By Clayton Dalton, a writer in New Mexico, where he works as an emergency physician. Originally published at Undark.
When President Biden said last fall that “the pandemic is over,” some people applauded what they saw as an honest appraisal, while others pointed out that hundreds of people were dying from Covid-19 every day in the United States. Americans are still dying from Covid-19. And yet life now resembles the pre-Covid times more than at any point since the start of the pandemic. Restaurants are crowded. Masks are scarce. Vaccines and medications have proven safe and effective. The World Health Organization has determined that Covid is no longer a public health emergency.
What seems clear is that we have crossed a threshold: The acute, collective crisis of the first years of the pandemic has ebbed. Now may be a moment to look back on what we’ve just been through, and try to make some sense of it.
What have we just been through? The dislocation and destruction wrought by the pandemic have touched every aspect of life, everywhere. Millions of people died. Millions more lost their loved ones, their livelihoods, their health. All of us endured years of isolation, fear, and uncertainty. At the emergency room where I work, I saw patients younger than me succumb to the virus. I saw patients die for lack of a hospital bed or ventilator.
The impact of the pandemic seems almost too vast to be reckoned with. But some experts suggest that the essence and consequences of what we’ve endured can be captured with a single concept: trauma.
“The scale of this outbreak as a traumatic event is almost beyond comprehension,” Yuval Neria, a professor of psychology at Columbia University, told CNBC in 2020. That same year, researchers writing in Nature Human Behavior described the pandemic as part of a cascade of collective traumas, and psychologists from New York University argued that the Covid-19 pandemic “can and should be viewed from the perspective of trauma.”
Were we all, to some degree, traumatized by the pandemic? If so, can an understanding of trauma suggest a path toward healing?
To decide whether the pandemic was a collective trauma, we should first define trauma. In its original Greek usage, trauma was physical — a wound to the body. The idea of psychological trauma, whereby experience alone could produce durable harm to the mind, wasn’t proposed until the 1850s, when a French physician argued that adverse experiences in childhood were associated with mental illness. In 1889, psychologist Pierre Janet described a consistent triad of symptoms that occurred after traumatic experiences: dissociation, reexperiencing, and hyperarousal — similar to the symptoms we now recognize as post-traumatic stress disorder. Trauma, he thought, resulted from an inability to integrate the experience into our narrative of ourselves, to give it meaning.
When PTSD entered the lexicon of psychiatry in the 1980s, the field had moved away from the conceptual world of Janet. A new biological materialism, focused more on the brain than on the mind, was ascendant. Researchers hunted for physical or structural abnormalities in the brain that might explain the disorder, and perhaps lead to a drug that could treat it. But their efforts didn’t produce a pharmaceutical cure. Although a number of drugs are prescribed to treat PTSD, their efficacy is limited.
As researchers continued investigating trauma, more questions emerged. For instance: What constitutes a traumatic event? In 1980, the Diagnostic and Statistical Manual of Mental Disorders, or DSM, a guiding text for psychiatric practice, defined it as anything evoking “significant symptoms of distress in almost everyone.” In 1994, this definition was revised to be more specific and objective: Traumatic events threatened death or serious injury, causing intense fear or helplessness. In 2013, the DSM definition was amended to include sexual violence alongside death and injury, and to allow that PTSD could result from simply learning about such an event.
The DSM appeared to be wrestling with two opposing forces. On the one hand, it seemed important to exclude minor adversity from definitions of trauma, lest common tribulations be pathologized. But on the other, there was recognition that post-traumatic symptoms did sometimes occur following a broader, more protean spectrum of exposures.
Some evidence suggests that the spectrum of symptoms may also be broader than those defined in the DSM. In the 1990s, a physician named Vincent Felitti partnered with the Centers for Disease Control and Prevention to undertake the Adverse Childhood Experiences Study, which surveyed 17,421 adult patients and tracked their health over time. The results were startling. Each patient was asked about eight categories of childhood adversity — physical abuse, for instance, or parental divorce. Only a third reported that they’d had no adverse experiences as children. People who had been exposed to four or more categories of adversity were seven times more likely than those with no exposure to develop alcoholism. Those who had been exposed to six or more categories were two times more likely to develop cancer, four times more likely to develop emphysema, 46 times more likely to use IV drugs, and 51 times more likely to attempt suicide than those who hadn’t suffered adverse experiences. In his 2015 book “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma,” psychiatrist Bessel van der Kolk cites Felitti in saying that practitioners “may be treating today experiences that happened fifty years ago.”
Paul Conti, a psychiatrist and author of “Trauma: The Invisible Epidemic,” told me that from his perspective, the definition of trauma can be simple: “We can just ask the question,” Conti said, “is this person different after something traumatic?”
Are we ourselves different, after having endured a global pandemic? Of course we are. In the E.R. these past three years, I’ve seen more substance abuse, more domestic violence, more anxiety. Painful things change us, sometimes in normal and healthy ways. “Such are the raw materials of life,” writes David J. Morris in “The Evil Hours: A Biography of Post-traumatic Stress Disorder.” “We are our scars.”
But is this trauma?
In his book “The Trouble with Trauma,” Tulane University psychiatrist Michael Scheeringa argues that such a formulation of trauma is so pliant as to allow almost any experience to be deemed traumatic. He worries that applying the lens of trauma indiscriminately serves only to pathologize normal experiences.
Is Scheeringa right? And if we believe he is, could we be enduring not trauma but just the difficult human consequences of a global cataclysm? Is there a difference?
Part of the reason trauma remains such a mystery may be because the concept doesn’t fit our usual models of disease. Medicine favors objectivity. (Does the scan show pneumonia or not?) But we can’t actually touch the stuff of mental illness. Advanced brain imaging and other technologies may further our understanding of trauma, but they have so far not furnished all secrets. The truth seems to be that trauma is inescapably subjective, and medicine struggles with this.
In 2018, researchers discovered something surprising. They compared rates of PTSD across 24 countries against an index of vulnerability to traumatic events. They expected to find that more vulnerable countries would have higher rates of PTSD, but instead they found the opposite: Countries with higher vulnerability had less PTSD. Some have criticized their methods, but the authors stand by them. Although they note their study has limitations, they hypothesize that PTSD may be a product not just of a life-threatening event itself, but of the degree to which it collides with our expectations. In other words, trauma is the product not only of our subjective experience of an event, but of its interplay with our understanding of the world itself, and of our place in it. Every trauma, then, may be perfectly unique — a product of the infinite variegation of each individual, their worldview, the context of their life, and the traumatic circumstance itself. How could we ever hope to standardize and codify such a multifaceted, multiplicitous thing?
Perhaps what we now need most, as the exigency of the pandemic ebbs and many of us reach for normalcy, is an understanding of how to integrate this experience into the narrative of ourselves, as Janet argued more than a century ago. Judith L. Herman, a prominent trauma researcher, has written that a trauma survivor “must be the author and arbiter of her own recovery.” How will we author our collective and individual recoveries from the calamity of the pandemic? Can we be better from it? Will we recognize and begin to rectify the structural inequities which the virus so effectively exploited? Will we see the importance of collective, concerted action against truly global problems?
I’m sympathetic to the idea that traumatic experience can cause real, persistent harm, in elusive and enigmatic ways. I recognize that a world of traumatic dark matter exists out there, the extent of which I can never fully know, exerting its gravity on the lives of my patients.
I suspect that I will never be able to definitively diagnose who among my patients has been traumatized, and who has not. I have no scan, no test, to guide me. But knowing that I cannot know creates space for humility, and empathy. Instead of dispensing a diagnosis, I might be better off asking them: What has the pandemic meant to you?
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My time to ‘bang head against laptop.’
I’ll once again roll out Ernst Simmel, who thought that the trauma suffered by World War I soldiers was due to their having felt abandoned to horrific experiences by their officers, leaving the soldiers in the bind of being filled with rage at those they depend on. You can cut that a variety of ways — we can see the soldier crying for mama as representative of all soldiers, just being more direct about it — but the key point is that trauma reflects a breakdown of social ties.
Reading through the article reveals a stubborn insistence on individualizing the problem. And so we have the empty notion of “not being able to give the experience meaning.” And then there’s whether it fits into a “worldview.” Particularly when we’re talking about the pandemic, which has been such a train wreck blending indifference and incompetence — epitomized in encouraging us to engage in individual risk assessment — it is amazing that these people can’t grasp that the experience of “being overwhelmed” is a failure of a social matrix, a safety net if you will, that is deeply internalized from early infancy. Here not being able to give something meaning is what happens when you suddenly feel like you’re meaningless, you don’t matter like you thought you did, and the failure/withholding of socially-established protections, heir to the original protectors, leaves you lost in space.
“Shell shock” was my first thought when he suggested PTSD just showed up out of the blue in recent memory. I mean, I have nerdly academic friends who can read about it ancient Greek.
Also, let me raise my hand as not part of the everyone who “endured years of isolation.”
Your perspective resonates with me from what I gather about trauma and tragedy. I know that I identify with the experience of having witnessed attempted ancestral cultural annihilation. Stephen Jenkinson speaks of how Modern Western Civilization has made orphans of us all. (Hope I am not misrepresenting his view.) In any event, I think you have cogently expressed the reality we are dealing with. It is a deeply felt spiritual crisis driven by a collapse of the supportive psycho-social network of community that creates transcendent meaning in lived relationships of compassionate humility. Without that kind of community all tragedy becomes trauma.
I was stuck in a long line at airport. a bunch of people around me started striking up a random conversation as random strangers often do.
After 5, 10 minutes or so, a woman revealed to the 6 of us that she lost 12? 21? family/extended family to Covid (can’t remember but it was a gobsmacking large number).
….how being only in her 50’s, she is the matriarch of her family now. while in my extended family everyone made it, even our 97 y.o. nan who spent all of covid in a nursing home.
has there been a census on the impact of Covid? i presume that it is very “fat-tail”…the bottom 1/2 of the income-ladder bearing the big traumatic brunt of it while the top 10% got DoorDash, Amazon and worked from home.
I’ve wondered so much about this, especially since the disparate impact on families seems to scream that there is some kind of genetic component.
Americans have acquired an inordinate talent in claiming victim status any time that something produces some amount of suffering in their lives.
Palestinians have endured genocidal policies for 70 years and in Syria a third of the population has been displaced. Afghanistan has lived through three decades of savage wars, bombing and religious brutality, due first to the US covert op and then direct invasion. This is collective trauma. African societies have been eviscerated by IMF austerity for decades, while East Europeans were forced into decades of social destruction by carefully designed policies of liberalization and privatization which the West required. In Romania, after 1989, while the inflation run at 300%, people sold their kidneys to rich foreigners and their daughters into sexual slavery in the Middle East. Russians lost 5-6 years of life expectancy under Yeltsin, whose 1996 election was won with the help of American PR experts, as proudly documented by the Time. Africa reported 17 million dead by 2001, because Pfizer refused to share the patents for the AIDS drugs; which meant that 60-70 million orphans were left destitute and without any social support. There were entire villages where all the adults had died, and only the orphans remained.
Let’s get some sense of perspective.
>>>Americans have acquired an inordinate talent in claiming victim status any time that something produces some amount of suffering in their lives.
Perhaps. Some of my people can be a bit whiny. Attention hounds, really. But I can see the growing number of people living on the streets as well as the increasing hunger. The ever growing lines at the food bank. If I wanted to, I can easily find the cardboard, tents, and encampments, the excrement and urine. Then there are the vehicles carefully moved about to keep the police happy. There are the towns and cities without work or government worthy of the name. Where the centers of towns and cities look abandoned because they are abandoned. Either neatly boarded up as in the small towns or often wrecks with people with nothing strewn about as if garbage in the larger. The factories, stores, and now hospitals gone away. Quiet, efficiently stripped away for profit and all in the name of Neoliberalism with our well educated Professional Managerial Class, the Good People, has deemed us the Disposable Ones because reasons.
I can write a book about this and others have written them. But let’s end this comment with my observations. I will say it again that for fifty years, long than my entire adult life, everything of worth businesses, jobs, government, healthcare, housing, even churches, charities, sports, and entertainment has been stripped away or crapified efficiently, quietly all for the profits of the wealthy few; everyone but that ten percent of the Good People must work ever harder for ever less; now we have a pandemic, which is said to not exist or only mildly horrible while a over a million died, tens of millions have suffered, perhaps crippled, perhaps dying decades early without care or hope, but with contempt. If you could see what I have seen from the Eagle’s landing to this joke of a diseased country, and know that our rulers are just fine with it because it doesn’t affect them, those with the wealth, privilege, everything that they need including the militarized police, maybe you could ignore the PR concocted to hide all this? Whiners and attention hounds? Very much yes of some. I can also agree that many people have had it far worse. But what of it?
Your indictment of America is appropriate, but as JBird4049 pointed out more eloquently than I can, your anger is better aimed at the top of American society. The rest of us Americans have been abused by our elites and their PMC acolytes for the entirety of my life. I could introduce you to many of my friends or family who have been wrecked by war, poverty, and lack of healthcare. This list is, of course, woefully incomplete, but you get the drift. Yes, America and the west have been belligerently evil across the world, but our “betters” have blessed us peons with the same treatment.
Your comment is an example of this: “PTSD may be a product not just of a life-threatening event itself, but of the degree to which it collides with our expectations.” In parts of the world without a major conflict or drought on their soil, Covid came to unravel the expectation that life would be pretty calm and orderly.
Read this part from the heart of the article, the author’s main thrust.
“Paul Conti, a psychiatrist and author of “Trauma: The Invisible Epidemic,” told me that from his perspective, the definition of trauma can be simple: “We can just ask the question,” Conti said, “is this person different after something traumatic?”
“Are we ourselves different, after having endured a global pandemic? Of course we are. In the E.R. these past three years, I’ve seen more substance abuse, more domestic violence, more anxiety. Painful things change us, sometimes in normal and healthy ways. “Such are the raw materials of life,” writes David J. Morris in “The Evil Hours: A Biography of Post-traumatic Stress Disorder.” “We are our scars.”
“But is this trauma?
“In his book “The Trouble with Trauma,” Tulane University psychiatrist Michael Scheeringa argues that such a formulation of trauma is so pliant as to allow almost any experience to be deemed traumatic. He worries that applying the lens of trauma indiscriminately serves only to pathologize normal experiences.”
What a load of manure. An overly generalized definition of trauma/traumatic event is offered. The author then cleverly declares that pandemics are normal experiences without actually saying so. He then quotes a scientist in a book that bad experiences from normal events shouldn’t be defined as trauma (I’m not sure I agree with that even on the general terms that it’s offered). Why even was this article written? I have to wonder at the motive. The obvious answer to the question posed, from even the most casual perspective, has to be “Yes, and with misery to spare”.
If the pandemic caused medically recognized trauma, wouldn’t that make it more costly for insurers? If an article seems pointless, follow the money.
(writing under assumed moniker to try to get around Skip Intro’s mysterious ban)
The trauma is not over. Wait until Americans confront the culpability of our elite in the disaster. As Jonathan Cook says in an a must read article—Across the West, People are Dying in Greater Numbers. Nobody wants to Learn Why
“The consistent and markedly elevated death rates each month across most of the Western world are not due to Covid and are far above the seasonal five-year average before the pandemic.
If we try to understand why a blind eye is being turned to the shocking data showing a sustained and unexplained rise in deaths, it’s hard not to arrive at one, and only one, conclusion. Governments, establishment media and the medical regulators are frightened. They are scared of what they may discover if the research is carried out.
And that suggests something further. That these are not groups with their own discreet or competing interests and agendas.”
“The trauma is not over.” Blunt force trauma? I’m not advocating that, but it seems a likely emerging variant.
Jonathan Cook discredits his treatise with this: “it was always unethical to insist that children should be routinely given the vaccine and boosters when it was evident that the virus posed no threat to the overwhelming majority of them”
https://www.chop.edu/news/chop-researchers-find-elevated-biomarker-related-blood-vessel-damage-all-children-sars-cov-2?fbclid=IwAR0kryOGtocCBjRaZeusVdwUtHpjSCCtlRleNo5wvOlBuIPiUO8tOw9YUFQ
Why were the 21 out of 50 hospitalized children with minimal COVID symptoms in the hospital? Would the vaccine have stopped this biomarker from appearing in those children? Not sure this paper supports coerced vaccination of all children.
This article? lol
What a miserable state of affairs when a journalist thinks that some kind of socratic, syncretic, rational middle-ground of reliably truthful information independent of the bullshit from both sides of the mainstream is… John Campbell.
Oh well, one just has to hope that the stupidity and the superstition will give way eventually, although the virus will of course leave an enormous trail of dead and immiserated in the meantime. And honestly, it’s pretty frightening to think how far the “everything bad that’s happening is because of the vaccine and not the virus, which is not a threat anymore for reasons that are transparently bullshit but which I am nonetheless choosing to believe. I am a freethinker.” cabal of idiocy has left to run. Probably at least a decade.
In an odd twist, life insurers appear to be the ones who have been blowing the whistle on this. Whether the excess deaths are due to Covid, the vaccine, the mental health breakdowns occurring due to foolish public policy choices or some combination of these, the breakdown of trust in CDC/FDA/FTC/FAA/PTA/NRA etc, the result is that people are going a bit mad. The narcissism and selfishness is off the charts, and our response to COVID made it worse.
Unless we can find a way culturally to figure out that our neighbor or the man/woman across the street that we don’t agree with isn’t our enemy, we will continue to circle the drain. Portland, Seattle, SF, LA are catastrophes in the city centers. 40 years ago this would have not been acceptable.
What we accept says who we are. It is immoral what we are choosing to accept.
“What we accept says who we are. It is immoral what we are choosing to accept.”
https://www.threads.net/@davidsirota/post/Cu2DvkhREow
Interesting. An average of two thousand dollars per a person.
I have mention this before, but in the past few years, 2.5 trillion dollars per year with the total of 50 trillion dollars since 1975 that they should have received; if the same trend of increased wages and increased income for the wealthy had continued the same as it did from 1947 to 1975 with both increases by inflation and by productivity matched with increases in income. However, after 1975 the increased productivity of the workers did not go to them, but to the wealthy and the corporations. The increase in inflation has either barely been matched for the middle class and the lower you go, the less the increases in pay has match with inflation.
2.5 trillion dollars divided 330 million Americans, regardless of class or legal status is $7,575 per year. If it was divided just by those who are employed, something like 168 million Americans, that would be $14,880 per year. This would be for every year and you would likely make more money or be hired to make more money because everyone below the highest ten percent has real bills and needs to pay for, and that would put the money into the economy and make it grow.
The majority of the money goes to less than one percent, more like half a percent of the population. Using one percent, that 2.5 trillion dollars is divided by 3,300,000, which becomes $757,575 per person per a year. Remember that this is now a yearly happening.
Even at the inflation cost of construction, which is partially caused by corrupt, and now by shortages everything, at one million dollars per a person we could house two and a half million people in decent homes especially if we had an inspector general office for it with real power. Something like 200,000 thousand Californians are homeless and who knows home many paid almost all of their pay for it. A least a million Americans are homeless each year as people cycle in and out of it.
But I guess being paid your fair share is socialism, and we can’t have that can we? Tumbrels, I am dreaming of tumbrels.
Maybe some wealthy creeps do want a fascistic political economy much like Italy and Germany during the 1930s. They threatened to go socialist, if not communist, but the fascists won. Unions busted, bankers and factory owners in charge and making big profit, while functionaries dictated the actions of the working class to keep the wealthy happy. It does sound like now, except the government expected and got manufacturing and construction as well. Even the wealthy had to listen to the polite men in their uniforms.
Those who think “the pandemic is over” are now essentially (and unknowingly) trading in “Trauma Futures”. What little solace traipsing around everywhere unmasked, and not using non-pharmaceutical interventions may provide today, is inversely proportional the the potential trauma invited upon oneself by such oblivious behavior. All (lagging) indicators show that infections are (have been, TBH) on the rise. And yet airport terminals and flights are largely chock full of unmasked people.
I’ve been thinking about what a permanent pandemic preparedness entity (private or public sector) would look like. Are there firstly, humanitarian opportunities to stitch COVID conscious communities together with some available business entity? And yes, is there a real economic opportunity in doing so as well? Should it be non-profit?! [Grinning from ear to ear as I write that last line because … well, you know (via NC)]
If trauma is defined as something that leads to a change in personality, then somewhere between March 2020 and June of 2022 (when I actually caught COVID*), I became a different person. I went from cheerful optimism to expectation of death in all sorts of circumstances: car crash, plane crash, hit while on my bicycle. And a general sense that the world I live in has had it. There is nothing to look forward to but bad weather and the ultimate collapse of a culture that values nothing but wealth.
*The experience of quarantine was very easy. One sleepless night, then boredom.
bassmule, how much time do you spend consuming news online or on the boob tube? When I take a break from news, I just feel better. It’s mostly bs anyway.
Too much, obviously. I’m teaching myself, when I open the NY Times, to immediately click on “Food.”
lol, I do the same with the LA Times. It’s the only section worth reading anymore. They’ve even ruined the sports section.
Has anyone in the commentariat sought out any kind of therapy or even self-help for this? For me, the acute phase of the pandemic was eclipsed by the trauma of the destruction of the Bernie Sanders “movement.” BUT it derailed my life and ended up having very bad financial consequences for me, worsened by the Great Inflation.
And I’ve never gotten a symptomatic case, didn’t lose anyone, didn’t even lose a job or a business, so it feels selfish to talk about it since probably at least half the US population had it worse than I did. And yet that feeling that most people had it worse just makes it worse, not better.
Pain is pain, and while it is very easy to whine and complain about the stubbed toe, that does not mean that you have not felt pain. If you compare yourself to an intensive care burn and say that the car you need, but lost its engine, does not really matter next to the hospital patient, that might be over doing it. Third degree burns are more significant than losing a job, but you still lost your means of getting food, clothing, and shelter.
I can’t speak to the adult population, but teenagers in the USA were most definitely traumatized by the pandemic. I have friends with teenage kids and the lock-downs and lack of social contact were a big deal – some parents went through hell – suicide attempts etc.
For myself the quarantine wasn’t too difficult although I lost a lot of work as a musician. Thankfully I was able to get WA state unemployment benefits for awhile which really helped. I’ve been careful but have had COVID at least twice, probably three times so I continue to behave as if it is still a threat and wear a mask when I go out, even though at this point I’m usually the only one doing so.
physician, heal thyself.
how do you live now? what do you feel daily in the ER? what system of thought enables you to return to it and stay with it? where and how did you learn that system of thought?
you carry within you the answers to the questions you think you are asking us to consider.
and remember:
the mind is a dangerous place.
don’t go there alone.
know thyself.
My initial reaction was an eye-roll until I got to the author’s reference to Vincent Felitti’s Adverse Childhood Experiences studies. Trauma is experienced individually rather than collectively, but it is real and there are a lot of folks out there processing personal traumas as a result of the pandemic, the loss of loved ones and of economic security, and the refusal of our political, scientific, or media institutions to offer a cogent explanation for its origin and spread.
The author is correct that individual experience of trauma is going to become of ever greater importance going forward and that people such as ER docs, teachers, and providers of social services must start inquiring about the client’s personal experience of trauma. I find this to be especially true if we frame the pandemic, like the current crises of anthropogenic climate change, mass migration, and conflict, as yet another impact of human overpopulation on planetary carrying capacity.
The lesson provided here is the need for all of us to pay greater attention to the dispensation of humility and empathy toward our fellow human beings. I’m grateful to have had the opportunity to read this prescription.
The impact of COVID that I worried about in addition to those of mortality and morbidity was how it hurt as well as improved systems and institutions. Telecommuting from work expanded and seemed to have decent results; education was impacted more adversely; legislatures like mine in California suffered in getting up to speed in interacting and responding to constituents; business closures were massive and their losses weren’t just personal but losses to the communities served as well. Some impacts these and other system changes accrued might fall under the definition of trauma – some might not. This article definitely got me thinking about all of the consequences of this pandemic as did the responses to this article.