‘Use of War Metaphors for COVID-19 Spreads Fear’: Psychiatrist

With COVID-19 cases on the rise, several global leaders and officials have repeatedly likened the pandemic to a war. US President Donald Trump equated himself to a wartime president.

In New York, the epicentre of the pandemic with over 139,385 positive cases and over 10,650 deaths as of 22 April, Governor Andrew Cuomo called healthcare workers “soldiers”.

Leaders in Japan, Italy and the UK, as well as the global media have used similar war metaphors to refer to the pandemic. In India, Prime Minister Narendra Modi has compared the pandemic and the challenges of lockdown to a war and a battle in nearly all his speeches.

In his maiden speech on COVID-19 on 24 March, Modi primed citizens for the lockdown reminding “today’s generation” of blackouts and drills observed during wars, and a reminder that the impact of the Coronavirus is worse than that of the two World Wars.

He continued such comparisons, when in his 14 April speech, he referred to those bearing the burden of the lockdown, including the migrant worker, as a “disciplined soldier”. He has called healthcare workers “defenders of the nation” and “Corona warriors”. On another occasion, Modi said, “Mahabharata war took 18 days to conclude, the war against Coronavirus will take 21 days.”

On 26 April, in his “Mann Ki Baat” address to the nation, Modi announced a new digital portal called covidwarriors.gov.in. The platform links volunteers, civil society organisations and local administration, and has around 12.5 million registrations including doctors, nurses, NCC cadets, and ASHA workers, he said. People can join the platform to be a “COVID warrior and serve the country”.

Experts have repeatedly warned against use of military language as it is dangerous and distorts reality. Soumitra Pathare, director of the Pune-based Centre for Mental Health for Law and Policy at the Indian Law Society, agrees with the view. In this interview with IndiaSpend, he explains the many problems and unintended consequences of using war metaphors.

Pathare, a psychiatrist, leads a multidisciplinary team of 40 that runs community interventions in mental health in Gujarat, and has helped draft India’s Mental Healthcare Act 2017 and the National Mental Health Policy 2014.

Through the lockdown, which began on 24 March, the team has been monitoring media reports on suicides linked to the pandemic. This is just the beginning of the mental health crisis, he cautioned.

How do the war metaphors used in handling the COVID-19 pandemic impact healthcare workers?

There are two angles here: One, war metaphors used to describe the whole response to the pandemic (‘War on Corona’, ‘Fight Against Corona’); two, specifically, in context of healthcare workers, (being) seen as “Corona Warriors” and “Corona Fighters” on the frontline.

Let us focus on the second point: Labelling healthcare workers as “warriors” is inappropriate because nobody who chose to become a healthcare worker wanted to become a warrior. Unlike soldiers, they did not sign up to put their lives at risk. But like soldiers, they are now supposed to show heroism and be stoic.

The unsaid message in a war is you are supposed to be quiet and not speak out or complain because everyone has to suffer. Even in the absence of personal protective equipment (PPE), healthcare workers are expected to put themselves at risk because they are “warriors”.

This is completely wrong because the issue of PPE is that of occupational hazard. Healthcare workers are in a healthcare system, whether private or government-run, where employers have a responsibility to reduce occupational hazards.

They are not supposed to put their life at risk while working. By calling healthcare workers “warriors”, you are covering up failures of the system to protect them.

So, if healthcare staff highlight the difficulties of poor working environments, it is seen as unpatriotic. There are instances where action has been taken against doctors and nurses who spoke out publicly.

Could you highlight other issues with the language used through this crisis?

Another issue is that every war requires an enemy. Otherwise how do you fight a war? Thus, enemies are manufactured at various levels, as we have seen. At the global level, for example, we see the World Health Organisation (WHO) labelled as an enemy. Leaders are saying: “It’s all their fault. They were responsible.”You can also see countries fighting with each other. It is now seen as perfectly alright for the US to divert supplies from Singapore meant for India to themselves. Because in a war everything is fair. People and countries are falling apart and fighting over scraps.

Instead of working together, we are identifying enemies and fighting with them. If we are going to deal with the global pandemic, we need global solidarity. We won’t get that by referring to it as a global war. The metaphor of war always triggers emotions within people as well as in countries, and makes it each one for himself/herself.

Moreover, a war metaphor to solve healthcare issues has always failed. For instance, the ‘war’ on drugs never actually succeeded. There are also civil society ramifications of using the war metaphor.

Governments are suspending civil rights and civil liberties, and nobody is supposed to complain because it is a war. There are multiple problems at the level of the individual, healthcare, human rights. It is not that we can’t use other metaphors, like the climate change movement has done

Can you give an example?

Greta Thunberg didn’t use the war metaphor in the movement for climate change, for example. I think it requires us to also see people as being intelligent and not just use simplistic, narrow metaphors. You could use the metaphor of a journey where you need to plan, but there will be some hiccups and setbacks, you might miss a train or a bus.

However, there will be a certain end. Or metaphors from sports where there is teamwork, getting together, and working for a particular outcome.

When you want to bring people together, those kinds of metaphors work well too.

What impact does the war metaphor have on those who have the disease?

Directly or indirectly, people are blamed for getting COVID-19 or “bringing it into a country”. It is not like luggage that you “bring” with you. People fall ill, but we blame them. Persons with COVID-19 and their families are ostracised by their community; housing societies say we don’t want any COVID-19 patients. People have been stigmatised unfairly in many ways because of the panic and anxiety around COVID-19. This has even led to suicides.

There’s a lot of anxiety and hopelessness among people, some of it is even leading to suicides. Will this extreme response worsen over time?

As an economic crisis inevitably follows the pandemic, suicides will be the next big challenge. There is evidence from the past. Suicides and alcohol-use disorders go up after an economic crisis.

We have been tracking the news for suicide stories; right now that is the only way we can get information. We have observed three kinds of suicides: One wave was early on in the lockdown due to alcohol withdrawal. That has stopped because many would have finished their withdrawal, which lasts 8-10 days.

The second wave in the next two-three weeks was because of the fear of getting diagnosed with COVID-19, as I mentioned before. Then beginning last week, there were suicides due to economic distress, and the panic and anxiety around it.

That is why we say: Don’t appeal to fear.

So, you are saying governments shouldn’t scare people with their messages. Then how should the severity of this crisis be communicated

Some amount of rational communication – which starts with the assumption that people are intelligent. Our experience with the HIV epidemic shows that appeals to fear don’t work. Scaring people actually decreases the chances of them seeking assistance in time.

You can’t direct fear in the right direction: You can’t have just enough fear that people stay at home, but not so much that they panic. So, in fact, most of us say don’t appeal to fear, which results in people ignoring the message and the bearer of the message.

There is the classic example of smoking, for example. Too many appeals to fear about the impact of smoking can result in cognitive dissonance: People think: That will happen to others, not me.

Is that what happens when people violate the lockdown thinking ‘it won’t happen to me’?

Correct. They deny the message. We should be having far more grown-up conversations with people rather than assuming that they will not understand anything.

Does a phrase like “social distancing” have any consequences for our mental health

We must encourage people to use “physical distancing” and not “social distancing”. Social distancing may lead to social isolation and ostracisation, both of which are problematic for mental health. Human beings are social animals.

You can have physical distancing but still have social contact. A large number of people with chronic mental health problems already experience social distancing, isolation, and exclusion from the community and job market.

Not everyone understands jargon like ‘flattening the curve’ that signifies slowing the spread of the virus over a period of time. Or ‘R0’ (R naught), which indicates how contagious the disease is. How does one spread these messages without talking down?

Communication is as much an art as a science. There are certain basic rules: Do not presume that the audience is dumb. If you explain things in a language they understand, then they will get it. Effective communication has to be two-way: Saying my piece and walking away is not communication, it is a monologue. I should follow up by letting you ask questions and clarify your doubts. Otherwise I don’t know what you have understood. I may have given out an unintended message and then the communication has failed.

We also have to be consistent and repetitive with that message. You can’t have bits and pieces of the government giving out contradictory messages. That’s what we have seen. Ministers have even said something about cow dung cures.

If the government’s message is that lockdown is going to reduce the number of cases and prevent the spread of the pandemic, everyone should spread that message regularly and not once in 15 days.

Saying things like ‘flatten the curve’ sounds fancy, and makes you feel like you are an expert but it actually means nothing to many. I was quite impressed by Angela Merkel who explained what ‘flattening the curve’ means in practical language.

This could be an opportunity for governments to communicate science and health to a larger audience. How do you think India has fared on this front?

We haven’t fared very well. We could have had better communication, not only the management of the pandemic, but also better communication of the science around it. The whole fiasco around hydroxychloroquine is just symptomatic of the mismanagement and the poor communication of the risks to people. We could certainly do better.

Communication also requires transparency. Nobody has all the answers, and it is fine. Our bureaucrats, governments, and experts need to stop treating our populations like they are idiots. People will understand if you offer them a complex answer and they aren’t going to lose faith in you if you tell them that they don’t know everything.

The problem is people are not trained to communicate in any field.

Science communication within the field of science is not valued, this is a failure of science as a sector. Opportunities and funding for science communicators is limited. Science has not succeeded in conveying what science actually does. A lot of the experts are used to talking to and writing for other experts. Hopefully one of the learnings in this is, health and science communication is important.

Do we need codified communication strategies for emergencies?

You wouldn’t need any guidelines if people were trained in communication. Guidelines fall flat if you don’t have people who understand the complexity of the science.

What can the government do to ensure that they are communicating well during the pandemic, and ensuring positive behavioural change?

Bringing in people whose daily job is communicating would have been great. Indian advertising and design studios are reputed for conveying ideas and concepts. Why aren’t they involved in the communication around the pandemic, for example? I am not suggesting that you spin.

But Indian advertisers have been dealing with the average Indian by simplifying and getting to the core of the message for years. Selling a product and selling an idea is no different.

There are also specialised science communication organisations who haven’t been involved at this point. It’s not like we don’t have any resources, it’s just that we don’t seem to value and use those resources.

(This story has been published in an arrangement with IndiaSpend)