COVID-19: Trapped in Trauma

The COVID-19 virus is engulfing just about every corner of the world as well as dominating much of our inner world. It reminds me of an old Twilight Zone episode. The one about an atomic explosion that destroys everything…except for one old man. In this episode, the old man struggles to find anyone who might be alive. He stumbles through rubbled streets peering through his Coke-bottle lens glasses.

Shocked and astonished he begins to realise he is the lone survivor. He repeatedly cries out, searching and hoping to find another living person. Destitute, his mind screams, ‘Where is everyone? Am I the only person left?’ Then, within a moment, far down a distant street he sees the remains of a library with books strewn everywhere. He feels lost, alone but quickly realises he can now indulge his one passion…his desire to read without interruption.

The old man struggles with cognitive dissonance, the destruction and abandonment of the world he once knew and the growing realisation that without reproach he can read forever and ever in his now destroyed home, the library. Finally, with arms full of books, he sits down to read on remains of the mangled library building, the ruins of his civilisation. Then, in a growing frenzied excitement to choose his first book, he knocks off his Coke bottle-lens glasses.

Horrified, he frantically struggles to find them, but they’ve fallen close to his shoe and without glasses, he can barely make out their form. He feels around the concrete rubble, but his shoe finds the glasses first. Without knowing, he steps on the Coke-bottle glasses, shattering them to pieces thus eliminating any possibility of reading and blind to what dangers the future brings.

I’m certainly not alone in feeling the COVID-19 virus has created a profound sense of loss. The world we knew has disappeared behind surgical masks, closed doors and lockdowns. Additionally, I fear what will happen in the aftermath of the virus; the effect and magnitude of lost humanity. How will this collective loss reconfigure the inner world of those who remain? Will we eventually lessen this fear from memory? Or, will we live within a constant agony of contagion?

There are many of us who, over time, will neglect fear of infection. But there are others who will not, who will always and have always felt plagued by potential disease. Specifically, people who obsessively agonise about non-existent infections, imagined viral attacks, or lifelong paranoia of germs. Hypochondriacal individuals who feel attacked by society’s ignorance of germs; frightened that dangerous infections lay in wait to penetrate their body; those who remain steadfast and emotionally armed for any imagined, nonexistent bacterial attack. They suffer alone in their viral vigil, frightened and helpless. Perhaps similar to the Twilight Zone man who stepped on his coke-bottle glasses. Alone, alone forever.

This is the plight of one of my patients: A woman in her mid-50s who spends each day paralysed by imagined lurking contagions. She obsessively devises compulsive ritualisations desperately hoping to stave off threatening delusive infections. For my patient, there is always a life-threatening virus, albeit an illusory one. But now, with the reality of COVID-19, I fear she may decompensate to an emotional tipping point.

My patient has spent a lifetime battling dangerous imagined germs; germs that will penetrate an infectious badness into her. If someone accidentally touches her or brushes past her in a crowded room, she devolves into a barely controllable obsession meant to physically decontaminate herself, to continually purify her now infected body. What will happen if she falls victim, if she really gets sick from the malicious destruction inherent in a severe level of COVID-19?

Many/most of us take precautions and hope we will not get the coronavirus. If we do become infected, we rely on relationships and resources to aid and promote physical and emotional restoration. But, my patient’s obsessional precautions against germs take up most of her time: multiple showers per day, ritualisations that inhibit leaving her home, a fear of being around people/anyone who will infect her. She spends nearly every moment inspecting her body or obsessing about not inspecting her body for disease. My patient demands her mind to repeatedly remember details of any inadvertent touch from people or objects that might contaminate her. She recently told me that if someone walks past her house, she ‘knows’ rapist germs have crept into her home and self. Hers is a moment to moment obsessional struggle against virus, bacteria, microbes. She has no time to develop resourceful relationships. And as a result, I have always treated her online as leaving her home sets off crippling panic.

We have statistics on people who die from COVID-19, we have statistics on people tested positive for coronavirus. But, under what statistic does the emotionally paranoid obsessive/compulsive individual, such as my patient, under what statistic will they be counted. Will they be listed as a victim of COVID-19?

How many other patients, how many people hide the fear of infection, mask shame by not admitting to a phobic preoccupation against germs. What imaginary-virus horrors surround people who obsessively fear infectious germs? What happens to people who hear voices instructing them to ignore virus warnings or voices telling them to tape windows shut, to barricade doors against vicious germs.

I remember once riding the subway in New York City with a friend, a clinician who worked with the homeless. We both became intrigued with a man sitting across from us. His hair was unkempt, his clothes dishevelled and dirty, yet there he was reading the New York Times. Every few minutes he repetitively rattled the newspaper as though shaking something off the page. But, each shake revealed nothing; nothing fell to the floor, not one single thing.

Soon my friend walked over to him and asked what he was doing. He responded he couldn’t shake the bugs off the page. She pointed to the words on the newspaper, “These bugs that look like words?” He looked panicked, “Yes, they aren’t words, they’re bugs and they’re all over. I can’t get away from them.” Later, I asked my friend why she wasn’t afraid to confront the man. She knew him from the homeless shelter where she worked and knew he often refused his medications. She said he constantly complained about his [anti-psychotic] meds that they made him see bugs, especially bugs that carried deadly germs. He won’t be someone counted as a COVID-19 statistic, but, metaphorically, he is.

Many of us who worry about COVID-19 infection will remember this fear, but the intensity will eventually mutate over time. Yet, the man on the subway and my female patient will always live within an imagined viral infection. What is the depth of emotional pain that remains concretised within her, what level of aloneness does she feel or are germs her constant companion, her life partner?

There will be no statistic of the emotional effect COVID-19 has or will have on severely hypochondriacal individuals. There will be no statistic recorded about the heightened paranoia or emotional paralysis of those who suffer from ritualistic obsessive/compulsive fear of germs.

To my way of thinking, the library steps are crowded with people who won’t be counted victims of the coronavirus, even though their suffering has increased from the viral threat…they just won’t be counted.

Photo by cheng feng on Unsplash