COVID-19 Neurosis

Back when traumatic experiments on animals weren’t ethically prohibited, human anxiety was modeled by subjecting lab animals to an irresolvable approach/avoidance dilemma.

The oldest and best-known example came from researchers in Ivan Pavlov’s laboratory. They classically conditioned dogs to associate food rewards with the sight of a circle, and also trained the same dogs to associate ovals with not getting food. Once trained, the dogs were shown ovals that looked more and more circular, until eventually, they couldn’t tell them apart. At that point, the animals became acutely agitated.

This paradigm became known as experimental neurosis. It was offered as a behavioral account of neurosis at about the same time Freud was developing a psychoanalytic account. Experimental neurosis could be induced in many different species, and via both classical and operant conditioning. As an example of the latter, thirsty lab rats were given access to a metal water spout with an electric charge. The rats wanted the water but didn’t want the shock. As a result, the rats had physiologic and behavioral reactions that looked a lot like human anxiety.

Many of us wince even at the description of these experiments. We empathize with the poor creatures confronted with an irresolvable problem. Nowadays, the experiments seem cruel, even though the goal was to relieve human suffering (e.g., the rat studies were done to test anti-anxiety medications before trying them on people).

The coronavirus pandemic challenges us with similar approach/avoidance dilemmas, leading to what we might call “COVID-19 neurosis.” Nearly all of us are strongly inclined to interact physically with others. We have lifelong associations of human touch and closeness with comfort and safety. Parents hugging children, lovers kissing, friends whispering comments from mouth to ear; hands on shoulders, playful roughhousing, gentle caressing: these and countless other acts of intimacy are high points in our emotional lives. They are undeniably rewarding — like meat to the dogs and water to the rats.

COVID-19 has made each of these aversive: It electrifies the water spout. Every physical encounter risks a potentially fatal disease. The threat looms even when the statistical likelihood is small; public warnings blare to shake us from our usual habits. Acts that used to be caring, comforting, or simply friendly are now threatening. We refrain from touching our grandparents. We steer clear of others on the sidewalk. In-person medical care may leave us sicker than when we arrived.

Coupling reward and punishment to the exact same behavior is crazy-making. No wonder so many of us have gone from anxious to depressed as the pandemic wears on. Indeed, that’s exactly what Pavlov described in many of his dogs: Eventually, the agitation died down and they gave up.

In this case, though, giving up leads to more sickness and death. The sad truth is that all infectious diseases, not just COVID-19, specifically exploit our social nature. There would be no contagion if we each lived in our own bubble. Pathogens unthinkingly, mechanically capitalize on the very traits that most make us human. That’s literally how they work.

It’s tempting to call this cruel, as though we suffer at the hands of an evil scientist torturing dogs or lab rats. Victimization leads many of us to point fingers at villains — rule mongers, rule breakers, the privileged, the needy — who represent this cruelty in our minds. But we’re not being punished, not really; no more than earthquakes or tornados punish us. The natural world has consequences. The virus doesn’t care about our political philosophy regarding masks, or whether we’re usually kind to strangers. It only cares about infectivity, immunity, and the now-famous R0.

One thing Freud had over Pavlov was a cure for neurosis. But we don’t need psychoanalysis for the experimental neurosis caused by COVID-19. Unlike dogs and rats, we can understand the problem, imagine a future after the pandemic, and delay now-risky gratifications until then. It’s not easy or fun, but a number of countries have shown it’s possible. It demands imagination and will, accepting reality, and not taking the affront personally.

©2020 Steven Reidbord MD. All rights reserved.