Psychiatrist and psychotherapist Frank-Gerald Pajonk looks after people who have hardly left their homes since the beginning of the pandemic. The fear of the virus is too great. The expert warns: In the first Corona year alone, 2020, there was a 25 percent increase in people with anxiety disorders and depression. what can help them.
FOCUS online: Since the beginning of the pandemic, there has been a lot of talk about corona trivializers and deniers. Recently, another group seems to be increasingly coming into focus: the corona exaggerators. Do you have such people as patients?
Prof. Frank-Gerald Pajonk: Yes, that’s the way it is. The spectrum ranges from those who still have reduced social contacts to individuals who have hardly left their homes for two and a half years. Partly with massive health problems as a consequence, by the way.
For example?
Pajonk: I know a woman with cancer who could probably have been treated well had she gone to the doctor in time. The tumor has since metastasized. Or I have a patient who has developed heart failure due to an untreated heart valve disease and who is bedridden in the meantime. In such cases, the damage caused by the self-chosen lockdown is much greater than the possible damage caused by leaving your own four walls.
Don’t those affected see that?
Pajonk: First of all, let’s be aware that there are decision-making processes behind the behavior mentioned. Each of us makes a risk assessment. If we decide to take certain precautionary measures, it happens comparatively quickly. Consideration of decisions about our safety takes much longer. That’s how it’s biologically designed. Look, at the beginning of the pandemic, it made sense to exercise great caution. We were dealing with a completely new type of virus, the threat was enormous. You forget that sometimes…
… was?
Pajonk: … that people were suddenly locked in their hotel room and couldn’t leave countries like India for six months, for example. The images of coffins and overcrowded crematoria. The world economy collapsed. There was a threat scenario of extreme proportions. And it’s quite normal when people have reacted to it with great fear.
And now?
Pajonk: A not insignificant part of the population still seems to have got stuck in this scenario to a certain extent. The way back to normality is still difficult for some. Every day we see patients who still retain certain behaviors from the lockdown period. Overall, we are currently experiencing a huge increase in fears, worldwide. According to the World Health Organization (WHO), one billion people were already suffering from anxiety disorders and depression in 2019. The first Corona year 2020 alone led to another increase of 25 percent.
Many still have the warning voice of Karl Lauterbach, who became Federal Minister of Health during the pandemic, in their ears. What do you say: Was there too much and too loud a warning? Pajonk: That was certainly the case with regard to certain groups. The main appeal was to people who didn’t take the virus seriously enough. At least that’s what I heard. They spoke to the unwary, perhaps also to the inexperienced.
And not to people like the patients you just reported on. Isn’t it unfair when a minister only has a cross-section of the people in the country in mind?
Pajonk: Karl Lauterbach is an epidemiologist. As an epidemiologist, his appeals were conclusive. An epidemiologist wants to keep the spread of the virus small. That has top priority. And this goal was understandable and sensible for society as a whole, especially at the beginning of the pandemic – when we didn’t know that much about the virus and didn’t have a vaccination.
But wouldn’t it have been better to choose a form of communication that also considers mentally vulnerable people instead of the endless warning loop? Wasn’t that a very one-sided way of dealing with the crisis?
Pajonk: It’s not as if it wasn’t pointed out early on and again and again that certain population groups would be endangered by the measures. Social scientists, doctors and psychologists, for example, warned early on about serious disorders in pupils and students and kindergarten children, which actually happened. In the risk assessment, decisions were made that were harmful to some people. Those who saw this coming were not heard enough or taken into account in the decisions.
How do you explain this omission?
Pajonk: We talked a lot about that among colleagues. And of course also about whether another communication would have been better.
And? In your opinion, would it have been better if politicians had worded some things less sharply?
Pajonk: If you ask me for my patients: yes. Overall, the communication was certainly not ideal. But it’s easy to say afterwards. I think people simply prioritized back then. The greatest fear was understandable, that of a system failure caused by too many people being infected and sick at the same time. Again: If I want to prevent this, I have to make sure that there are as few infections as possible. As I said, some people lost sight of this.
Have these people been sacrificed to a certain extent?
Pajonk: No, I don’t want to call it that. However, it would have been good if protection programs had been put in place for them at an appropriate earlier time. Mentally ill people who withdraw out of fear are not visible, do not demonstrate and do not have a large lobby.
Now that the child has fallen into the well, so to speak: What can help those who are overly anxious about Corona?
Pajonk: It makes sense to consciously ask yourself the following questions: Based on my personal considerations, where do I want to remain cautious? And where would that hurt me more? A 60-year-old woman with asthma will probably come to a different conclusion than a 20-year-old athlete. Either way, we simply need some time to correct decisions once we have made them. The dismantling of measures is an active process. For many patients, just knowing this is a relief.
And what is right in the current situation? From your point of view, should we continue to wear masks consistently, at least in certain settings, or would it be better to get away from it step by step
Pajonk: If you ask me personally, I would say: It’s time for a life without a face mask. But I can’t give a general answer to your question. In addition to the individual risk analysis, there is the question of what we call the hierarchy of values: what is important to me? If my quality of life is significantly influenced by factors like ‘meeting friends’ or ‘going to festivals’ then I guess I can’t avoid putting myself at risk from the virus if I don’t want to become unhappy. But that is only one aspect. Usually, many, even competing, wishes and needs play a role in the decision-making process.
The grandma you want to protect, right?
Pajonk: For example. The question is always: What risk am I willing to take?
Does that mean that I might come to the conclusion: I’m ready to infect grandma?
Pajonk: It could mean that, yes. That sounds drastic, I know. But unconsciously, decision-making processes take place in each of us in exactly the same way. Therapy means becoming aware of these processes and dissolving ambivalences. And that is exactly what we work on with our patients.
