Society

How COVID-19 Is Deepening Anxiety Disorders

Mental health professionals in Argentina note an uptick in people seeking help, especially patients already struggling with issues like hypochondria and OCD.

On the second day of the quarantine in Buenos Aires
Verónica Frittaoni

BUENOS AIRES — The situation is extreme. It's an economic, social and a healthcare crisis that exempts nobody and will leave its mark on all. It is a global emergency. And even in the coolest of heads, anxiety is creeping in as people struggle to navigate these uncertain times.

So far, those with the emotional tools to manage their feelings are riding the wave of events without succumbing to undue fear or disproportionate concern. But for those who struggled with anxiety even before the epidemic, people who had trouble leaving their homes even in the best of times, or hypochondriacs who struggle against a constant obsession with disease, the coronavirus has become a double threat. It may or may not attack their physical health, but is most definitely harming their emotional state.

"The generalized stress this pandemic is generating has resulted in a 20% relapse rate," says Gabriela Martínez Castro, head of the Argentine Center for Specialized Studies in Anxiety Disorders (CEETA).

Like other mental health professionals in Argentina, Castro says there's been an uptick in recent weeks in patients seeking help. Many people being treated for anxiety disorders and phobias and who were gradually recovering are now relapsing, she explains. And what's triggering them, the specialist adds, are the restrictions being put in place.

"Many patients have become much worse, to the point of provoking symptoms again, in spite of the progress we were making," she says.

Gustavo Bustamante, president of the Phobia Club Foundation, says that among patients who already had a phobic framework or specific disorders like Generalized Anxiety Disorder (GAD) or Obsessive Compulsive Disorder (OCD), panic attacks or agoraphobia, anxiety levels have risen considerably.

"These are people who were already stressed about money and the pandemic's consequences," he says. "Even before the government began issuing guidelines, most of my patients had abandoned their daily routines and were in self-confinement. Some had to move up their appointments or seek closer attention, as the level of anxiety and worry the illness is generating is making them feel vulnerable."

Virtual platforms have become essential in providing emotional support. "We are implementing a strategy to give them support through online services," Bustamante says. Among other things, his foundation is offering more after-hours or night night consultations.

The Argentine anxiety disorder center has also adopted remote consultations for those who need them most. Patients are being encouraged to continue their therapies, says Martínez Castro. "Not only are they not stopping but we have people who are consulting more than once a week," she adds.

OCD patients with cleaning-related rituals are convinced their longstanding fears were not baseless after all.

Specialists say that for patients with GAD and OCD and forms of hypochondria, behavior patterns are now even more intense. Rossana Speranza of the Argentine Association of Anxiety Disorders (AATA), says patients "overestimate the level of danger." People overly concerned about health show a "heightened observation of the general state of the body, and you have to work to make sure they won't go to night pharmacies," she adds. "With OCD, patients with cleaning-related rituals boost this kind of behavior, convinced that their longstanding fears were not baseless after all."

Susana Dagos, a 63-year-old podologist and agoraphobic, is familiar with a lot of this conduct. She had managed, since 2012, to control her fear leaving her home. She'd been attending workshops and even managed to travel abroad. She was "well enough," she says. But with the pandemic, she's struggling once again.

"There is fear, which is what makes the phobia reappear," she says. "I decided not to travel on public transport. I took the precaution two weeks ago. I don't want to be with people all packed together... I'm much more afraid."

Liliana Traber, coordinator of the Trauma and Anxiety clinic at INECO, a public research body, points out that there are different kinds of fears and phobias, and that to treat them it's important to distinguish one from the other. "Fearing the illness or its contagion is not the same as being really worried about the future, about what will happen with the economy, for example, or your family," she says.

What many patients have in a common is a fear of death — of their own death and the death of others. And the panic over the pandemic, says Martínez Castro, "can arouse and trigger latent disorders, as it can work as an unleashing factor."

Bustamante of the Phobia Club says the coronavirus outbreak will also impact people who hadn​"t previously sought mental health advice. He says there is precedent for this in Argentina, where there 2001 financial crisis prompted a 300% increase in therapy visits. For many, he says, the trauma of the crash soon became a "constant worry" about falling into poverty that "became chronic, and changed the way daily lives developed."

The pandemic will have a similar effect, Bustamante says. "It will alter many habits in society generally," he adds. "And many people who previously had no history of mental illnesses or disorders, or thought they were less at risk, will from also be living in a heightened state of alarm."


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Economy

European Debt? The First Question For Merkel's Successor

Across southern Europe, all eyes are on the German elections, as they hope a change of government might bring about reforms to the EU Stability Pact.

Angela Merkel at a campaign event of CDU party, Stralsund, Sep 2021

Tobias Kaiser, Virginia Kirst, Martina Meister


-Analysis-

BERLIN — Finance Minister Olaf Scholz (SPD) is the front-runner, according to recent polls, to become Germany's next chancellor. Little wonder then that he's attracting attention not just within the country, but from neighbors across Europe who are watching and listening to his every word.

That was certainly the case this past weekend in Brdo, Slovenia, where the minister met with his European counterparts. And of particular interest for those in attendance is where Scholz stands on the issue of debt-rule reform for the eurozone, a subject that is expected to be hotly debated among EU members in the coming months.

France, which holds its own elections early next year, has already made its position clear. "When it comes to the Stability and Growth Pact, we need new rules," said Bruno Le Maire, France's minister of the economy and finance, at the meeting in Slovenia. "We need simpler rules that take the economic reality into account. That is what France will be arguing for in the coming weeks."

The economic reality for eurozone countries is an average national debt of 100% of GDP. Only Luxemburg is currently meeting the two central requirements of the Maastricht Treaty: That national debt must be less than 60% of GDP and the deficit should be no more than 3%. For the moment, these rules have been set aside due to the coronavirus crisis, but next year national leaders must decide how to go forward and whether the rules should be reinstated in 2023.

Europe's north-south divide lives on

The debate looks set to be intense. Fiscally conservative countries, above all Austria and the Netherlands, are against relaxing the rules as they recently made very clear in a joint position paper on the subject. In contrast, southern European countries that are dealing with high levels of national debt believe that now is the moment to relax the rules.

Those governments are calling for countries to be given more freedom over their levels of national debt so that the economy, which is recovering remarkably quickly thanks to coronavirus spending and the European Central Bank's relaxation of its fiscal policy, can continue to grow.

Despite its clear stance on the issue, Paris hasn't yet gone on the offensive.

The rules must be "adapted to fit the new reality," said Spanish Finance Minister Nadia Calviño in Brdo. She says the eurozone needs "new rules that work." Her Belgian counterpart agreed. The national debts in both countries currently stand at over 100% of GDP. The same is true of France, Italy, Portugal, Greece and Cyprus.

Officials there will be keeping a close eye on the German elections — and the subsequent coalition negotiations. Along with France, Germany still sets the tone in the EU, and Berlin's stance on the brewing conflict will depend largely on what the coalition government looks like.

A key question is which party Germany's next finance minister comes from. In their election campaign, the Greens have called for the debt rules to be revised so that in the future they support rather than hinder public investment. The FDP, however, wants to reinstate the Maastricht Treaty rules exactly as they were and ensure they are more strictly enforced than before.

This demand is unlikely to gain traction at the EU level because too many countries would still be breaking the rules for years to come. There is already a consensus that they should be reformed; what is still at stake is how far these reforms should go.

Mario Draghi on stage in Bologna

Prime Minister Mario Draghi at an event in Bologna, Italy — Photo: Brancolini/ROPI/ZUMA

Time for Draghi to step up?

Despite its clear stance on the issue, Paris hasn't yet gone on the offensive. That having been said, starting in January, France will take over the presidency of the EU Council for a period that will coincide with its presidential election campaign. And it's likely that Macron's main rival, right-wing populist Marine Le Pen, will put the reforms front and center, especially since she has long argued against Germany and in favor of more freedom.

Rome is putting its faith in the negotiating skills of Prime Minister Mario Draghi, a former head of the European Central Bank. Draghi is a respected EU finance expert at the debating table and can be of great service to Italy precisely at a moment when Merkel's departure may see Germany represented by a politician with less experience at these kinds of drawn-out summits, where discussions go on long into the night.

The Stability and Growth pact may survive unscathed.

Regardless of how heated the debates turn out to be, the Stability and Growth Pact may well survive the conflict unscathed, as its symbolic value may make revising the agreement itself practically impossible. Instead, the aim will be to rewrite the rules that govern how the Pact should be interpreted: regulations, in other words, about how the deficit and national debt should be calculated.

One possible change would be to allow future borrowing for environmental investments to be discounted. France is not alone in calling for that. European Commissioner for Economy Paolo Gentiloni has also added his voice.

The European Commission is assuming that the debate may drag on for some time. The rules — set aside during the pandemic — are supposed to come into force again at the start of 2023.

The Commission is already preparing for the possibility that they could be reactivated without any reforms. They are investigating how the flexibility that has already been built into the debt laws could be used to ensure that a large swathe of eurozone countries don't automatically find themselves contravening them, representatives explained.

The Commission will present its recommendations for reforms, which will serve as a basis for the countries' negotiations, in December. By that point, the results of the German elections will be known, as well as possibly the coalition negotiations. And we might have a clearer idea of how intense the fight over Europe's debt rules could become — and whether the hopes of the southern countries could become reality.

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