw every day, through my impersonal mask and visor. I would hate somebody looking back on this time to assume universal support of the lockdown measures. The closing of businesses and hospitality, the restriction of contact between family members and friends, the prevention of group meetings for any reason, including congregational worship, all these things have caused untold damage and many people warned of it.
Something I would like remembered is this advice from the government’s scientific advisors: “The perceived level of personal threat needs to be increased among those who are complacent, using hard-hitting emotional messaging. To be effective this must also empower people by making clear the actions they can take to reduce the threat” 1. Amidst the volleys and counter-volleys of statistics thrown around in favour or against various measures, this approach has been tangibly successful. I hope that in the future people will be unable to imagine a society living in this kind of fear. I’ve seen people encouraged to let their relatives die alone to prevent possible transmission of this virus. I have seen 5-year old children being told not to touch climbing frames because they might die or kill someone else. I saw someone jump into a street of busy traffic because a jogger passed them at a distance less than two meters. Happy groups of young people are called “selfish granny-killers” and recently I’ve heard advice that fathers of brides should stay two meters from their daughters during their hopefully soon-to-re-commence ceremonies.
You can see how these examples are just tips of an enormous iceberg of pervasive fear. If at work I only considered the risks of not-doing-something, I’d recommend everyone I see be admitted to a psychiatric ward. There’s always some risk. There’s also a wonderful life to be lived out amongst that risk and I think very hard and carefully before depriving people of that. I hope we all do so next time.
1. Options for increasing adherence to social distancing measures. 22nd March 2020. Scientific Advisory Group for Emergencies