Journal Identification = NRP Article Identification = 0641 Date: June 16, 2021 Time: 4:53 pm
doi:10.1684/nrp.2021.0641
REVUE DE NEUROPSYCHOLOGIE
NEUROSCIENCES COGNITIVES ET CLINIQUES
82
Point of view
Rev Neuropsychol
2020 ; 12 (S1) : 82-3
Covid-19 and suicide attempts:
Lessons from a pandemic *
Covid-19 et gestes suicidaires : les lec¸ons d’une pandémie
Franc¸oise Chastang1, Pierre Gérard2, Alexandre Markassi3,
Louise Collonge3, Gérard Boittiaux4
1MD PhD, Psychiatric Emergency Unit, University Hospital, Caen, France;
Paris-Saclay University, U1018, CESP, Villejuif, France
<chastang-f@chu-caen.fr>
2MD, Psychiatric Emergency Unit, University Hospital, Caen, Public Institution of Mental Health, Caen, France
3Psychiatric Emergency Unit, University Hospital, Caen, France
4MD, Hospital Center, Pontorson, France
To cite this article: Chastang F, Gérard P, Markassi A, Collonge L, Boittiaux G. Covid- 19 and suicide attempts: Lessons from a pan- demic.Rev Neuropsychol2020;12(S1):82-3 doi:10.1684/nrp.2021.0641
T
he present hypermodern society pushes everyone toward a life style driven by speed[1]. In this context of sudden pandemic outbreak, the lockdown forces every citizen to brake hard, and confronts the health system to the unprecedented and to its technological and human boundaries. It is as if, with the help of the infinitely small, nature confronted the Promethean man to his own future.Psychiatry does not work in the same timeline as somatic care, and thus has not been impacted in the same way.
Psychiatry had not to directly manage COVID patients, but it had to face different challenges and deal with unprece- dented problems.
The first observation was that people less frequently con- sulted physicians, including in the area of mental health, at a time when an outbreak of psychological trauma was expected. Severe decompensation of psychotic diseases, and even an excess of mortality related to difficulties for these patients to observe lockdown were expected. Actu- ally, everything happened as if patients, while suffering from serious psychological disorders and somatic comorbidi- ties, tolerated the lockdown better than expected despite reorganized health care (especially closure of day hospi- tals and the marked decrease in consultations replaced by telephone calls). But did the patients feel better indeed?
∗This article is an English language translation of the following article:
Chastang F, Gérard P, Makdassi A, Collonge L, Boittiaux G. Covid-19 et gestes suicidaires : les lec¸ons d’une pandémie.Rev Neuropsychol 2020 ; 12 (2) : 205-6. doi:10.1684/nrp.2020.0571.
Correspondence:
F. Chastang
How did their specific vulnerabilities cope with this health crisis?
Several hypotheses can be raised. Patients suffering from chronic psychotic diseases are already used to have a poor social life and long hospital stays sometimes without consent (which is another form of lockdown). First, since lockdown was the rule for every citizen, these patients felt less stigmatized, just as if they finally joined the large French family. Furthermore, this exceptional worldwide health cri- sis could be seen like an exciting story, a particular and intense break in their monotony that is ordinarily punctu- ated by psychic suffering. It is somewhat like these teenagers who, grappling with a number of psychological difficulties, benefit from being temporarily away from the usual environ- ment; or these patients showing a capacity for resilience and understanding of the epidemic crisis that psychiatry could not suspect.
The world of mental health also noticed a significant decrease in admissions for suicides compared to 2019 in metropolitan France. This decrease was close to 26% in the former Lower Normandy, an area which is one of the most affected by suicide in France. In a somewhat provocative way, it could be said that what suicide prevention usually manages to achieve with a large amount of energy and time thanks to the “Vigilan’S programme”[2](based on keeping in touch and maintaining the link with suicidal people), the coronavirus did the same, but much more brutally and noisily. Yes, but at what cost?
What does the decrease in the rate of suicide attempts entering hospital emergency departments since the onset of the pandemic really mean? Certainly not a sudden decrease in psychiatric disorders, let alone the end of mental
Journal Identification = NRP Article Identification = 0641 Date: June 16, 2021 Time: 4:53 pm
REVUE DE NEUROPSYCHOLOGIE
NEUROSCIENCES COGNITIVES ET CLINIQUES
83
Point of view
suffering. Did suicidal behavior decrease? Did the patients cope with it within the family’s closed-door environment?
Did other local solidarity groups protect them? The lock- down has resulted in family members gathering, which on one hand can exacerbate relationship strain, but on the other hand can also make people strengthen different but positive relationships, renew long lost human links, create specific (not only traumatic) memories, share a collective history, and overall encourage everyone to make an effort for the group welfare. It also made the loneliest feel less excluded, as if they had a slightly more “normal”, less stig- matizing, life, and benefit from a generous surge of solidarity by hearing from people through various telephone lines.
In his time (1897) Durkheim made the same kind of observation, namely that great upheavals in society con- tributed to the (unfortunately temporary) reduction in the number of suicides, at least in part through a strengthening of social links: “The great social commotions, like the great popular wars, heighten collective feelings [...] and, by concentrating activities towards the same goal, determine, at least for a time, a stronger integration into society. The salutary influence is not due to the crisis, but to the struggles caused by it”[3]. He also drew attention to the facts that only crises that harshly and emotionally affected a large
population manifested themselves in such a way, that the stronger the shake, the longer the effects, and above all that these effects in terms of reducing suicides ceased as soon as the struggle ended.
What will be the next step in the Covid-19/2020 pan- demic? After the time of emergency care, comes that of thinking and handling its social and political consequences.
Will we witness a downward stabilization in the number of suicidal acts, which is a sensitive marker of the level of inte- gration of an individual in society, or will we face a new worrying increase in these behaviors, associated with (as many psychiatrists fear) an outbreak of anxiety, depression and post-traumatic manifestations in a society threatened by a risk of economic crisis? Will we witness a societal paradigm shift that will support the emergence of a more cohesive and fair society, taking care of the most vulnera- ble, or will we remain in a hypermodern anomic society, a breeding ground for exponential psychological suffering?
Undoubtedly, the true lessons of the present major health crisis will be of an ethical nature.
Conflict of interest None.
References
1.Rosa H. Aliénation et accélération : vers une théorie critique de la modernité tardive. Paris : La Découverte, 2012.
2.Vaiva G, Berrouiguet S, Walter M,et al. Combining Postcards, Cri- sis Cards, and Telephone Contact Into a Decision-Making Algorithm to Reduce Suicide Reattempt: A Randomized Clinical Trial of a Personal- ized Brief Contact Intervention. J Clin Psychiatry2018 ; 79 : 17m11631.
3.Durkheim E.Le suicide. Paris : PUF, 1930/1993.
