Of all the literary masterpieces describing humanity’s experience of disease pandemics, none describes suicide more vividly than Ovid's Metamorphoses, when in response to the psychosocial distress of the plague the citizens “hanged themselves, to kill the fears of death by death’s own hand.” Just like a pandemic became a reality for the first time in more than a century, in a destructive "life imitating art imitating life" way, news of suicides linked to the COVID-19 crisis have swept the globe and sadly show no signs of abating.
K. Balakrishna, a 50-year-old Indian father-of-three, may be the first suicide victim linked to the coronavirus epidemic. Panic is suspected of precipitating his death. Historically, disease pandemics have been associated with grave psychological consequences. This should not come as a surprise. In its simple definition “pandemic” describes the spread of a disease across a large region, but words such as “pandemic,” “plague” and now “coronavirus” are not experienced in a simple way; they come riddled with fear, anxiety, grief and chaos. Balakrishna kept watching coronavirus-related videos and became convinced he had the virus and would infect his family: he was a victim of panic contagion. Panic can demoralize us, it can paralyze us with paranoia and fear, and these emotions in turn lead to hopelessness and desperation.
Emily Owen, a British 19-year-old, is likely the youngest suicide victim of this epidemic. She hadn’t been diagnosed with the virus or reported any symptoms. Rather, the announcement of the lockdown and the impending isolation petrified her. The relationship between isolation and suffering is perfectly illustrated in Albert Camus’ masterpiece The Plague. Camus fictional account of an outbreak of the bubonic plague in the town of Oran now holds eerie similarity to reality: the gates of the city were closed, quarantines were imposed, the citizens were isolated from each other. He aptly compares the plight of the inhabitants to imprisonment: “they had been sentenced, for an unknown crime, to an indeterminate period of punishment.” Uncertainty about how long these measures would last led the Oranians, just as they do us, to feel powerless in planning for the future.
The elderly are at particular risk. Following the SARS outbreak in 2003, there was a spike in suicide among older adults, which could be a harbinger of what’s to come. Older adults are sensitive to loneliness and isolation, as they depend on strong social support, especially during difficult times. Social contact in the community is now at a minimum with social distancing encouraged. The elderly have been especially advised to reduce their social contacts and remain homebound. The weakening of social networks disrupts normal social lives and feelings of worthlessness emerge.
In just one day, two health care workers, Daniela Trezzi, a 34-year-old nurse in Italy, and a U.K. nurse in her 20s took their own lives. Both were deeply traumatized by the horrors experienced on the frontline. Communities look to the paramedics, the nurses and the doctors as pillars of strength, but compassion fatigue—emotional burnout from caring for patients with a bleak prognosis—is prevalent in these workers. Health care professionals are now being called to make difficult ethical decisions about resource allocation, and, once resources become scarce, they will be left with the role of simply diagnosing with not much to be done about treating. Add this emotional toll to the fear of contracting the disease, and you have a level of hopelessness and defeat that can be catastrophic.
Even when the epidemic is under control and the isolation measures are lifted, the economic ripple effect will be immense. The looming economic crisis has already claimed its first suicide victim: the German state of Hesse’s finance minister Thomas Schäfer. In a note he left behind, he explained that he was deeply concerned that he would not manage to fulfill the population’s huge expectations for financial aid. “You’re going to have suicides by the thousands,” Trump said in a Fox News town hall. At a White House briefing, he noted that “people get tremendous anxiety and depression, and you have suicides over things like this when you have terrible economies.”
Yes, Trump’s warning may be exaggerated, but it is still nonetheless one worth considering. The economic crisis may not cause as many deaths as COVID-19, but the high rates of unemployment, poverty and homelessness will all cause the suicide risk to surge. And indeed, suicides tend to go up during periods of economic downturn: the suicide rate rose to a record high of 21.9 per 100,000 people in 1932, in the depth of the Great Depression.
So, while global attention is largely focusing on the active physical treatment of patients, suicide populations in the society, now more vulnerable than ever, are being overlooked. What can be done? The government as well as the health care sector both have roles to play.
For example, we should immediately establish mental health initiatives focusing on educating the public and health care workers on how to best deal with the immense pressure and anxiety; this may help minimize the psychosocial toll in these times of crisis. We should also implement targeted mental health surveillance of populations at risk, including patients with prior mental health diagnosis and the elderly, followed by effective interventions to minimize suicidal ideation. And we should proactively establish mental health programs specifically designed for the aftermath of this pandemic. The psychosocial needs of those affected will be unique and interventions for mental rehabilitation should be designed us such. Treatment should be crisis-oriented.
Above all, we must take care of one another now more than ever. In the conclusion of The Plague, Camus questions, through his main character, physician Bernard Rieux, whether in the aftermath of so much suffering, humanity can find a peace of mind. Offering a glimpse of hope, Camus concludes that we can, as “if there is one thing one can always yearn for, and sometimes attain, it is human love.”