What should society have top priority

"The drastic measures in Italy and the recent tightening in Switzerland signal that something dangerous is happening"

How is the coronavirus affecting society? Are Fear Reactions Useful? Stefan Vetter, former chief psychiatrist of the Swiss Army, provides the answers.

What has been taken for granted in some Zurich clubs since the Corona crisis also applies to the Psychiatric University Clinic Zurich (PUK): Without registration, visitors are prohibited from entering. In the legendary “Burghölzli”, as the extensive complex was once called, everyone is also asked to keep a distance of two meters from their conversation partners. Stefan Vetter, chief physician and head of the PUK's pandemic team, is setting a good example. The interview with the journalist takes place in the large ballroom. Despite the generous safety distance, the acoustics are excellent.

Vetter is predestined for management in times of crisis: until 2013 he was chief psychiatrist in the Swiss Army. And since 2003 he has headed the specialist center for disaster and military psychiatry, a joint project of the University of Zurich and the competence center for military and disaster medicine. The doctor, who specializes in stress-related disorders, was on duty in many disasters and major events. These include the terrorist attack in New York (9/11), the kidnapping of school children in Beslan and the tsunami in the Indian Ocean.

Mr Vetter, the behavior of people in times of the coronavirus is reminiscent of a war situation: In Australia there was a police operation over toilet paper, in Swiss hospitals visitors are hoarding face masks. How do you explain that?

The current situation creates stress. All of us, the population, the authorities, but also we experts are confronted with a new virus about which we know very little. And because we don't know how it behaves and what the consequences are, we can only plan for the short term.

And only react at short notice: New security measures and restrictions follow every hour.

Conventional medicine is a gigantic machine. It collects knowledge non-stop and continuously generates new results. Monitoring requires constant adaptation of the rules of conduct. For me as a doctor, this is part of everyday business. However, the population is unsettled when the authorities keep providing new information at shorter intervals. The drastic measures in Italy and the recent tightening in Switzerland signal that something dangerous is happening.

Is uncertainty a sufficient reason for extreme stress?

If you don't know exactly how to behave, then that's stress, and every kind of stress causes us to focus in terms of brain physiology. But stress and fear are actually something positive. They are there to be able to maintain proper behavior for survival in a dangerous situation.

Does it happen instinctively?

Yes, these are primal mechanisms that helped us to survive in early times. The prime example is the encounter with a lion in the middle of the savannah, which triggers a fear reaction. This takes a maximum of 16 minutes - and makes sense. Because it prevents you from being eaten. Three mechanisms protect us: We can freeze into a pillar of salt and play dead, run away or defend ourselves. This is how we react neurobiologically when we are afraid. In order for us to fight or climb the tree that will save us, it is essential to focus our perception.

That makes sense. But why do people focus on toilet paper of all things?

Without a doubt, toilet paper is not the most important thing to survive the coronavirus. But if I go into the store with a high level of focus in order to get the essentials and the toilet paper runs out, it becomes stressful. If you are too focused, you can no longer think clearly.

Can that explain the panic buying in Switzerland?

Panic is the end state of fear in which you are so focused that you do anything to get something. The so-called panic buying in Switzerland has nothing to do with panic. They were very targeted and well-considered because it was feared that the major distributors would no longer be able to supply the population for a long time. So it was a controlled behavior. But if everyone suddenly buys everything, there will be temporary supply shortages. In the beginning the racks were empty because the staff couldn't replenish them quickly enough. They are now full again.

Is the hamstering of face masks also considered carefully?

Every emergency situation promotes criminal energies. And because there is a black market for protective masks, profit can be made from the shortage. To serve yourself on a large scale is criminal. But if people stock up for their own needs, it is a fear reaction.

In the Corona crisis, everyone looks for themselves, even the other person on the bus becomes a danger. Does the virus poison interpersonal relationships?

There are group psychological phenomena. The perception of a society has to change before a state can even enter a war. As the head of the specialist center for disaster and military psychiatry, I have scientifically studied these phenomena in detail: It takes three to ten years for the overall perception of the neighbor to change so that he is no longer human and can be attacked as an enemy.

Are such phenomena emerging in Switzerland?

Not until now. But if we had a protracted pandemic, i.e. one that lasts longer than four or six months, our perception would begin to change. I think that in China the perception has already changed.

In what way?

In China, behavior is more orderly again. Sure, the government orders are drastic. But thanks to strict guidelines, a kind of normality has emerged within the pandemic. Meanwhile, in our part of the world, we tend to reactivate images of the enemy that are deeply anchored. Everything foreign and outsiders, everything that does not belong to the "clan" is considered dangerous and excluded because one wants to protect one's own circle in this way.

Is solidarity falling by the wayside?

There is also another phenomenon: in crisis situations one has the need for human closeness and contact. As soon as people notice that there is enough, the sharing starts again. At the moment, however, there is a lack of solidarity with the older risk group. Younger people in particular, who are forbidden to dance, say that they are not at risk. I believe that containment, i.e. avoiding infections as far as possible, has not yet really reached the population. The individual perspective still dominates: I am not at risk myself.

You just don't want to be deprived of your personal freedoms.

The movement-restricting measures are very drastic for us Europeans, the Italians are particularly hard hit. In Switzerland, too, people are not used to football games being canceled or schools being closed across the country. Of course, that arouses resistance.

Quarantines are drastic. Are there any studies on the psychological consequences?

We know that if those affected recognize the purpose of quarantine, there will be no mental disorders. However, if there are previous psychological stresses, it can lead to illness.

So quarantines can trigger depression?

Yes, but not in people who have never had depression. Isolation is of course a stressful situation. Even those who have to go to rehab after a heart attack can become depressed, provided the basis for it is available.

There are mentally healthy people who have a tendency to constantly wash their hands. In the current situation, could your tic develop into obsessive-compulsive disorder?

Obsessive-compulsive disorder can actually break out through stressful events. Our investigations after the tsunami showed that around four percent of those affected in the broadest sense developed an obsession.

A tsunami is a natural disaster. Is it comparable to the corona crisis?

From a biological point of view, a tsunami is rapid and extremely intense stress. Then it is clear how to proceed: you clean up, identify the dead, hand them over to the relatives and rebuild the land. Now we are in a situation of chronic stress that is currently at a lower level. The stress right now is knowing that something is coming without knowing how dangerous it is.

And there is a chain reaction: not only are people dying, but recession and poverty are looming.

Exactly. The main stress at the moment is rather: What will happen to our second pillar? What if the stock market keeps crashing? Is the food supply secure?

Is that she?

With the national supply, we have a long enough autonomy that you really don't have to worry.

They say fear is a normal response to being able to act in dangerous situations. When is anxiety a mental disorder?

Anxiety is a mental disorder when there is no real risk and it influences behavior over a long period of time, i.e. for hours, days and months. If I have a panic attack in the zoo because I think the lion is on the pedestrian path because of a new pane, that is not yet an anxiety disorder, but an excessive fear reaction. But if I see lions everywhere and therefore don't go out of the house, then I suffer from an anxiety disorder. We doctors differentiate between fears, which all run in the head, and anxiety states, which are associated with strong emotions and physical reactions.

The virus could be anywhere. Doesn't the fear of it also paralyze healthy people?

Ultimately, fear is always characterized by avoidance behavior. In the corona crisis, all situations that could lead to infection should be avoided as far as possible. A great social fear can still not be determined. In contrast to Italy or China, in this country people are on the streets, they walk and shop.

But there are fewer. Does the PUK have more consultations?

Yes, which was to be expected though. As I said: Stress can trigger disorders in the case of previous mental illnesses. In order not to make our patients additionally nervous, we bring calm to the clinic with clear rules.

The corona crisis is changing social life, and online channels are getting a boost. What long-term behavior changes do you expect?

The effects cannot yet be assessed. Because travel is difficult at the moment, there could be a huge wave of travel after the virus dies down.

The longer the state of emergency lasts, the more inventive psychiatry has to become. Is Online Psychotherapy an Option?

Psychotherapy is based on a paradox: the patient must reveal his inner life and make himself dependent on the doctor in order to become independent in a problem area. That takes trust. It is much easier to build trust in direct contact than digitally. But the smaller the problem, for example in the case of a spider phobia, the easier digital therapies are. These are already practiced today.

Is the PUK considering temporarily continuing psychotherapy, for example via Skype?

Because we have a social distance of two meters, such a step is actually not far. At the moment, however, inpatient psychotherapy is not the top priority in psychiatric care. As a rule, psychotherapy lasts one to one and a half years. A break of four months is justifiable. In the case of bipolar disorders, for example, which cannot only be treated with psychotherapy, the treatments cannot be suspended.

Many say the virus will stay. What would that mean?

We don't know if the virus will stay or if it will leak. We also don't know if, like the influenza virus, it will come back every year or twice a year. My personal assessment is that in China - if the number of cases of infection continues to decline - it will be over in a month. In Switzerland we are at a completely different point. The biggest uncertainty factor: how far can we motivate people to stay at home if it is fully spread?