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It all started in the middle of the fourteenth century, when the ghost of the Black Death flew over Europe. The evil affected the Genoese, who began to spread it in the ports where they docked. Venice, which at that time was an important commercial epicenter, was affected by the disease, so it began to leave ships that came from infected ports anchored for 40 days (quaranta giorni). Thus the word quarantine emerged, although about preventive isolation had already spoken long before Hippocrates.
A lot of time has passed since then, but the shadow of COVID-19 has reactivated that protocol on a large scale. Entire cities in China have been placed in massive quarantine, entire Italian regions are isolated and thousands of people around the world are self-isolated in their homes.
The separation and restriction of movement of those who may have been exposed to a contagious disease to determine if they are sick and reduce the risk of infecting others has proven to be an effective containment measure to prevent the spread of infectious diseases. However, it can also have a lasting psychological impact on some people.
The emotional price of quarantine
Quarantine can be a psychologically challenging experience. To the separation from the people we love, the impossibility of moving freely and the radical change of our habits are added boredom and uncertainty about the course of the disease. That psychological cocktail has its price.
Researchers at King’s College London analyzed the results of 24 studies conducted in 10 countries in which quarantine measures have been applied to control outbreaks of diseases such as Severe Acute Respiratory Syndrome (SARS), Ebola, H1N1 Flu, Middle East Respiratory Syndrome (MERS) and equine flu.
The results, published in The Lancet, indicate that the most common problems associated with quarantine are posttraumatic stress and depression, which can be dragged even three years after the experience. Another study conducted at Columbia University noted that some people resort to maladaptive strategies such as substance abuse to deal with these problems.
The emotional state also suffers. Sadness, irritability, fear, anger and guilt are the most common emotions. However, quarantine does not affect everyone equally. People with a history of psychiatric disorders and health workers suffer a much greater psychological impact.
Samantha Brooks, lead author of the study, explained: “Entering quarantine is a lonely and often scary experience. Our study found that it has negative psychological effects. The fact that these effects last for months or even years is especially worrisome and indicates that measures must be implemented during the quarantine planning process to minimize that psychological impact.”
What stresses us most in quarantine?
We don’t all live quarantine in the same way, and all quarantines are not the same. There are certain factors that can aggravate the psychological effects of that isolation:
• Too long periods of insulation. Quarantines of more than 10 days usually cause more negative emotional states and their psychological repercussions are greater, according to a study conducted at the University of Ontario. An extension of quarantine, however small, can greatly exacerbate frustration.
• Insufficient information. One of the most stressful factors for people in quarantine is the limited information on the purpose of isolation or not having clear guidelines to follow. Being isolated creates a defenseless situation that is very difficult to manage. If we do not have reliable information, catastrophic thoughts skyrocket and we fall into a dangerous loop of negativity.
• Frustration and boredom. The confinement, the loss of the habitual routine and the reduction of the social contact are some of the most distressing factors for the people in quarantine, which end up generating frustration and irritability.
• Lack of basic supplies, such as food and medicines. During a period of confinement people cannot provide themselves with the basic things they need, so lacking them or not having a regular supply further sharpens the feeling of lack of control.
Another study published on Comprehensive Psychiatry revealed that having been exposed to traumatic situations before quarantine, as well as perceiving a high level of risk of becoming ill, increases the chances of suffering a stronger emotional impact and that it will last longer.
Once quarantine is over, economic losses due to the inability to work, as well as the social stigma that may have been generated around the disease, also influence our mental health.
How to mitigate the psychological impact of quarantine?
During outbreaks of important infectious diseases, quarantine may be a necessary preventive measure, but it is also important to be aware of its psychological effects to try to alleviate them – as much as possible – especially if we are more vulnerable people.
There are many factors that are beyond our control, such as the duration of the quarantine and the information we receive. However, there are other factors that we can influence to mitigate the psychological effects of that seclusion.
As Viktor Frankl pointed out: “When all the goals have been taken away from us, all that remains is the last of human freedoms: the ability to choose the personal attitude in a set of circumstances.”
– Prepare psychologically for what will come
Centuries ago, Seneca, the Roman philosopher, warned us that “The unexpected has more overwhelming effects, adding to the weight of the disaster.” That is why the Stoics encouraged to prepare for the worst in the best way. That means we must be aware that sooner or later boredom, irritability, worries and anguish will knock at our door. In that case, stress management techniques such as trascendental meditation will be our best allies.
– Stop catastrophic thoughts focusing on our strength
Having so much free time is fertile ground for catastrophic thoughts to break loose. The fear of the disease and its consequences can become a double-edged sword that makes us assume a hypervigilant attitude, which will make us exaggerate the symptoms and imagine the worst possible scenario. Attempting to stop those thoughts consciously often generates a rebound effect. Sheltering in happy memories or in future plans is a good way to conjure them. And remember Seneca’s wisdom: “There are more things that can scare us than crush us; we suffer more often in the imagination than in reality.”
– Find an altruistic sense
Feeling that other people will benefit from our situation can make quarantine easier to bear. In fact, the psychological impact of a chosen quarantine will be much less than that of mandatory isolation. It is, therefore, to make sense of what is happening to us and understand that isolation is helping to keep others safe, including the people we love, but also those particularly vulnerable. It is also about being aware and responsible.
– Feel connected
Feeling connected is also essential to deal with quarantine. Activating our social network through phone calls or social networks allows us to maintain contact and not feel so alone. A study conducted at Chung Yuan Christian University revealed that participating in support groups after quarantine facilitates the connection and exchange of similar experiences that allow validation and empowerment.
There is no doubt that a quarantine not only disrupts our routine, but also takes away our sense of control and creates confusion and helplessness. In that state we are emotionally vulnerable. But we can choose the attitude with which we will face it. And that counts a lot.
Brooks, S. et. Al. (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet; S0140-6736(20)30460-8
Liu, X. et. Al. (2012) Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry; 53(1): 15-23.
Wu, P. et. Al. (2008) Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol Alcohol; 43(6): 706-712.
Pan, P. et. Al. (2005) A Support Group for Home-Quarantined College Students Exposed to SARS: Learning from Practice. The Journal for Specialists in Group Work; 30(4): 363-374.
Hawryluck, L. et. Al. (2004) SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis; 10(7): 1206-1212.