Everything is going to be all right.

Psychopathology in the time of an epidemic in Italy

Andrà tutto bene.

La psicopatologia in Italia al tempo dell’epidemia


*E-mail: llorettu@uniss.it

1Psychiatric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, AOU Sassari

RIASSUNTO. Scopo del presente lavoro è descrivere alcune reazioni umane e alcuni elementi di psicopatologia durante la pandemia. La pandemia ha messo in luce diversi aspetti dell’animo umano negli operatori sanitari, nei pazienti  e nelle altre persone. Vi sono medici, infermieri, operatori che lavorano 24 ore su 24 per curare e assistere i malati, accompagnare chi non ce la fa. Incuranti del rischio di contagio, della fatica, dei propri bisogni hanno  un’unica  priorità : aiutare, fare il proprio dovere. Molti di loro si sono ammalati, molti sono morti. Tra loro vi è un alto tasso di contagiati, malati, qualcuno muore. Tutti sono stremati. Sono stati chiamati eroi, ma non tutti sono eroi. I  nostri pazienti psichiatrici, inizialmente, sono i più adeguati, prudenti, saggi, responsabili. Con poche, semplici  parole esprimono tanta consapevolezza e sana umanità. Al contrario, altre persone, quelle che normalmente si sentono “al di sopra delle cose”, entrano nel panico Questa pandemia ci ha fatto capire (se ancora lo ignoravamo) che la vita è fragile, che tutto ciò che ci circonda e su cui costruiamo le nostre sicurezze è precario e incerto.

SUMMARY. The aim of this paper is to describe some human reactions and some elements of psychopathology that occurred during the pandemic. The pandemic  highlighted different aspects of the human soul in doctors, in health workers, in patients, in other people. There are doctors, nurses, health workers who work round the clock to treat and assist the sick, and to support those who won’t make it. Ignoring the risk of contagion, fatigue, and their own needs, they have only one priority: to help, to do their duty. Many of them become severely ill, many have died. All are exhausted. They have been called heroes, but not all are heroes. Our psychiatric patients, initially,  have reacted appropriately, in a judicious, sensible and responsible way. They expressed a lot of awareness and  humanity. In contrast, other people, those who normally fee “on top of things” get into a panic. This pandemic has made us realize that our lives are fragile, that all the things on which we base our sense of security are actually precarious and  uncertain.

I must confess that at first I thought that some reactions to the coronavirus threat were overblown and that what we were facing was little more than an epidemic of the flu. But soon enough, a friend and colleague who lives in Northern Italy called me and told me about the situation in the hospitals: large numbers of infected people admitted to hospital, ICUs almost at full capacity, entire hospitals that had become contaminated had to be closed down and their patients transferred to other hospitals. A disturbing account.

A real eye-opener for us, on the wonderful island of Sardinia. And once our eyes are wide open, there is so much to see. From my viewpoint at the Psychiatric Clinic, I can see a rich and varied humanity. In such exceptional situations, all sorts of things will happen.

Our first concern is for our psychiatric patients, who already live in a subjective, frightening and disturbing reality. We were concerned the news might exacerbate their fears and trigger mental decompensation. Surprisingly, none of this has happened; on the contrary, our patients have reacted appropriately, in a judicious, sensible and responsible way. They will call me saying: “Professor, I’m not feeling bad, I’d rather cancel our routine appointment, I would have to take the bus..., I’ll be in touch at a later time, I will continue the treatment... And you, Professor, take care, be careful, and help others who are in more need than me”. With a few, simple words, they manage to convey their awareness of the situation and their support.

In contrast, other people, those who normally feel ‘on top of things’, the ‘winners’, get into a panic. Suddenly they are confronted with their vulnerability; they are stripped of their mask of strength and are hit by the recognition of how fragile and precarious their lives are. They realise they lack the inner resources needed to cope with suffering and that they have a lot of unfinished business they have to work through before they can be at peace with themselves. So they demand urgent appointments and quick fixes, they claim priority and special attention: the fear of the virus speaks through their body, with more acute physical suffering than that experienced by many patients who develop an asymptomatic or mild form of the disease.

And there is more to be observed. A range of human reactions is also found among doctors and health workers. Many doctors, nurses and paramedics work round the clock to treat and assist the sick and to support those who won’t make it. Ignoring the risk of contagion, fatigue and their own needs, they have only one priority: to help, to do their duty. By saving others, they save themselves, because this too is solidarity. Among healthcare workers, infection rates are high; some become severely ill, some die1. All are exhausted. These are the heroes who will have to face difficult decisions: whom to treat and whom to let die, once resources are no longer enough for everyone. At the other end of the spectrum, there are those doctors and healthcare workers that display the worst selfishness and opportunism by playing the system, with the smartness that is the hallmark of fools. They call in sick, find an excuse not to go to work, end their shift sooner rather than later. They leave others on the frontline while they step back, tiptoeing their way around their duties, ostensibly sticking to the rules, while actually using them as a screen to cover their selfishness. We are not all heroes!

Then there is the rest of us. Many of us understand that this is the time to be responsible and socially conscious, that we must all make some sacrifices because we must be united in fighting this war and the small actions of each of us are essential if we want to win it. Others believe that what is happening does not concern them, that the outbreak is a sort of virtual game that should not force them to change their habits and give up their social outings and fun life. Often this cavalier attitude that contributes to the spread of the infection is the result of an educational failure by our generations and of the consumerist culture to which years of affluence have accustomed us. Then again, there are those who pin the blame for the epidemic on the Chinese, seen as the ‘others’, the ‘plague-spreaders’, thereby finally legitimising their own violence, racism and xenophobia, with the silent approval of many. Here, psychopathology, fear, anxiety, failure to assess risk, violence become mixed and confused with the crisis of values, with moral illiteracy, and butt heads with the sense of duty, sound ethics, solidarity and acceptance  of others.

The epidemic has made us understand other things too. First of all, that the Italian Health System is one of the best in the World and that it guarantees free treatment to everyone as established by our Constitution. Secondly, it has made us realise how fragile our health system has actually become due to the cuts in resources that it has suffered over the years. Today we realise that its precarious balance, which was largely made possible by the dedication and sense of duty of health workers, must be strengthened by funding and far-sighted planning, both of which have been lacking in recent years. Let’s hope that our policymakers learn their lesson and that other countries also take heed of our experience: investing in the health of citizens is the soundest budget choice for all countries.

Lastly, the epidemic has made us understand that death is highly ‘democratic’ and makes no distinction, and that our sheer diversity will help us fight the virus: many will fall ill, but while some will tragically die, many more will recover, because luckily we are all different from one another. This pandemic has made us realise (if we still needed reminding) that our lives are fragile, that all the things on which we base our sense of security are actually precarious and uncertain.

What else can this health emergency teach us? That in the face of great threats, response strategies can only be collective, shared and rational. And as the events unfold, the grief for an epidemic that sows death and suffering stands in contrast with Nature that, here in Sardinia, greets the summer. The blue sky, the colours of the flowers, the scent of the sea, the gentle breeze tell us that it cannot end like this. Despite our mistakes, our human failings, Nature tells us that… everything is going to be all right. But at what price. After all this, many things will return as before, but we will not be better… We do not learn from experience.


 1. Lorettu L, Dessanti A, Nivoli A, Bellizzi S. The COVID-19 Pandemic in Italy and the World: to be or not to be? That is the real problem. Health Security 2020; 18(6).