PANIC AND PANDEMICS

From time immemorial epidemics (1) threatened man’s survival, mental peace, and the social order that man has come to create.

As Walter Pasini writes in his presentation of a recent Symposium on “old and new epidemics”:

Plague, smallpox, syphilis, cholera, tuberculosis, influenza have changed mankind’s history for their impact on men’s life and health, and their demographic, financial and social effects. The great epidemics created panic and anxiety as they decimated entire populations. If one single person’s illness or death represents a tragedy for his/her family, the collective death adds on feelings of impotence and fear concerning men’s fate. (2)

Besides being a haunting ghost, a terrible memory of the past, epidemics have recently also become a present nightmare, a source of individual and collective fears, so much harder to bear in that they symbolically represent all the unseen or disavowed insecurity, complexity, and vulnerability belonging to our current life, as well as the archaic anxieties and “nameless terrors” belonging to every human being’s early childhood experience.

During the last decades on the stage of an increasingly globalised world – where everything, even risks, tend to happen on a world wide scale – over 30 new infectious, epidemic or pandemic illnesses appeared, the so-called “emergent infections”: AIDS, SARS, Ebola virus, the H5N1 “bird flu”, the “prions illness” (Mad Cow), and the new entry, the H1N1 A influenza or “swine flu”, are only the best known among these new threatens, while the traditional ones (malaria, typhus, cholera, tuberculosis, etc.), although no longer feared in Western countries, are still going on and killing thousands of people within the poorest lands.

During 2009 the flu pandemic shook the world. While causing fewer casualties than expected it demonstrated the extent to which “the king was naked”, namely, how vulnerable our social systems were and how inadequate our managerial, scientific, technical and communicational abilities have been shown to be. Above all, it highlighted how deeply unprepared the governments, technical bodies and mass media were when faced with the need to manage not just the virus and the illness, but also the spreading of fear amongst the populations.

In order to deal with present and future challenges – as Pasini outlines – we need to start by keeping in mind the lessons from the past, and the understanding of epidemics’ history. To this relevant warning I would also add one more: in order to deal with challenges involving anxiety, fear and panic for thousands or even millions of people, we also need to better understand these human emotions, the way they develop, what may enhance or mitigate them, what their psychological and social dynamics are, how do they impact on individual and group behaviour, as well as organisational functioning.

In what follows, I want to offer a contribution to this necessary process of understanding.

The Centuries of Fear (3)

Words like “epidemic”, “infectious”, “contagion” are still able to trigger fear by their mere sound, although the modern medicine has by now eradicated, at least from industrial societies, most of the infectious diseases which have been plaguing mankind for centuries.

The first evidences of an epidemic may be traced back since the Egyptian and the Babylon epochs, and terrible pandemic plagues devastated ancient China as well as the Mediterranean lands during Troy war. Ancient and modern history describe all along the centuries cyclic periods of major plagues throughout the known world. In 430 BC Athens falls prey of a plague, as Tukydides narrates in detail; the Western Roman Empire, just prior to be destroyed by the barbaric invasions, has already been weakened by plague and smallpox epidemics; the Eastern one, the Byzantine, during Justinianus is lashed by bubonic plague. In Middle Ages leprosy first and then tuberculosis adds to the plague. The greatest epidemic of the pre-modern era, the so- called Black Death, develops in central Europe by 1345: probably carried from Asia through the caravan routes, in few years it spreads all over the continent, striking Constantinople in 1347, Florence, Marseilles and Paris in 1348, and many other Countries in the following years, until it came to an end in Russia in 1351.

With the great discoveries the sailors bring to Europe syphilis they have contracted in the Americas, while the natives are decimated by the illnesses exported by the

conquerors: smallpox, measles, and even ordinary cold. During the 17th Century, thanks also to the Thirty Years War, the plague strikes again in Europe, spreading death in collaboration with other then endemic illnesses, like malaria and smallpox, and new killers like spotted fever.

In the following century plague pays still a further visit to Europe, in Austria in 1711 and in the Balcanic area from 1770 and 1772, to reappear sporadically by the second

half of the 19th century, on the edge of a big Eastern pandemic which lead to more than 12 millions of dead in China and India.
During the first half of the same century cholera had struck Italy, while in England the new working class was paying to industrial revolution the heavy toll of thousands of victims for tuberculosis, which then would also hit France, Germany and Japan. Furthermore, tuberculosis appeared to be a fatal gift of colonial expansion, which spread mainly in Africa and in the Southern Seas; smallpox, measles, diphtheria and influenza over time also crossed countries and continents and became exported almost everywhere.

Influenza and viral illnesses were the absolute protagonists in the 20th and early 21st Centuries’ epidemics and pandemics. The discovery of bacterial origins of many infectious diseases, an increased concern for the public health, the practise of vaccinations, and the new drugs, the antibiotics, allowed to eradicate nearly all the sources of the traditional plagues and epidemics, or at least to contain their diffusion. The last enemies however, the viruses, appeared harder to fight against than bacteria, and from their ranks arose what may be considered the two most dreadful “plagues” of the contemporary age: AIDS and flu pandemics.

The first HIV epidemics – which presented the world with a new disease, AIDS – date back to the 1980s. Oddly enough, although this illness is still far from being defeated and goes on bringing pain and death among the emergent and the poorest nations, the people’s fears and the mass media’s attention massively moved away to focus on the flu.

Influenza viruses, always at the origin of large epidemic events, during the 20th Century have provoked three pandemics: the Spanish flu (1918-20), which claimed approximately 20 millions of victims; the Asian flu (1957), which killed 2 millions of people; and the 1968 Hong-Kong influenza, which made one million of dead. In this

first decade of the 21st Century influenza viruses spread panic within the globalised world on three occasions: the SARS in 2003, the Bird flu in 2005-06, and the last one, the A influenza so-called “Swine flu”, in 2009.

Epidemics as psycho-social processes

The relation between epidemics and contagion has been taken for granted, but for a considerable time the science, the culture and partly also the people’s opinion attributed them to other causes. Quite paradoxically, however the concept of contagion – a transmission of some illnesses from a person to another person (or from animal to person) – is really a very old one (4), for centuries the official medicine has been supporting different explanations, adding to those coming from popular fantasies and superstitions, and from the religious doctrines.

Hyppokrates (5) believed that epidemics were provoked by seasonal changes and the action of “miasmata”, i.e. the air polluting substances, while in Oedipus Rex Sophokles gives the miasma a religious meaning of impurity (and guilt) due to a bloodshed, which caused the plague afflicting Thebe. The miasmatic theory of contagion remained pivotal to the Western medicine until 19th Century. From the Renaissance the "miasmatic theory" of contagion - pivotal to Western medicine until19th Century and the discovery of bacteria as infectious agents - contributed, at least indirectly, to improve the struggle against epidemics and poor hygienic life conditions. Measures such as safeguarding the purity of water and freshness of food, promotion of personal cleanliness and responsible waste and sewage disposal protected the population from plagues as well as through quarantines and isolation of ill people in lazarettos.

However, the Catholic Church, from its very origins, during the Middle Ages and, to an extend, to these days had been declaring that epidemics represented nothing but God’s punishment for men’s sins, drawing on the accounts of biblical plagues and furnishing people’s terrors with a reassuring cultural container based on the dynamics of: guilt/ punishment/ penance. From this perspective we could say that both the Church and the medicine, by taking on the roles of “managers” of primitive fears of illness, contagion and death, have established themselves as parallel institutions acting as social defences against such anxieties, and relying upon these “psycho-social” functions to increase their cultural and political influence and authority.

The modern institutions responsible for dealing with contemporary epidemics also inherited, to a great extent, the following functions: besides their “rational” task such as: to anticipate the outburst of an epidemic, to identify its etiological agent, to interpret its trend and dangerousness and to make decisions on what and how should be organised in order to face it, they are also expected to manage individuals’ fears and mass panic amongst the populations.

Over such a terrain, where emotional, unconscious and irrational aspects reign supreme, even amongst those charged with the task of governing the process, the logic of science, rationality and critical reasoning will not have a sufficiently strong hold. Hence the great importance of a sophisticated social communication in situations of alert and panic; if not inspired by a deep understanding of personal and social aspects of human fear (and particularly the fear of contagion), such communication may boil down to a series of procedures and informational routines, and risks to be perceived by people as a superficial, bureaucratic and self-absolving reassurance, inevitably turning into a source of mistrust and of further insecurity. These considerations bring us directly to the core of the problem. Epidemics are not just a health problem, they also imply psychological, social, cultural and political processes which require complex, multi-dimensional approaches. These should be focused on the individual-society interface and on the overlap between these two-way relational dynamics: one part of this is the way social order impacts upon individuals’ behaviours and responses, the other refers to how people's mental functioning interacts with and gets to shape or change social systems sometimes to a great extent.

Some authors, though not so many and mainly following the shock for the discovery of AIDS, explored these specific aspects of epidemics. One of the most interesting contributions, from the perspective I wish to develop here, is an article by Philip Strong on “Epidemic psychology”. (6)

Although his work is mainly sociological and intended to describe a general model of human behaviour during epidemics, in his analysis Strong pays a great attention to psychological elements and to individual and collective emotions, which are an integral part of the process and have a deep impact on the process itself and on the social order in a broad sense. He points out how an epidemic may become “a medical version of the Hobbesian nightmare – the war of all against all”, and how the spreading of the biological disease may be followed by psychological epidemics of fear, suspicion, panic and stigma, fierce moral and ideological controversies, veritable wars of religion around causes, responsibilities and solutions to be adopted. As Strong puts it:

Epidemic psychology, indeed, seems to involve at least three types of psycho-social epidemic. The first of these is an epidemic of fear. The second is an epidemic of explanation and moralisation and the third is an epidemic of action, or proposed action. Any society gripped by a florid form of epidemic psychology may, therefore, simultaneously experience waves of individual and collective panic, outbursts of interpretation as to why the disease has occurred, rashes of moral controversy, and plagues of competing control strategies, aimed either at containing the disease itself or else at controlling the further epidemics of fear and social dissolution. (7)

Strong comes then to remark that, just like the infectious disease, the three “psycho- social” epidemics are able to infect almost everyone within the social system, individuals as well as organisations, and for this reason they “simultaneously possess profound psychological and collective characteristics” (ibid.).

Another relevant consideration, though it might appear quite obvious, is that the epidemics of fear, interpretation and action seem to be much more severe when the disease is new or strikes in a new way. Two aspects are relevant here: one relates to the way social systems are equipped with norms, routines, narratives, roles, beliefs etc. –in order to deal with novel and unknown issues, on the other raises a difficult psychological question: whether fear is more triggered by what is completely unknown or by what is somehow deeply known but still unbearable and therefore impossible to think and articulate? (8)

For the purpose of this chapter I will focus more on the first epidemic, the epidemic of fear, but keeping in mind the problems of both morality and action, as all three domains are profoundly intertwined.

On Fear and its vicissitudes

I’d like to make some preliminary remarks on fear as an emotion and also as a related behaviour. Fear is a primary emotion which is aroused by a danger (actual or potential) and mobilises bodily as well as psychic coping processes and fight/flight behaviours aimed at allowing the subject to escape from the danger or to suppress its source. Fear is thus necessary for survival, first of all, as it helps us to become aware of risks, but sometimes it may turn into a counterproductive or even damaging device, both for the individual and for the social system.

Fears may be inborn or learned. The first are part of the instinctual equipment and are triggered by:

 

• -strong or unexpected physical stimuli like pain, light, noise;
• -unknown (9) objects, people or events, which the individual cannot face, like strangers or new diseases;
• -risks for survival, like altitude, darkness, cold, lightening, aggression, illness, wounds and bleeding, abandonment by parents.

Learned fears come from the individual’s personal (or sometimes ancestral) story and from the beliefs and the prescriptions held by his/her group or community concerning what should be considered dangerous or painful. They may sometimes turn into excessive or inappropriate fears – the phobias – through complex unconscious dynamics and social learning processes.

This leads us to the distinction between “normal” and pathological fears, the latter often being a disguised expressions of internal dangers based on unconscious fantasies, anxieties and related defences. What is important here is that for this very reason such pathological fears are rather inaccessible to evidence, reasoning or reality testing.

If fear is useful when working for survival, it is admittedly such a painful emotion that, in order to be tolerated and allowed to exert this function, it needs psychic and social devices which would protect the individual and the environment from its potential damages, such as stress, mass panic and social paranoia. Some of these defences are psychological and working on an individual basis, like repression, projection, or denial, while other are concretely embodied in social institutions, like for example the police, whose task is to protects us from other people’s (but also our own) anti-social behaviours. Like emotions, defences may also be relatively “normal” and adequate, as well as excessive and pathological, just as defensive social systems like police services might come to perform a socially destructive role when used by a totalitarian government. Denying one’s own fear of an illness may expose an individual to fall ill or for a disease to become more severe if left untreated.

Fear may present different degrees both of strength and concerning the quality of emotional experience, from sustainable worry, awe, hesitation, disquiet to heavy conditions of scare, anxiety and terror, or even pathological states like distress, anguish, panic and phobia.

Although individually perceived, some fears are less rooted in the individual than in the group to whom he/she belongs or is connected by means of identification: if a threat is hanging over the group, then all individuals are likely to feel menaced by it, even though they might not be actually in danger. These collective, social fears are enormously increased as a result of group or organisational dynamics, which may act as real emotional “amplifiers”, as the recent market meltdown has shown eloquently.

The psycho-social roots of fear are to be found in the mix of primitive early anxieties and needs for safety present in the internal world of the child from the very beginning of life, and the sense of insecurity and helplessness stemming from our relationships with natural and societal environments. Naturally, what adults are afraid of is generally quite different from what scares the children, but there is evidence that adults’ fears – and the consequent coping strategies – are largely modelled by those experienced during early childhood.

The first shield against all fears is the mother, later on the family or its social equivalents. But with growth this protection appears increasingly defective, partial and full of ambivalence, which enhances the role of individual and social psychic defences. Faced with unbearable fears, the mind may try to repress, displace or deny them or the dangers, to project them unto others, to find reassurance in some rational explanation, or to split the reality into a bad, dangerous outside world to be warded off, and a good, safe and idealised place – including legal and illegal drugs – where to withdraw in search of salvation.

Social defences (10) may also serve the purpose of avoiding fear: the social system itself, its institutions and politics may be involved in a defensive set of beliefs, actions and organisational routines aimed at protecting their members from an experience of fear, provided the latter accept to live within a social bond essentially based on dependence, fidelity, obedience and conformism, or on the splitting and projection of all responsibility for the danger into the demonised Other – the scapegoat, the enemy , which therefore has to be feared, excluded, blamed, or even destroyed. As a result, all theories and catch-phrases which sound reassuring and optimistic exert a strong seduction for the public opinion, even when apparently false or manipulated; another consequence is how rapidly and superficially do these defensive systems identify dangers, enemies, faults, unhealthy foods, causes of cancer, terrorists, etc. Nothing would please us more than having a quick fix to heal most fears, to find a name for them and to point a finger to a culprit: splash the monster across the front page, and people will resume peaceful sleep at night.

Another problem is the fact that these social defences are not just unconscious processes managed by individuals, groups or communities searching for safety. As Freud pointed out in Group psychology and Analysis of the Ego (11), their capacity of convincing people, dragging them and blinding their critical functions, is well known to leaders and to anybody wants to achieve or exert power on others. That’s why occasionally “politics of fear” arise and develop, by riding or feeding collective anxieties and conflicts (12). See also a chapter in this book On the New Unconscious.

Fear of epidemics and epidemics of fear

The fear of contagion and infectious epidemics has some very specific characteristics. One is the fear of the invisible, something that is among us but cannot be seen, because it is too little (like bacteria and viruses), too big (like pollution, radioactivity, stock market, or an epidemic process), or homely and familiar (13), like air, water, food, the next-door neighbour, the members of our family. The core unconscious fantasy in the fear of epidemics is that “the enemy is among us or even one of us”. Its hallmark is a set of paranoid defences, involving split (between the guilty and the innocent, the pure and the contaminated) and projection of guilt and blame on individuals and groups supposed responsible for contagion.

As Strong points out “the epidemic of fear is also an epidemic of suspicion. There is the fear that I might catch the disease and the suspicion that you may already have it and might pass it on to me” (14). The central character of the drama is the “untore”, a term used in 17th Century Italy to denote a plague-spreader, as vividly described in Manzoni’s novel I Promessi Sposi (“The Bethroted”).

In our times of global connectedness the role of plague-spreader has been extended from one single person to entire groups or even systems. During contemporary pandemics one continues to be afraid of individuals, but the suspicion extends rapidly to embrace groups such as: strange people, foreign communities (like the Chinatowns), enemies (like Islamic terrorism), or large organisations, hidden powers and obscure interests. This is the case with recent pandemics, when heavy doubts have been raised about the financial interests of some corporations (food industry as well as pharmaceutical companies) or against the governments themselves, accused to play with people’s lives for politic reasons or even to spread new plagues through their secret laboratories for biological warfare.

Although in these suspicions there is probably more truth than one could imagine or wish for (15), undoubtedly they are right in the range of delusional persecution and magic omnipotent fantasy. Looking at this with the psychoanalytic lens we could see how such paranoid transformation of mourning may well serve to fight the depressive view of human frailty (16), and how conspiracy theories, involving the idea of malignant all-powerful organisations, are somewhat reassuring if confronted with the discouraging evidence that faced with pandemics even highest powers appear substantially disarmed and helpless.

The use of epidemics as a social defence, displacing internal insecurities on an external bad object, allows individuals and societies to keep a fantasy of locking out dangers and fears, and making themselves immune against them. In this sense epidemics appear not very different from wars (17). The combination of a splitting of reality and a special mobilisation of energies (including the crucial role of mass media) may help for a while to divert attention both from individuals’ everyday problems and from governments’ failures.

What makes the difference is the very nature of danger, which in epidemics is invisible and difficult to spot, which makes them more similar to terrorism than to war. Where the enemy might be “any one of us”, including the family, no team spirit or social solidarity, that are likely to work in wartime, can develop or survive. As Strong reminds us, this may turn into a war of all against all:

A ... characteristic of novel, fatal epidemic disease seems to be a widespread fear that the disease may be transmitted through any number of different routes, through sneezing and breathing, through dirt and through doorknobs, through touching anything and anyone. The whole environment, human, animal and inanimate may be rendered potentially infectious. If we do not know what is happening, who knows where the disease might not spring from? (18)

As the core risk is contagion, namely contacts, relationships, empathy, and social interactions, the sole safety lies in isolation, not so much in a medical sense, as a means of preventing the transmission of infectious agents, but rather as an anti-social drive, leading first to withdrawal and mistrust, then to exclusion, ostracism or even persecution of the scapegoated other.

These defensive dynamics are similar to those of social phobias: primitive anxieties from individual’s inner world, matching with everyday “endemic” worries and the global insecurity of present life, are fully displaced unto an external object perceived as bad, dirty, strange and ill – the epidemic and the virus, first of all, and secondarily some kind of plague-spreader. In this sense the “fear of contagion” rather than to dirt phobia or pathophobia appears closer to xenophobia, the fear of strangers.

The idea of epidemic as an exotic production and of strangers as typical “untori”, vehicles of contagion, wards off the troubling evidence that the danger is with us, inside our family or in human nature. Immigrants, specially when illegal, are the best candidates for the role of plague-spreader: they are poor, not very clean, coloured, badly speaking, they steal (our jobs and our things), rape, peddle drugs, kill – surely they are the ones who brought this damn virus here! They look like us, but actually they are different: in fantasy “they are not what they appear”, that is to say they are kind of alien, unreliable objects, precisely dangerous as they seem familiar, just like air, water, daily bread, and next-door neighbours during an epidemic.

Again, in such gross biases there may be something true, and after all most of infectious agents really do come from across the border; but this idea of illegal immigrants as potential plague-spreader essentially reassures us against further puzzling evidences:

• - that we ourselves could be a vehicle of epidemics as tourists or business travellers or peace-keeping soldiers;
• - that to some extent the main “untore” is globalisation, whose human, financial and social costs are still far from being quite understood and mastered and contained.

Another link which could be explored is the one between infectious and mental diseases. This connection is somehow obvious if one thinks of how easily an epidemic might drive people crazy, or bring to mind what Foucault describes in his History of Madness (19), namely how old lazarettos for infected people were being gradually transformed into asylums for “lunatics”. But subtler links may be also found in certain persisting attempts to discover some infectious agent as a source of psychic disorders (jokingly called a “schizococcus theory”); and at least partly in the strong emphasis that some theories, even within the psychoanalytic field, place on traumatic events as the origin of mental diseases. It is as if there was a shared wish to ascribe madness to some external agent instead of having to acknowledge what Marion Milner called “the suppressed madness of sane men”. (20)

What we need to be aware of is, as Bion suggested, the defensive meaning and use of theories, which basically protect us from facing a world so often uncanny, unknown, inexplicable and unpredictable. In the case of epidemics what is being avoided is the evidence that all the time we live among viruses and bacteria, which since time immemorial have been our constant “travel companions”. Some of them may actually be useful like intestinal bacteria, or the germs involved in the production of antibiotics or biological agriculture, but more often than not they are dangerous, reminding us of what our technological hubris would sometimes try to make us forget: our human limits and own vulnerability.

The last point I wish to discuss is how the fear itself may spread and act as a kind of epidemic. Let us consider an epidemic of fear following or concomitant with an epidemic illness as a social pathology overlapping the biological disease, the two being relatively independent from one another. A wave of fear an panic indeed may explode among a population even when very few individuals have actually been infected. On the other hand, a society may come to adapt itself to periodic epidemic cycles, at least when the illness is known, so that epidemics may become “normalised and institutionalised”, just as AIDS has by now become over the period of the last thirty years or so. (21)

When an epidemic of fear is under way one can see panic and irrationality going well beyond the ordinary citizens, to strike even those who should be either best informed about the disease, like doctors, or well equipped to find the best solutions, like government bodies and officials. As mentioned above this epidemic causes serious damages to the social order as a whole and particularly to social cohesion, solidarity and collective ability to deal with the problems. The main symptoms of such social pathology seem to be confusion and stigmatisation.

Confusion appears from the very beginning of epidemics as a collective process of “exceptionally volatile intellectual state” (22), an inability to decide whether the situation is serious or not, and a flood of explications on how it could be originated (sometimes hiding moral or ideological judgements) as well as of suggested strategies to solve the problem. This leads to a general disorientation that is usually amplified by mass media. People experience this as an evidence of profound disorganisation of public authorities that as a result become more and more denigrated, their warnings and instructions increasingly ignored and unheeded.

Stigmatisation is not a product of epidemics, as it is a permanent potential process in all societies, along with beliefs, stereotypes, biases and myths. An epidemic may help underlying stigmata to surface, and to apply to the specific situation (as was the case of AIDS and homosexuals), resulting in what Strong calls an “epidemic of stigmatisation”:

“the stigmatisation both of those with the disease, and of those who belong to what are feared to be the main carrier groups. This can begin with avoidance, segregation and abuse and end - at least potentially – in pogroms. Personal fear may be translated into collective witch-hunts. Moreover, so we should note, such avoidance, segregation and persecution can be quite separate - analytically at least - from actions aimed at containing the epidemic. Such behaviour can occur with all types of stigma, not just with that of epidemic disease. We are dealing here with magic and taboo, not just with quarantine. (23)

Unveiling hidden social issues

It has been said that in extremely dangerous conditions such as epidemics or wars the human beings reveal its very nature, particularly the dark instinctual side hiding behind the well-mannered civilised façade. This is certainly true, but more than that, an epidemic may represent a powerful test for the social system itself. Experience shows that large-scale epidemic diseases (or pandemics) may deeply undermine the conventional social order, bringing about a collapse of its structure or a corruption of its culture, as well as highlight its hidden distortions, failures and unresolved businesses. Strong gives a vivid description of the former process:

All kinds of disparate but corrosive effects may occur: friends, family and neighbours may be feared – and strangers above all; the sick may be left uncared for; those felt to be carriers may be shunned or persecuted; those without the disease may nonetheless fear they have got it; fierce moral controversies may sweep across a society; converts may turn aside from their old daily routines to preach a new gospel of salvation; governments may panic. For a moment at least, the world may be turned upside down. (24)

The emergence of the shadow side of a social system seems very hard to recognise mainly because it’s so easy to hold epidemic responsible for anything is going wrong; however, claiming that the plague has revealed such and such bad facets of our society also risks unveiling just that sort of crusade spirit and moralising frenzy which is an integral part of the epidemic’s social pathology.

It’s certainly possible that inhuman behaviours of individuals or organisations portray the narcissistic decay and lack of solidarity of post-modern communities, that isolation and difficulty to work in groups is an expression of a growing liquidity (25) and a loosening of social bonds, that transgression and crimes may indicate a general crisis of leadership and authority. However, all these hypotheses would remain a vain intellectual exercise unless a collective mental space to work through them is offered at a proper time and provided with enough authority to promote an uncomfortable awareness and to inspire reasonable decision making processes.

Otherwise the place for thought is bound to be filled by action, namely the storm of control measures (not always so mindful) taken to contain the epidemic: a generally impulsive and mindless kind of action, driven by fear or its denial, or by the projection of vulnerability, impotence and guilt.

If we agree that great epidemics and pandemics, when also studied by historians and social scientists, may enlighten not only the evolution of science and healthcare, but in particular the demographic, economic, structural and cultural changes occurred in human societies, then we could assume that such exploration should result in increased understanding and awareness.

But here we close the circle by connecting back to the issue of fear, because it is well known – above all from the psychoanalytic psychology – that fears and anxieties are major obstacles preventing us from both awareness and understanding of our external and internal realities.

How could we heal or at least contain collective fears or mass panic? You cannot just tell people: “hey, listen, you must not be afraid!”, or spread clouds of Valium throughout the planet. Neither the politics nor the official medicine today seem able to create enough safety and trust to reduce such fear.

From this point of view admittedly even individual and social psychology are not likely to provide effective solutions for such unpredictable and uncontrollable phenomena. One can just reiterate the following common-sense points:

• - that facing fears should be better than denying them or turning a blind eye to them - that putting them into words and creating reflective spaces for their exploration is already a good enough way to reduce them
• - that experience shows us how the simplest solutions may be highly attractive but actually are often mostly deceptive.

Can psychoanalysis be of help?

Psychoanalysis also puts forward awareness as a good enough antidote to fears saying that if adult people want to face their own anxieties as well as to consider real dangers, they should be able to match a mature vigilance of actual reality with the capacity to get in touch with their own “inner child” and early ways of experiencing fear, while at the same time giving up any pre-packaged, conformist and mechanistic responses offered by the current culture.

As Gaburri and Ambrosiano point out:

“Strong emotions – and fear among them – require a response which is to be specific, namely the result of a work made by the adult in order to hold and to some extent share the child’s point of view, finding a way to get through. Resorting to group prefab responses... only shows that adults cannot stand to let themselves to be infected by the child” (26)

The contribution of psychoanalysis might therefore be to enlighten the general picture in terms of developing or encouraging a ”weak thinking” aiming to achieve a deeper understanding of a problem, rather than a strong set of “how-to” prescriptions. This is similar to what Bion intended when spoke of a “negative capability” (27) to bear uncertainty for a while instead of rushing into action or explaining away what should be first tolerated and understood. Some authors (28) emphasised the use of such capability as a specific quality of leadership, particularly in turbulent conditions or environments, when mind, thought and linking are under attack for the pressure of primitive anxieties.

The first pathway to try to face epidemic panic would therefore imply setting up a rather steady political as well as clinical governance of the phenomenon. Here a psychodynamic approach may help the development of an appropriate “situational” leadership and support its capacity for keeping on thinking when things become tough.

Trying to work directly upon mass opinions and behaviours would be a sign of unforgivable omnipotence, if not arrogance and manipulation. What people need when facing real danger is feeling that they are in the mind of their leaders and wisely and realistically conducted by them. They also need leaders who make them feel safe and prevent from experiencing pain, often in a magic way, and this is what triggers omnipotence among those in charge of making crucial decisions.

But a good enough leadership should be aware that when emotionally driven population must be respected and treated as reasonable adults, but also need to be understood as frightened children. That’s why in order to lead them towards a real safety and security an authentic parental attitude and state of mind is generally required. Also in terms of neither pursuing popularity nor reassuring people by false and seductive solutions. Such qualities are to some extent intrinsic in some individuals’ personalities, but they may even be inspired and fostered with suitable means, like psychoanalytically oriented in-depth coaching or role consultancy, organisational diagnosis and group relations training to enhance both awareness and the exercise of personal and delegated authority.

As you also need to deal with day-by-day problems and emergencies while keeping in mind the overall frame, a systems psychodynamics consulting to the numerous bodies involved in emergency processes and related decision-making might help them to maintain the necessary “binocular vision”: upon the here and now as well as the future; on both individuals and large groups and systems; considering rational, mature and task-oriented functioning but also taking into account the primitive, emotional basic assumptions dynamics.

One last point where psychoanalysis may give a contribution is after the storm, that is by helping to learn from the occurred experience, in order to be prepared to deal with future crises without repeating the same errors. Repetition compulsion is a general tendency of human mind, both in individuals as in population, and in some cases might even prove useful as a way of sparing energies and maintaining homeostasis. But it also represents a by-product of traumatic experiences badly worked-through, and the resulting stress disorder may thus obstruct the capacity for thinking and learning. The last “swine flu” pandemics expired unexpectedly, while people were prepared to see millions dead on the streets and whilst the local authorities were holding emergency meetings to decide where to locate the necessary mass graves! A sigh of relief has been breathed worldwide, but two clouds are still hanging on the horizon: another pandemic wave is expected next year (the future is still uncertain) and no lesson learned has been drawn from the last events as yet (the past is still to be deciphered).

On such a large and complex scale learning from experience is nearly a “mission impossible”, but just by looking at what happened some elements are actually available for insight and reflection. The extraordinary level of panic which affected all the layers of our societies, individuals as organisations, powerful statesmen as well as ordinary citizens, scientists as well as uninformed people, shows the power of the global, overwhelming uncertainty that we continuously live under. It warns us all of the urgent need to reduce the weight and the duration of widespread insecurities, to rebuild trust and a safer base for coexistence and co-operation, to restore more mindful authority and leadership structures, which may act as learning organisations, reflective spaces and institutional containers capable to hold and to transform societal anxieties – as well their own worries – as a liable drive for action.

This obviously will not prevent epidemics from occurring, nor people from feeling scared by the last plague; but may help to use an overcome (not just passed over) crisis as a tool to cope with the next one.

And, as somebody (29) argued with reference to the Lehman Bros.’ bankruptcy and the past market meltdown, “A crisis is a terrible thing to waste”.