COVID-19: Healthy by separation?
Dr. Peggy Bosch
Dr. Peggy Bosch
- Master in psychology →Radboud University Nijmegen
- Heilpraktikerin (Germany)
- Acupuncture → Shenzhou Open University of TCM, Amsterdam
- PhD → Radboud University Nijmegen in collaboration with the LVR-Klinik Bedburg-Hau (Germany)
Situated in Nijmegen
Amsterdam
Paris
Berlin
London
Bedburg-Hau
COVID-19: Healthy by separation?
- Social isolation
- Group versus alone in isolation
- Existential psychotherapy
- How to deal with a hospital admittance or
death in case of separation?
- The role of social media
- Advice
COVID-19: Healthy by separation?
- What do we know from social isolation?
- Definition → is a state of complete or near-
complete lack of contact between an individual
and society
COVID-19: Healthy by separation?
- What do we know from social isolation?
- Types of social isolation →
1) staying home for lengthy periods of time
2) having no communication with family,
acquaintances or friends
3) willfully avoiding any contact with other
humans when those opportunities do arise
COVID-19: Healthy by separation?
- What do we know from social isolation?
COVID-19: Healthy by separation?
- What do we know from social isolation?
- True social isolation over years and decades
can be a chronic condition affecting all
aspects of a person's existence.
-Social isolation can lead
to feelings of loneliness,
fear of others, or negative
self-esteem.
COVID-19: Healthy by separation?
- What do we know from social isolation?
“The magnitude of risk associated with social
isolation → comparable with that of cigarette
smoking and other major biomedical and
psychosocial risk factors. However, our
understanding of how and why social isolation is
risky for health or conversely how and why
social ties and relationships are protective of
health, still remains quite limited”.
House (2001). Psychosomatic Medicine, 63(2), 273‒274.
COVID-19: Healthy by separation?
- What do we know from social isolation?
- Social isolation is both a potential cause
and a symptom of emotional or psychological
challenges.
- As a cause → the perceived inability to
interact with the world and others can create
an escalating pattern of these challenges.
COVID-19: Healthy by separation?
- What do we know from social isolation?
- As a symptom → periods of isolation can be
chronic or episodic, depending upon any
cyclical changes in mood, especially in the
case of clinical depression.
-COVID-19 situation is different! External
cause!
COVID-19: Healthy by separation?
- Group versus alone in social isolation
- Group: For example →
• Big Brother
(television reality
game show)
• (Severe) psycho-
logical (after)effects
up to even traumatic
COVID-19: Healthy by separation?
- Group versus alone in social isolation
- Group: For example →
• Space missions
• COVID-19 is different
→ no reward (However, not getting ill is some
kind of reward?)
COVID-19: Healthy by separation?
- Group versus alone in social isolation
- Individual:
-For example →
• Prison (solitary
confinement)
COVID-19: Healthy by separation?
- Individual:
Prison →
• As well as severe
and damaging
psychological effects,
solitary confinement
manifests physiologically as well. Solitary
confinement has been reported to cause
hypertension, headaches and migraines, profuse
sweating, dizziness, and heart palpitations.
COVID-19: Healthy by separation?
- Individual:
Prison →
• Many inmates also
experience extreme
weight loss due to
digestion
complications and
abdominal pain.
COVID-19: Healthy by separation?
- Group versus alone in social isolation
- Individual:
For example →
• Psychiatry
(isolation cells)
COVID-19: Healthy by separation?
- Group versus alone
in social isolation
- Individual:
• Psychiatry (isolation cells) →
Patients in psychiatric hospitals
are often put into solitary
confinement, when staff members
determine that they are a danger
to themselves or others.
COVID-19: Healthy by separation?
• COVID-19 is different → it feels like
punishment (However, the individual is not to
blame?)
COVID-19: Healthy by separation?
- Group versus alone in social isolation
• Disease isolation (like COVID-19)
serves as an important method to
protect the general community
from disease (especially in a
hospital or community-wide outbreak).
• However, this intervention poses an ethical
question on rights of the individual versus rights
of the general community!
COVID-19: Healthy by separation?
- Group versus alone in social isolation
• In cases of disease outbreaks, isolation can
be argued as an ethical and necessary
precaution for protecting the community from
further disease transmission.
• Other examples from the
recent past → 1) The 2014
Disneyland measles outbreak
2) 2014 Ebola outbreak.
COVID-19: Healthy by separation?
• Several forms of isolation exist (e.g., strict
isolation, contact isolation, respiratory isolation,
reverse isolation).
• COVID-19 → Self-isolation or home
isolation → is the act of voluntarily
quarantining oneself to prevent infection of
oneself or others.
Siegel et al. (2007). 2007 guideline for isolation
precautions: Preventing transmission of infectious
agents in health care settings. American Journal of
Infection Control, 35(10 Suppl. 2), S65–S164.
COVID-19: Healthy by separation?
Existential psychotherapy →
- is a form of psychotherapy based on the
model of human nature and experience
developed by the existential tradition of
European
philosophy.
COVID-19: Healthy by separation?
Existential psychotherapy
- It focuses on concepts that are universally
applicable to human existence, including:
1) death
2) freedom
3) responsibility
4) meaning of life
Existentialistic Thoughts
COVID-19: Healthy by separation?
Existential psychotherapy →
- Instead of regarding human
experiences such as anxiety,
alienation and depression as
implying the presence of
mental illness →
*Professor Yalom is an
American existential psychiatrist
who is emeritus professor of
psychiatry at Stanford University
COVID-19: Healthy by separation?
Existential psychotherapy →
- existential psychotherapy
sees these experiences as
natural stages in a normal
process of human
development and maturation.
Yalom, I.D. (1998). The Yalom
Reader: Selections from the
Work of a Master Therapist and
Storyteller. New York, NY: Basic
Books. ISBN: 0465036104
COVID-19: Healthy by separation?
Existential
psychotherapy →
- In facilitating this
process of development
and maturation →
existential
psychotherapy involves
a philosophical
exploration of an
individual's experiences.
COVID-19: Healthy by separation?
Existential psychotherapy →
- stressing the individual's
freedom and responsibility to
facilitate a higher degree of
meaning and well-being in his
or her life.
Yalom, I.D. (1980). Existential
Psychotherapy. USA: Basic
Books. ISBN: 9780465021475
COVID-19: Healthy by separation?
Existential psychotherapy →
- What do we think about dying?
- How do we want to die?
- Who should be there?
COVID-19: Healthy by separation?
- How to deal with a hospital admittance or
death in case of separation?
• COVID-19
situation is
different → no
direct contact
with the
(dying) patient
is possible.
COVID-19: Healthy by separation?
- How to deal with a hospital admittance or
death in case of separation?
• Previous research
(Barth et al., 2016) →
Difficulties in communication
and in the relationship with
the patient admitted to the
intensive care unit were identified as the main
stressors by their relatives.
• With the state of coma being predominant.
COVID-19: Healthy by separation?
- How to deal with a hospital admittance or
death in case of separation?
• Previous research (Barth et al., 2016) →
By contrast, the environment, work routines,
and relationship between the relatives and
intensive care unit team had the least impact
as stressors.
Barth et al. (2016). Stressors in relatives of patients
admitted to an intensive care unit. Revista Brasileira de
Terapia Intensiva, 28(3), 323‒329. PMID: 27737424
COVID-19: Healthy by separation?
- How to deal with a hospital admittance or
death in case of separation?
• COVID-19 situation → The patient dies alone.
• Funerals → Only
in very small
groups and/or are
postponed.
COVID-19: Healthy by separation?
- How to deal with a hospital admittance or
death in case of separation?
• COVID-19 situation → What the exact
consequences will be for the relatives is
unknown yet.
• There's a tension between the demands of a
crisis and people's spiritual needs (The
Economist, 2020)
The Economist (2020). https://www.economist.com/britain/
2020/04/11/how-covid-19-is-changing-funerals
COVID-19: Healthy by separation?
- How to deal with a hospital admittance or
death in case of separation?
• COVID-19 situation →
It is too early to draw
any conclusions.
• This COVID-19 crisis will provide completely
new data and insights → how relatives and
friends (psychologically and physiologically)
deal with his or her beloved ones being/or
dying in a hospital alone.
COVID-19: Healthy by separation?
- How to deal with a hospital admittance or
death in case of separation?
- Previous research showed (in a normal
situation) →
• That people react differently to death.
• Dealing with death, particularly the death of
someone you love, is one of the most
stressful experiences you can go through.
COVID-19: Healthy by separation?
- How to deal with a hospital admittance or
death in case of separation?
- Previous research showed (in a normal
situation) →
• The most common reaction on hearing of the
death of someone close to you is shock.
• Shock can affect you for a few days or a
number of weeks.
COVID-19: Healthy by separation?
- How to deal with a hospital admittance or
death in case of separation?
• Shock →
1) Sick
2) Dizzy
3) Nauseous
4) Dazed
5) Numb
6) Empty
COVID-19: Healthy by separation?
Institute of Medicine.
(1984).
Bereavement:
Reactions,
Consequences, and
Care. Washington
DC: National
Academies Press.
ISBN-10: 0-309-
03438-8
Yalom, I.D. (2008). Staring at the sun: Overcoming the terror of death
A book about all aspects of dying.
COVID-19: Healthy by separation?
COVID-19: Healthy by separation?
- The role of social media
- COVID-19 crisis:
Definition of social media →
are interactive computer-
mediated technologies that
facilitate the creation or
sharing of information, ideas,
career interests and other
forms of expression via virtual
communities and networks.
COVID-19: Healthy by separation?
- The role of social media
- COVID-19 crisis: social media play an
important role →
- YouTube
COVID-19: Healthy by separation?
- The role of
social media
- COVID-19
crisis: social
media play an
important role →
-Facetime
-Skype
COVID-19: Healthy by separation?
- The role of social media
- COVID-19 crisis: social media play an
important role in order to →
1) establish social contact (in times of
forbidden direct/physical contact)
2) spreading (fake) news, facts, and
information
COVID-19: Healthy by separation?
- The role of social media
- COVID-19 crisis: social media play an
important role in order to → Highly interesting
data on usage will come.
• In 2019, it is estimated that there will be
around 2.77 billion social media users around
the globe, up from 2.46 billion in 2017 (Statista,
2018)
Statista (2018). Number of social media users worldwide
2010-2021. Statista.
# Network Name Number of Users (in millions)
Country of Origin
1 Facebook 2,375 United States
2 YouTube 2,000 United States
3 WhatsApp 1,600 United States
4 FacebookMessenger
1,300 United States
5 WeChat 1,112 China
6 Instagram 1,000 United States
7 QQ 823 China
8 QZone 572 China
9 TikTok 500 China
10 Sina Weibo 465 China
11 Twitter 330 United States
12 Reddit 330 United States
13 Baidu Tieba 320 China
14 LinkedIn 310 United States
15 Snapchat 294 United States
16 Pinterest 265 United States
17 Viber 260 Israel
18 Discord 250 United States
Source:
Wikipedia
(2020)
COVID-19: Healthy by separation?
- The role of social media
- COVID-19 crisis: different
consumer behavior →
1) Shopping forbidden →
Significant increase in
postal orders/services
such as Amazon
2) Significant increase in
online shopping
COVID-19: Healthy by separation?
Advice
- Social connections (via
telephone, social media,
facetime, skype, etc.)
- See the news only once
a day
- Physical acitivity/
Fitness at home
COVID-19: Healthy by separation?
Advice
- Mindfulness
- Yoga
Creswell, J. D. (2017). Mindfulness interventions. Annual
Review of Psychology, 68, 491-516. PMID: 27687118
James-Palmer et al. (2020). Yoga as an intervention for the
reduction of symptoms of anxiety and depression in children
and adolescents: A systematic review. Frontiers in
Pediatrics, 8:78. PMID: 32232017
COVID-19: Healthy by separation?
Advice
- Keep a kind of daily
routine as much as
possible
- Make a time plan for
every day (Especially for
children this can be very
helpful because they
prefer routine)
COVID-19: Healthy by separation?
Advice
- Intellectual challenges
(computer, reading)
- Television
- Netflix
- Watch movies/series
COVID-19: Healthy by separation?
Advice
- Plan your next holiday
- Plan what to buy
-Try a recipe and cook
COVID-19: Healthy by separation?
Advice
- Existential planning/thinking:
- Draw that lifeline
- Remember your dreams and plan to fulfill them
- Decide not to follow old dreams
- Define new dreams
- Talk about old dreams and new dreams with
your partner/friends/relatives
- Find oud their dreams
COVID-19: Healthy by separation?
Advice
- Existential planning/thinking:
- Write on a sheet what you like and do not like
about your relationship or family life
- Ask your partner or family to do the same
- Discuss and make plans to increase nice
experiences together
- Stay open to each others experiences and try
to find solutions for the less-positive-experiences
COVID-19: Healthy by separation?
- References
• Barth, A. A., Weigel, B. D., Dummer, C. D.,
Machado, K. C., & Tisott, T. M. (2016).
Stressors in relatives of patients admitted to an
intensive care unit. Revista Brasileira de
Terapia Intensiva, 28(3), 323‒329. PMID:
27737424
• Creswell, J. D. (2017). Mindfulness
interventions. Annual Review of Psychology, 68,
491-516. PMID: 27687118
COVID-19: Healthy by separation?
- References
• House, J. S. (2001). Social isolation kills,
but how and why? Psychosomatic Medicine,
63(2), 273-274. PMID: 11292275
• Institute of Medicine. (1984). Bereavement:
Reactions, Consequences, and Care.
Washington DC: National Academies Press.
ISBN-10: 0-309-03438-8
COVID-19: Healthy by separation?
- References
• James-Palmer et al. (2020). Yoga as an
intervention for the reduction of symptoms of
anxiety and depression in children and
adolescents: A systematic review. Frontiers in
Pediatrics, 8:78. PMID: 32232017
• Siegel, J. D., Rhinehart, E., Jackson, M.,
Chiarello, L., & Health Care Infection Control
Practices Advisory Committee (2007). 2007
guideline for isolation precautions: Preventing
transmission of infectious agents in health care
settings. American Journal of Infection Control,
35(10 Suppl. 2), S65–S164. PMID: 18068815
COVID-19: Healthy by separation?
- References
• Statista (2018). Number of social media users
worldwide 2010-2021. Statista.
• The Economist (2020).
https://www.economist.com/britain/2020/04/11/h
ow-covid-19-is-changing-funerals
• Wikipedia (2020).
https://en.wikipedia.org/wiki/Social_media
• Yalom, I.D. (1980). Existential Psychotherapy.
USA: Basic Books. ISBN: 9780465021475
COVID-19: Healthy by separation?
- References
• Yalom, I. D. (2008). Staring at the sun:
Overcoming the terror of death. San Francisco:
Jossey-Bass.
COVID-19: Healthy by separation?
- References
• Yalom, I.D. (1998). The Yalom Reader:
Selections from the Work of a Master Therapist
and Storyteller. New York, NY: Basic Books.
ISBN: 0465036104
Collaboration
1. Psychiatric Research Group, LVR-Klinik
Bedburg-Hau, Bedburg-Hau, Germany
2. Donders Institute for Brain, Cognition and
Behaviour, Radboud University Nijmegen,
Nijmegen, The Netherlands
3. Research Group of Pain and Neuroscience,
Kyung Hee University, Seoul, Republic of Korea