Like most Israelis, I am greatly concerned to see that more and more of my fellow countrymen are getting infected by the coronavirus. I believe that this pandemic is the greatest public health and economic disaster of our times. But I am also greatly concerned to hear that Health Minister Yuli Edelstein announced that we will need a “medical miracle” if we want to avoid another lockdown and that our nation’s leaders are now discussing implementing additional restrictions, with the possibility of implementing a full closure within the next several days. They are starting with weekends.
As it appears that our government may decide upon a second lockdown, I want to implore Israel’s Health Minister, Prime Minister and other members of the Israeli government to think twice about whether this is the best method for fighting the coronavirus, because the psychological cost of a prolonged lockdown is quite severe.
Yedioth Achronothas reported that the NGO Sahar noted a 350% increase in the number of calls due to mental distress caused by economic difficulties and they also emphasized that there have been more people calling in who are suicidal. Imagine how much worse this figure will be if a full lockdown is implemented for a second time. Do we really want to take the chance?
Last February, Lancet, a British medical journal, reported that “long durations of quarantine were associated with poorer mental health, specifically post-traumatic stress disorder symptoms, avoidance behaviors and anger. Those quarantined for more than 10 days showed significantly higher post-traumatic stress symptoms than those quarantined for less than 10 days.” Living under quarantine causes long-term stress, anxiety, insomnia, and a feeling that one is unable to do anything. Although living under quarantine is not the same as living under lockdown, more recent studies have also demonstrated that lockdowns can also adversely affect one’s mental health.
A similar study conducted in China found that the lockdown orders there caused 35% of the residents to show symptoms of psychological distress and 5.14% experienced severe symptoms of psychological distress. According to the report, those most likely to develop adverse psychological symptoms under lockdown are women, individuals between ages 18 and 30, and those over 60 years of age.
Medical News Today reported that the coronavirus pandemic “has many potential sources of trauma,” such as losing a loved one, standing by as a relative is infected, experiencing grave economic loss, fearing for one’s health and safety just by doing mundane activities, living in social isolation, and more.
For some people, lockdown can exacerbate the risk of developing post-traumatic stress disorder. Rape survivors, assault survivors, discharged soldiers who fought in wars and victims of terror attacks who already suffer from PTSD and other mental health issues are likely to have their mental health deteriorate under lockdown. During the first lockdown, the Association of Rape Crisis Centers in Israel reported that many women and girls who were raped in the past and suffer from PTSD and complex PTSD experienced a deterioration in their mental health under lockdown, which required psychological treatment. In some cases, such women and girls required hospitalization.
However, the PTSD diagnosis does not cover the extent of the mental health cost caused by the pandemic itself. Psychology Today recently reported that the unique circumstances of the pandemic are so grave that the mental health disorders associated with it combine a mixture of PTSD, acute stress reaction, major depression, adjustment disorder and anxiety disorders, and even these do not capture it all: “Researchers Steven Tayor, Caeleigh Landry, Michelle Pluszek, Thomas Fergus, Dean McKay and Gordon Asmundson previously developed a model of COVID Stress Syndrome (CSS, 2020), identifying five distinct yet interrelated elements”:
1. DAN: Fear of danger from COVID-19 and getting infected by different means e.g. touching contaminated objects, breathing contaminated air.
2. SEC: Worry about the social and financial impact (socioeconomic costs) of the virus.
3. XEN: Marked concern that foreigners spread the disease.
4. TSS: Related symptoms of traumaticstress.
5. CHE: Compulsive checking and seeking reassurance.
According to this study, out of the 6,854 individuals surveyed for COVID Stress Syndrome in the US and Canada, only 2 percent have been diagnosed with corona and only 6 percent knew somebody that was diagnosed. However, 28 percent of the people interviewed reported feeling extreme anxiety and 22 percent suffered from clinical depression. At the time, 12 percent reported facemask use, nearly 90 percent regular hand-washing, nearly 60 percent regular hand sanitizer use, 95 percent social distancing, and 48 percent self-isolating. In other words, being socially distant and isolating oneself seems to be correlated with deterioration in one’s mental health.
Many people take mental health for granted and only focus on their desire to survive physically. However, if an individual becomes mentally ill after living under a prolonged lockdown, there is no turning back the cycle of time. As someone who was raped at age seven and suffers from complex PTSD, I would like to stress to everyone that you do not want this.
Since then, I have suffered from insomnia, horrific nightmares, flashbacks, depressive episodes and other terrible complex PTSD symptoms, revealed in Emerging from the Depths of Despair: A Memoir on Rising Above the Trauma of Childhood Rape, which I am in the final stages of editing.
It would be much more effective to quickly evacuate sick people from their homes to coronavirus hotels and to allow people living in tight urban quarters to go outside, enjoy the sunlight and exercise than to shut down the whole country.
When I was a child, the complex PTSD symptoms were such a nightmare that I was suicidal. I spent seven years in and out of hospitals because of them. Back then, just living and breathing was a daily horror show. That is what the illness does to you if you do not receive proper treatment in time. In other words, I lost seven years of my life to this illness and I believe that is more than enough for one lifetime.
During the last lockdown, these complex PTSD symptoms, which were becoming less frequent and more under control after the successful completion of trauma therapy, became worse overnight. It was like the government decree to issue the lockdown instantly undid most of the progress I made in trauma therapy. I was dreaming about exploding qassam rockets and rats invading my home under lockdown. I had flashbacks of myself lying on the floor, dead. And then, I had to pretend that everything was normal, so that I could keep my job, maintain the home, and take care of my three children, all under age five.
I want to stress that I followed every guideline given to me by mental health experts on how to psychologically survive a lockdown. I also listened attentively to Nathan Sharansky’s video about his experience in solitary confinement and spoke to people that were imprisoned in Evin Prison in Iran. In addition, I read every article that I could find on how to psychologically survive a lockdown.
Based upon what I learned, I did everything to preserve structure. In the morning, I did the morning blessings and homeschooled my children. Afterwards, I did exercise videos with them. Then, I went to work, either writing articles or working on my memoir. On my free time, I read books and studied foreign languages. I also kept a detailed coronavirus diary, documenting everything that was happening in our lives. Putting my sorrow into words did help me a lot to deal with the pain. On top of that, I paid 350 NIS per session to meet frequently with an online therapist and got on a new PTSD medication. I drank calming marva tea. By doing all of this, I managed to hang on until towards the end.
At that point, towards the end of the last lockdown, despite my best efforts to prevent it, I was experiencing complex PTSD symptoms that were so severe I had not felt such a thing since immediately after the trauma at age seven. At that point, I knew I was given a choice of becoming a repetitive lockdown violator yet remaining mentally healthy or being a law-abiding citizen in a mental hospital. I chose the first option, for I have people who depend on me remaining mentally healthy enough to function. I am still nowhere as good as it was prior to the last lockdown.
It is important to emphasize that there are so many other people who suffer from PTSD and complex PTSD, who would be going into a second lockdown in an even worse situation than me. It should be stressed that many people with this illness are such psychological wrecks that they do not manage to work. If you are unemployed, how can you pay 350 NIS per session for a private online therapist? Although there are charities that help such people, obviously a therapist who is paid well for her time will be more committed to helping you than some mental health professional who has zillions of poor people to help. It is simple economics.
Furthermore, if you are poor economically for you were too mentally ill to work, how can you afford to buy things that will cheer you up and help to preserve structure under lockdown, such as books on Amazon Kindle, Babel or Netflix? It also should be added that it is one thing to be locked down in a beautiful house with a lovely garden and another thing to be locked down in a run-down apartment that does not even have a balcony. These things very much affect one’s psychological ability to survive lockdown.
And if your starting position is that you have not successfully completed trauma therapy, how can you mentally cope with the new trauma that was added on top of your prior trauma? Thus, if even someone like me, who has managed to overcome this illness enough in order to become a published author and professional journalist, struggled to maintain their sanity under lockdown, imagine how other people with this illness who have been less successful in fighting against it feel under lockdown.
Prime Minister Netanyahu and Health Minister Edelstein would argue that they are just trying to save lives and some may claim that people like me are a necessary sacrifice for the greater good, I would like to add that there is no conclusive proof that a second lockdown will save lives and suggest another possibility. Israel Hayom reported that roughly 65 percent of people got infected at home, so it seems apparent that the worst thing that one can do is confine people at home, especially in the Haredi and Arab sectors, where dozens of family members live in tight quarters. It would be much more effective to quickly evacuate sick people from their homes to coronavirus hotels and to allow people living in tight urban quarters to go outside, enjoy the sunlight and exercise than to shut down the whole country.
South Korea has managed to be ahead of Israel in flattening the curve, without having an economically and psychologically destructive lock-down, just by doing extensive testing, isolating rigorously the sick in coronavirus villages, and wearing masks. Today, South Korea, unlike Israel, is listed as a safe country, whose citizens can travel to the EU. Israel should follow in South Korea’s footsteps and give up on the South Korea has managed to be ahead of Israel in flattening the curve, without having an economically and psychologically destructive lock-down, just by doing extensive testing, isolating rigorously the sick in coronavirus villages, and wearing masks.lockdown model.
In conclusion, I would like the Prime Minister and Minister Edelstein to put themselves in my shoes, just for one moment. Imagine that you are an American Jewish woman, who made Aliyah in 2009 without having a single relative in Israel, not even a distant cousin. You had a horrific childhood in America and want to move beyond your traumatic past. In Israel, you managed to overcome the trauma enough to marry an Israeli man, have three children and to work a professional job as a writer.
Then, the coronavirus came and suddenly, out of nowhere, you have a reduced workload as a writer, for the economy caused freelance journalists to get cut back left and right. Then, your parents, aunt and uncle, who were supposed to visit for Passover, could not come due to the coronavirus. Now, you don’t know if and when you will ever see them again, for you do not have the logistical ability to quarantine in order to go to America to see them and they are too old and at risk to come here, even if given a special visa to do so.
Around the same period, you find yourself locked down and isolated at home with three small children all under age 5 in a construction site, since your building was in the process of adding balconies. Therefore, you were stuck at home with only one window for light, children scared of the noise caused by the construction work and dust everywhere bothering everyone. Any time you wanted to go to the park, to the sea, to the mall, to the gym, to grandma’s or to a friends to escape that situation, you were legally barred from doing so. Thus, all your support system was taken away from you, just as you needed it the most.
I had to complete the work that I still had, manage my home and be a functional parent who took care of everything, as my husband works at a company that produces masks and he had to work overtime during the coronavirus lockdown, often coming into the office at night and on weekends. I was forced to do ten times more housework than usual with no adult company. Soon afterwards, my uncle in America passed away and we had a zoom funeral, absent a proper minyan due to the coronavirus. His wife was unable to see him as well for the last seven weeks he was alive due to coronavirus restrictions in nursing homes. I could not go to America to comfort her.
If this was your life story during the last lockdown, how would you feel about another lockdown, Minister Edelstein and Prime Minister Netanyahu? Please exercise mercy, and please do not implement another psychologically destructive lockdown.
Rachel Avraham is a freelance writer and a political analyst working at the Safadi Center for International Diplomacy, Research, Public Relations and Human Rights. She is the author of “Women and Jihad: Debating Palestinian Female Suicide Bombings in the American, Israeli and Arab Media.” Her second book, cited above, is in the final stages of editing.