The worldwide panic over COVID-19, and the heavy-handed government response to it, has generated a wide range of reaction among patients. As a family physician and a psychiatrist, we have seen some patients adapting well. On the other hand, many feel anxious over the thought of getting the illness or experience other negative emotional responses resulting from the lockdown. Invasive public policy intervention always comes with a host of unanticipated consequences. Politicians initially gave into their usual impulses to reassure rather than inform, calling for “business as usual,” and “nothing to see here.” But it quickly became evident that the disease spread fast and could be life-threatening in a minority of cases. In response, federal and state entities called for “social distancing, “hand and surface washing, and “hands off the face,” all of which seemed reasonable. Then, as the news media sensationalized their coverage, public officials became anxious and fell back on their all-time favorite method of problem-solving: risk management. Emergency statutes and orders have mandated masks, closings, and in some states, curfews. Governors are deeming which businesses and services are to be considered essential or not. Some of our neighbors are mandated to work, despite the risk, while others are now unemployed or are forced to stay home and lose income. Other consequences of mandatory “stay at home” measures and deferred medical care include mental health and substance use disorders, other illnesses, and domestic violence. And of course, the economic damage caused by the lockdowns will also degrade patients’ ability to obtain medical care in the future. In our practices, we are seeing patients make health compromises that might increase their susceptibility to the viral scourge. Some have become so anxious or depressed, due to fear stoked by the media, that they are unable to work. One potty-trained four-year-old patient had a curious manifestation. In the last month, as her entire routine changed, she had daily unpredictable urination, or incontinence: probably a disorder driven by all of the media blitz, adult anxiety, and related disruption. Physicians, guided by the principle of “do no harm,” are always on the alert to side effects and unexpected reactions to their interventions. Physicians are expected to take responsibility for the “iatrogenic” harms they cause. The side effects of government intervention might be dubbed “solonogenic” (after the historic Greek lawgiver), although accountability in a political context does not reach the standard of the medical model. Economist and philosopher Thomas Sowell put it this way: “It is hard to imagine a more stupid or more dangerous way of making decisions than by putting those decisions in the hands of people who pay no price for being wrong.” Patients beware: Politicians are not your doctors! As a family physician and a psychiatrist with more than fifty years, collectively, of clinical experience, we are not the only ones to observe that the current intervention in the name of public health is so invasive and far-reaching that it has caused considerable amount of preventable mental illness in adults and children alike. Our colleagues are, no doubt, also spending considerable time treating patients’ mental health symptoms stemming from the government-caused crisis. It is imperative to recognize these solonogenic harms so they can be treated properly by clinicians. It may not be possible to remove the mental irritant of public health orders right now, but their effects can be mitigated if we distance our minds from the parts of the guidance that irritate. We propose the name “lockdown panic syndrome,” in order to highlight the public health intervention as the etiology of the mental disorder. Put simply, this syndrome consists of anxiety about the coronavirus and confinement at home that leads to paralysis rather than productive problem-solving. In some cases, it even results in loss of sphincter control — a rather transparent metaphor for the general problem we face. It is inherently anxiety-provoking and fatiguing to have one’s own judgment about managing the risks of everyday life preempted by the micro-risk-managing directives of public officials who are remote and unaccountable. As physicians, we grapple with the same mental challenges as our patients. It is anxiety-provoking to be faced with the possibility of punishment if one does not practice medicine according to government edict, particularly when the authors of those directives are nonclinicians, remote, unaccountable, and concerned with the well-being of populations rather than individuals. Physicians beware: public officials will not be responsible for the clinical outcomes resulting from your compliance with their guidance! How can lockdown panic syndrome be treated? Encourage patients to take back control over their own daily lives as much as they safely can. Tell patients that their own judgment about protecting themselves will be sound once they have vetted their information carefully and sought individualized guidance from their personal physicians. Patients can also be supported in taking the initiative to rebuild their own lives on their own terms, in safe and realistic ways, rather than waiting for the go-ahead from public officials. Physicians can heal themselves by staying in charge of their own clinical decisions. As always, doctors interpret the scientific literature in the context of their own unique practice experiences. Individualize treatment plans to the needs and values of each patient. Physicians will feel less anxious, and their morale will improve when they remind themselves that they are servants of their patients, not the state. Public officials and the media could stop lockdown panic syndrome in its tracks by allowing physicians to treat the clinical problems created by COVID-19, and empowering patients to use their individual judgment and take responsibility for themselves and their families. Unfortunately, it may be too much to ask public officials to shelve their partisan agendas, but the rest of us, practicing physicians and patients, can partner together to make America a healthy nation again, mentally, physically, and perhaps we can learn to put politics in places less central in our minds. Craig M. Wax is a family physician. Robert Emmons is a psychiatrist Source
