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 Table of Contents  
Year : 2020  |  Volume : 36  |  Issue : 5  |  Page : 93-94

Sophie's choice: The costs of the COVID-19 pandemic versus the costs of its “treatment”

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission24-Jul-2020
Date of Acceptance25-Jul-2020
Date of Web Publication02-Oct-2020

Correspondence Address:
Prof. Debasish Basu
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijsp.ijsp_234_20

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How to cite this article:
Basu D. Sophie's choice: The costs of the COVID-19 pandemic versus the costs of its “treatment”. Indian J Soc Psychiatry 2020;36, Suppl S1:93-4

How to cite this URL:
Basu D. Sophie's choice: The costs of the COVID-19 pandemic versus the costs of its “treatment”. Indian J Soc Psychiatry [serial online] 2020 [cited 2020 Oct 28];36, Suppl S1:93-4. Available from: https://www.indjsp.org/text.asp?2020/36/5/93/297139

The thoughtful and comprehensive article by Professor Sudhir Khandelwal in this issue [1] is remarkable for its exhaustiveness, erudition, balance, simple plain talk, and ground-touching realism…much too familiar for those who have been following Prof. Khandelwal's writings.

This ultra-small virus, now named as SARS-CoV-2 that causes coronavirus disease 2019 (COVID-19), knows nothing about society, history, geography, economics, culture, races, castes, tribes, rich or poor, male or female (or any gender, for that matter), high or low class, education, occupation, low- and middle-income countries, Global North or Global South… In fact, it knows nothing. It only has this primordial, preconscious urge to spread, invade, replicate…spread, invade, replicate…

And, we, humans, with all our wisdom but also all our human-made divisions, are grappling to fit ourselves in the scheme of things. We are learning every day. But are we?

The COVID-19 pandemic, as a bizarre macabre natural experiment, has exposed the chinks in our armors. It has shown our vulnerabilities, our discriminatory capabilities, and our essential penchant for nurturing stigma (or “othered-ness,” or xenophobia) in various forms, as essential human characteristics. However, it has also shown our strengths, our innovativeness, and our dogged pursuit to win, as essential human characteristics.

The pandemic has, no doubt, caused – and has been causing as I pen down this commentary – unthinkable damage in terms of infections, morbidity, mortality, and material and societal costs. However, in the fight against this pandemic, the unavoidable steps taken to prevent, contain, break the chain of transmission, or, in general, “treat” the situation have also taken their heavy toll. Social distancing, lockdown…boon or bane? Or both? The debate continues. And, in the meanwhile, at the macro level, the world economy has crashed. At the medium level, countries/regions are struggling to regain their lost ground. And, at the micro level, thousands and thousands of the so-called “informal sector” employees, essentially unsecured, uninsured, unprotected migrant employees, having lost their jobs literally overnight, started walking – yes, walking – thousands of miles in possibly the world's largest “reverse migration” and dying.

This is, truly, a case of “Sophie's Choice” where a mother being taken to Auschwitz had to make the heart-rending choice between which of her two children would live and who would go to the gas chamber. Who would she have saved? And who would she let die? This is what, at an international but certainly at a national and regional level, politicians and decision makers had to decide.[2] Who lives? Who dies? As always, it is the vulnerable sections of the societies all across the world including India who have to bear the brunt of such harsh decisions. And, everyone knows, the national lockdown imposed by the Indian government, with a 4-h window (yes, 4 h to sort your life), was one of the most sudden, extensive, and stringent lockdowns in the entire world. Interestingly, the lockdown was begun to be lifted just when the numbers of infected cases had started – no, not decreasing or even stabilizing – but rising sharply. And, as of today (July 24, 2020), India has reached the dubious distinction of the world's second-highest country in terms of total and daily infection cases – just toppling Brazil and now second only to the USA. And, the economy has crashed as well. So, what should have been done differently? What can be done differently now?

And, all these impact mental health. The pandemic affects mental health by its morbidity, mortality, uncertainty, anxiety, posttraumatic symptoms, paranoia, and stigma. However, the “treatment” of the pandemic, by the way of social distancing, quarantine, isolation, and, most importantly, a stringent, extended and widespread lockdown, all take their tremendous toll on mental health too, by generating boredom, anxiety, depression, irritability, insomnia…but more importantly and at a much larger scale, joblessness, hunger, and even impending death. Death from COVID-19 or death from hunger? That becomes the modern-day Sophie's Choice.

As I have mentioned in the editorial of a special issue of World Social Psychiatry,[3] the play being enacted before us is not new. As depicted poignantly by the French philosopher-author Albert Camus in his 1947 book La Peste (the Plague), such reactions and dilemmas have confronted humankind many times in the past too. The question is: have we learned from these lessons of history? Apparently, no. Are we ever likely to learn from them in future, for example, from this pandemic? Apparently, no. Well, rather than sounding that pessimistic, let me say, well, possibly yes, provided we learn, and act upon the eco-social “dormant” determinants of health, including mental health, which are the predisposing background factors that act as the “chinks” in the ostensibly formidable modern-day healthcare “armor.” Otherwise, it will take just another pandemic in future again to expose these chinks in our armor.

This is where social psychiatry comes into the forefront, and has an absolutely vital role to play to understand, research, document, analyze, advocate, and evaluate the eco-social factors in predicting, treating, and preventing mental health issues arising out of any major disaster, including the current pandemic. And, this is where the article by Professor Khandelwal has done a ground-breaking job, literally. Let's hope we all can build upon this Bhoomi pujan.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Khandelwal SK. Debating the Process, Impact and Handling of Social and Health Determinants of the COVID-19 Pandemic. Indian J Soc Psychiatry 2020;36 (Suppl):S64-S83.  Back to cited text no. 1
Times of India. India faces Sophie's Choice: The Government's Tragic Lockdown Dilemma is that it has to Pick between Lives. Published April 17, 2020. Available from: https://timesofindia.indiatimes.com/blogs/men-and-ideas/india-faces-sophies-choice-the-governments-tragic-lockdown-dilemma-is-that-it-has-to-pick-between-lives [Last accessed on 2020 Jul 24].  Back to cited text no. 2
Basu D. The Plague by Albert Camus, the COVID-19 pandemic, and the role of social psychiatry – lessons shared, lessons learned. World Soc Psychiatry 2020;2:51-6.  Back to cited text no. 3
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