Brahim Hammouche was elected MP for MoDem in the 8th district of Moselle (West Thionville) in 2017, when he hung up his psychiatrist’s coat. The Covid-19 epidemic led him to join the health reserve. On March 30, he resumed his medical activity and provided psychiatric emergencies at Bel Air Hospital, the North Moselle site of CHR Metz-Thionville. On the troubles linked to confinement or on those which could be triggered afterwards, on the tracks to be developed from an individual and collective point of view, he poses his medical diagnosis often, sometimes political.
What could be the psychological consequences of almost two months of confinement?
“Already, we must speak of” confinements “in the plural, because it is not the same thing to be two in a large house with garden or five in a small apartment. The family environment and the socio-economic context play a key role, as does temperament: we will not experience the situation in the same way depending on whether we are naturally positive or negative. Without forgetting the preexistence of social difficulties or psychiatric history.
There may be a preexisting vulnerability. The question of attachment is essential: if one has developed a secure attachment in childhood, one will rather experience confinement as a protection. Otherwise, it will be experienced as a danger, a source of anxiety awakening fears of separation or old trauma. “
The notion of context is essential, you say, with the idea that an attitude adapted to a moment M can no longer be the moment after.
“In psychic life, time does not exist. Contrary to what we have been taught for a long time: for example, there is no “normal” period for mourning. Since there is no rule about what is normal or not, what is problematic or not, there is no right attitude or not. It all depends on the context first. Thus, an ideal attitude at a time, withdrawal into oneself in a period of confinement, becomes a problem if it lasts beyond this period. Rigid responses are a risk. “
Who are the most fragile audiences in this unique context?
“We have talked a lot about the elderly, and rightly so. Adolescents are also very vulnerable in this context. At a time of life where their personality evolves, where they are in search of meaning, in search of themselves with a body that transforms and the need to confront others to compare or distinguish themselves, these teens find themselves trapped in the family environment, where they must renegotiate their place. And everything is exacerbated, for example I saw a teenage boy in sentimental breakdown with a very aggressive, unstable behavior: the illustration of a great suffering.
There are also vulnerable families where confinement can amplify intra-family violence and drinking behavior. Since the start of confinement, there has been a decrease in reports for worrying information related to dropout and an increase in calls to 119. These two indicators testify if necessary to the need for a return to school and a commitment on the strength of our child welfare policies. “
To return to the elderly, what are or have been the risks related to confinement concerning them?
“We talk about the“ slip syndrome ”. The most widely used definition is that of letting go of the elderly. More stimulated, alone, he lets himself die: a form of depression with a fatal prognosis. A more advanced definition speaks of a depletion of a person’s resources, especially after an episode of illness, sometimes with a burst of vitality but which ends in death. The isolation of the elderly has certainly not been beneficial. For many of them, as for certain teenagers, we go from withdrawal to seclusion. After the society of exclusion, then of inclusion, we come to that of seclusion. “
The most complicated is not to not know what to expect, when and how?
“Not knowing is certainly anxious but it is important that the framework is more flexible than rigid. It is imperative to understand that if there is no absolute date, it is that we learn by walking. I also really appreciated the term “Learning Nation”, this process of collective learning at all levels, political, institutional, territorial. I feel like we have been able to cope. At the start, there is a staggering phase, it’s normal: we don’t know what’s going on. Then you have to adapt, hence the necessary flexibility. I believe that no territory or person has been forgotten or sacrificed. “
Otherwise ?
“For example, we risk a dissociative episode with the impression of being in another dimension. I notably saw a young man brought in by the police with a knife, he was convinced that he had been given the task of cutting the virus with a knife. “
What is at stake in the massive deployment, during and probably after, of telework?
“This is a real anthropological question: until then we managed to confine the professional space and the personal, intimate space. There is a real intrusion of work in the intimacy to which one must beware. The notion of space will be one of the first things to restore once deconfined.
We develop through three types of relationships: to ourselves, to others and to the world. It is the same for spaces, inside and outside, that you have to know how to separate. However, with confinement it borders on the risk of confinement. Not everyone will see a shrink after confinement, not everyone will sign up for a support group. For some, sport will be an excellent therapy. “
In this period of confinement, we have used and abused digital. What should we think ?
“On the issue of cyberaddictions in particular, I have questions. Are we addicted because we spend hours in front of a screen? Not necessarily: the notion of quantity may not be enough, otherwise at the time of the democratization of books, we should have qualified heavy readers as dependent. Some experts believe that cyberaddiction is excessive language, others who have oversubscribed on the subject see it as a reality. I do not know, I wonder but I think that we will have to redefine this concept. I tell myself that from the moment it is a tool of which we have had the utility and the urgency, we may need to review our criteria. “
Furthermore, from a relationship point of view, can the telephone or digital make up for the lack of contact?
“No, and I notably experienced it through telephone consultations that I was able to conduct. The question of times of silence in particular: when you are face to face, silences allow reflection or even meditation, they are experienced as a presence while on the phone the same silences are experienced as an absence.
It’s like empathy, this primordial notion which consists in being present and listening to the other, to share the share of common humanity. Personally, empathy by video, I don’t know how to do it.
In any case, there is a loss of information in the virtual world: do not tell me that a look in the camera is the same as face to face. However, the gaze and all the non-verbal have an essential role in communication.
Beyond these questions, the physical contact, the real meeting are inscribed in us. Empathy has a physical dimension and when you hear bad news, you have only one reflex, a drive: to go see the person who is suffering. To touch her or not, but to be by her side, in the first sense. “
Is this particularly true for the impossibility that we may have had to accompany bereaved people?
“For some, mourning could not start as it should, because they could not accompany their deceased before or after their death. Because they were unable to truly express their feelings. For those, you will have to find the right tempo, specific to each. And it is for example in these moments that we can regret the rejection, almost, of our society for the question of the spiritual. The Anglo-Saxons do not feed this taboo, they distinguish the spiritual from the religious while we mix everything. Now the spiritual is precisely what allows us to give meaning to things. One of the best attitudes will be to give new meaning, to give life back to all that, to go beyond the state of amazement. “
Do you think there will be a before and after Covid in terms of society?
“Much has been said about the centuries of autonomy. Very good, but I think that the concept of interdependence is also fundamental and we have experienced it in recent weeks. We are on the same planet, we have all been affected by the same evil. We must imagine a form of global sovereignty that allows us to envisage new episodes, viruses have no borders. We need to redefine the concept of citizenship, which I think has been associated too much with the individual. I rather think that we are not citizens alone, that it is a point that will deserve to be thought of for The day after (literally and figuratively, Brahim Hammouche being part of the sixty parliamentarians registered in this post-Covid think tank, editor’s note).
Ditto for “the society of taking care” which has been talked about a lot, philosophically. Here we are in the hard, the question of universal income will return in particular on the carpet with the social crisis which is announced. We need a return to social democracy, which takes into account the fundamental solidarities among which culture and the environment. “
What do you recommend doing after leaving containment to “exorcise”?
“I wonder how this episode will be transmitted in families, in a few months, a few years, a few generations. How will we talk about all this? What will be left of it, what shall we do with it? If we knew we were mortal, we were not fully aware that we were not essential from an individual and societal point of view. And we notice that we are fragile, vulnerable and not essential. Besides, nature is doing much better without us. We will have to digest this without forgetting it, not be in denial. One certainty is that you have to put words into the classes when school starts, not to pretend that nothing has happened. We will have to organize discussion groups in the strongest sense of the term. Verbalizing makes it possible to give meaning to things, to beings, to oneself. Essential in the management of post-traumatic stress in particular. “
Precisely, tell us about this risk, what is it and who does it concern?
“Post-traumatic shock syndrome is often linked to a strong event that threatens the subject’s life or physical integrity. Under Napoleon it was called “the ball wind syndrome”, for all soldiers who, having survived the fighting, relived the horror of the past situation. This may be the case of an attack or an earthquake, it may be the case of caregivers who have been directly or indirectly confronted with the virus, sometimes with death. This renewed threat can, once it’s over, translate into a feeling of horror, helplessness, fear that can turn into hypervigilance. During the epidemic, intra-hospital psychologists have been and are listening to professionals, we will have to be very attentive afterwards as well. “
What consequences for caregivers after this epidemic attack? Could they live a form of Covid-blues, not that they would miss the danger but that the pressure falling, the statues to their glory collapsing, they would risk falling from high very low?
“We could witness depressions, in the etymological sense: depression. Today caregivers do not ask for much, they are in action. You will have to practice a form of withdrawal after that, with the adrenaline provided by emergency action, with the united team to go to the front. Fall back into normal operation, with the daily difficulties of a service put in brackets. It will be necessary to be very attentive to the professionals and to the troubles which could result from it. “
What are the psychic risks of deconfinement?
“There are three pitfalls to watch out for: avoidance, overinvestment, and collapse.
In the first case, it is the fear of going out, of any social interaction. And this attitude, which protected during confinement, becomes a problem if it continues afterwards.
Overinvestment is about committing, a lot. To want to make up for lost time in a way, to want to reassure oneself by multiplying confrontations with reality, to go to battle to prove that we have won. A classic defense mechanism.
The third attitude presents the most risks: collapse. This is the threat of depression, to see everything in black. Build a negative world for yourself, see guilt or shame resurface. And all the emotions to be mirrored with helplessness: anger, sometimes hatred, especially vis-à-vis the political world and there I fear that we take full our rank, there is only already read the conspiracy theories that abound. To avoid collapse, the role of the shrink (psychologist, psychiatrist) is important, as is that of the entourage who must first put up scaffolding before the person collapses for good.
There is also the risk of the survivor’s guilt syndrome, which is notably experienced by many survivors of the death camps who cannot accept having been saved and not the others. “
What do you advise to the future deconfined that we are?
“Restoring differentiated spaces and going back to school is involved, as are the levels of relationships we have in the world. To return to the world in general, in social or associative activities. We can even decide to go and stay in a monastery for a retreat, nothing paradoxical because the big difference is choice, freedom.
I must repeat, it is necessary to give meaning to all this, it is the best prevention. And the meaning can be found in mundane things. We should be in full consciousness back to basics, starting with our own sensory existence. If we had doubts about Cartesianism we can be persuaded of it: it is false to believe that reason governs and enlightens us. We are governed by our senses. And since we are talking about philosophers, we must pay homage to the Stoics and remember, and admit, that there are things that depend on us and others that do not. And others are better off without us. “
So you appeal to our resilience?
“This ability to resume our life after a traumatic event, this ability to put to sleep a part of you that we consider dead and to develop another part of you, alive. It’s necessary. We do not all have the same capacities in the matter but it is working, by proposing another reading of its own history for example. Not to be confused with denial which would make us forget everything and prevent us from learning lessons. “
The first thing you will do once you are deconfigured?
“To tell the truth, I don’t feel like I was confined because I resumed a full-time activity and that I very often left my home. “
So what is the first unnecessary thing you will do?
“That’s a good question! I know that: I’ll go fishing. I’ve been thinking about it for a very long time without ever having taken the plunge. I recently chatted with a fisherman and I can see myself going to sit in a quiet corner, try fishing, read a book and take a nap. The same goes for the journeys I have dreamed of for a long time without undertaking them. Like Ulysses, I am one of those who will go to battle. “
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