Since the start of the pandemic there have been almost daily warnings of the effects that this natural disaster will have on our mental health. The impending mental health crisis has even been given a name: the “shadow pandemic”.
However, beneath the headlines, there is surprisingly little hard evidence. Many surveys have found people increased levels of stress and anxiety, but that is not the same as mental illness.
Some papers have predicted a big spike in mental illness based on patterns from previous natural disasters and economic crises. However the workings of the human mind are complex and not well understood, and it is not clear how useful it is to compare this pandemic to an earthquake or a tsunami. The winners and losers of crises are determined by class struggle. The mental health implications of the economic crisis and pandemic recovery will be determined by how that struggle plays out.
Other papers have predicted a rise in mental illness due to people experiencing trauma, grief, stress, and isolation. These are known factors for increasing risk of mental illness, but there is nothing to suggest trauma, grief, stress, or isolation are made more psychologically damaging if they are the result of a coronavirus pandemic.
The 14 July Academy of Medical Sciences report is very measured. “While there is considerable uncertainty, it seems likely that the combination of factors will result in an increased mental health burden this winter.”
It cites two longitudinal studies [i.e. studies of the same variables over time periods] that show raised levels of anxiety and mental distress at the beginning of the lockdown in comparison to pre-Covid trends. The increase was small compared with the general trend of increased mental distress experienced over the past few years, and almost all the Covid-specific increase in mental distress is reported by women and young people, perhaps reflecting increased domestic violence.
There is some evidence that anxiety and distress has tailed off since the start of the pandemic. A German study has found that the strongest indicator of whether an individual experienced the optimal stress response is whether they thought positive political or social consequences will flow from the pandemic.
There is evidence from Germany and Japan that suicide rates decreased by 20% during lockdown compared to previous years. There is also evidence from the alcohol industry and from surveys that alcohol consumption has reduced substantially during lockdown and more people have reduced or stopped drinking than have increased the amount they drink. But then again, there has been a huge increase in domestic violence, which may result in very significant rise in mental illness.
In any case, we have already been living through a pandemic of mental illness for many years in the advanced capitalist world, and nothing has been done about it. There has been almost no attempt to tackle this or even understand its causes. The only attempt by epidemiologists to grapple with this question is the body of research explained in The Inner Level by Richard Wilkinson and Kate Pickett.
Wilkinson and Pickett demonstrate that there is a consistent correlation between a country’s income inequality and rates of mental illness. They theorise that the root of much mental illness is status anxiety that causes extreme stress and manifests in individuals as depression, anxiety, addiction and narcissism.
So the lockdown may actually mitigate mental illness. Many low paid workers have seen a rise in social status as their work is seen as essential. Many key workers have a new sense of pride in our work and a sense that our work is valued by the overwhelmingly working-class communities that we serve. Although that is yet to be reflected in our pay packets, this moment of celebrating cleaners, bus drivers and Amazon delivery drivers is a sharp departure from pre-lockdown norms.
We might also wonder about the effect of senior management and rich people in general being tucked away at home for three months. Wilkinson and Pickett suggest that status anxiety is triggered by living in a highly unequal class society where there are multiple encounters with strangers and near-strangers, leading to worries about how we are judged by others. The reduced physical contact demanded of everyone through the lockdown has reduced the number of these encounters. The fact that most top bosses and the rich retreated to the safety of their private residences and the streets were only populated by fellow workers on similar incomes may also have had an impact.
Many people have reported that this is the first time in their lives when they have not worn make-up, or let their hair grow long, worried less about their physical appearance, all perhaps signifying reduced status anxiety.
We don’t know the outcome. We do know that before the virus, at any one time, up to quarter of the population was experiencing intolerable mental suffering, and mental health services were massively under-resourced.
As we rebuild our world after virus peaks, we should aim to make it a place that nurtures mental well-being. That means aggressive pursuit of economic equality.