Prevention of Covert COVID Iatrogenesis

We want to make sure that when we treat a patient with medications or psychotherapy, there are no unintended consequences where the cure is worse than the disease. To my mind, that is iatrogenesis.  As psychiatrists, we are often canaries in the coal mine.

We need to keep in mind that there is a cost to be paid for our hyperfocus on COVID. That cost includes a continuing denial of aging and entropy, and the ageism that goes along with this denial. We do not want any measures that we take to be done mindlessly or to offer short-term gain at the risk of undermining long-term resilience.

We also have to be careful about the extent to which measures to ensure isolation may interfere with identity formation, especially for children who are being isolated from their peers. I think of the insights of Kathe Kollwitz, an artist in Weimar Germany, who noticed parents and children becoming more and more estranged from each other and from themselves. I worry about inauthenticity. Here is a Goya print, done in 1798 during a Spanish civil war at the time of the Napoleonic invasions. Everyone is wearing a mask. Now we are all wearing masks, in some cases mandated to do so. Goya said, “No one knows who anyone else is.” We don’t want social alienation to be the cost of wearing masks.
 

I worry about inauthenticity. Here is a Goya print, done in 1798 during a Spanish civil war at the time of the Napoleonic invasions. Everyone is wearing a mask. Now we are all wearing masks, in some cases mandated to do so. Goya said, “No one knows who anyone else is.” We don’t want social alienation to be the cost of wearing masks.

More important, we don’t want perfectionism, self-righteousness, vigilantism, scapegoating, and dehumanization to be the costs of fighting the pandemic. This drawing called “Marsayas,” was done by Hyman Bloom in 1953 as McCarthyism was rising and there was a whiff of the Shoah in the air, at least for American Jewry, much of which was in denial. We have to be careful that we do not, like Apollo, have such high standards that we begin to dehumanize people.

Bloom’s Seascape III (predatory fish) was a homage to Turner’s “Slave Ship.” It reminds us that, for a start, we must weigh the costs of the disease vs the costs of lockdown. We will not achieve perfect control of the virus before we need to begin to provide more and more services and employment and begin to move back to normality. We have to be careful not to create an atmosphere that leads to Enduring Personality Change After Catastrophic Experience (EPCACE). This was a diagnosis in ICD-10 but unwisely taken out of ICD-11. The diagnosis focused on the kind of perfectionism that can be an unintended side effect of response to catastrophe and that can actually interfere with resilience, as in Weimar Germany, where resilience after World War I led to Nazism and World War II. That was unhealthy resilience. We want instead to foster moral, bioethical resilience.

Even in winter there is hope.

We want to remember that there is hope.

Hope lived on for my parents, who fought the typhus epidemic in the Lodz ghetto as Fekalists.

If people, in such extreme circumstances can maintain hope, efficacy, ethics, and heritage, so we can, so we should, and so we shall. Bloom’s favorite Rabbi provides us inspiration.

Here is a painting by Henryk Epstein, a painter from my hometown of Lodz in Poland, done during the rise of Nazism. The owl, as a medieval symbol of the Jew, was often used disparagingly, but here it is a symbol of hope, surrounded by beautiful flowers. Epstein was murdered in 1944, but his legacy of maintaining hope against all odds lived on.