‘April is the cruellest month, breeding Lilacs out of the dead land, mixing Memory and desire, stirring Dull roots with spring rain.’
TS Eliot’s immortal words from The Waste Land do not just have poetic truth, they have scientific validity too.
The arrival of spring with the promise of beauty and growth brings pain with it. For people who live with depression the stark contrast between the beauty of spring and the perceived wasteland within is more apparent.
Most people think that suicide rates peak in the winter. But the counterintuitive fact is that suicide rates are highest in Spring. The 19th century French sociologist, Emile Durkheim, the first person to study suicide systematically and to identify this trend, agreed with Elliot when he said, ‘everything begins to awake; activity is resumed, relations spring up, interchanges increase.’
What then for the millions of vulnerable people coming out of lockdown? For them, June may well be the new April. The vast majority of people are delighted to finally shed the shackles of the confinement of these last months.
To commune with family, friends and colleagues once again is an enormous relief. But there are many among us for whom the opposite is true.
I was at first surprised that a good number of my more troubled patients found lockdown a relief when it began. Covid-19 turned psychopathology on its head: those suffering from OCD, hypochondriasis, paranoia and depression became the new normal.
For my patient, Mr L, self-isolation is what he’s always done and it was somewhat of a relief for him that everyone else was doing it too. But now that the sun is coming out and people gather outside, he looks out the window and feels the bitter taste of loneliness as the lockdown chill starts to thaw.
His sense of isolation is apparent once more. He feels a huge burden of expectations to do things again. The feeling that other people are being productive in their work makes him feel he has no purpose. He feels he contributes little to the world and the bleak, hopeless feeling of depression returns.
For the population as a whole, lockdown saw a huge increase in levels of anxiety and a reduction in feelings of well-being. But this global crisis is a slow-release trauma.
We pass through the first phase of this pandemic, health and financial devastation left in its wake. Then as the dust settles the real socioeconomic ordeal begins to reveal itself.
Just like soldiers in wartime are absorbed by the fight and only show the signs of trauma when they emerge from combat, so too the real psychological costs of Covid-19 will show themselves in the months and years ahead.
In the 1980s, the economist HA Bulhan showed that for every one percent increase in unemployment this consistently corresponded with an increase of 2 per cent in mortality figures, 6 per cent in homicide and imprisonment, and 5 per cent infant mortality.
The effects of the pandemic on suicide rates are unclear at this stage. But a recent study in 26 European countries over four decades shows that a rise of 3 per cent in unemployment rates is associated with increases in suicides by 4.45 per cent.
With projections for unemployment in the post lockdown period to reach 15 per cent, we have a crisis of truly epic proportion on our hands. It is estimated that an unemployment rate of 15 per cent followed by a gradual decline over ten years would produce a staggering 2,761 extra deaths due to suicide.
There are many among us who will become increasingly troubled by the shift back to life lived as we used to live it. As people ease back to the new normal those who were sheltered by furloughing won’t be protected any longer.
When those suffering mental health problems look out of the window and see people interacting with one another and they feel acutely their own lack of purpose in the world and lack of a network of care, so we should worry about the vulnerable who are going to be at much greater risk.
Suicide is the tip of the iceberg of a great well of despair in the population. The increased rate of suicide in the spring belies an underbelly of deeply unhappy people whose anguish is unlocked as memory and desire are stirred by spring rain.
It is imperative that we think about and anticipate the potential for a mental health pandemic as restrictions are eased.
Dr Stephen Blumenthal is Consultant Clinical Psychologist and Psychoanalyst at the Portman Clinic, Tavistock and Portman NHS Foundation Trust, and Queen Anne Street Practice. This article first appeared in The Daily Telegraph.