Interview – Prof. Wulf Rössler, MD; MSc.
The translation of the article written by Francesco Benini / 21.03.2020, 7 p.m., published in the NZZ am Sonntag.
23.03.2020 - Interviews
“SOCIETY IS NOW SUBJECTED TO A STRESS TEST,”
says psychiatrist. Prof. Wulf Rössler, MD; MSc. explains why many struggle with the restrictions.
He analyses fears, panic buying – and emphasizes that the crisis also activates positive things in people.
— Francesco Benini 21.03.2020, 7 p.m.
Prof. Wulf Rössler, MD; MSc.
Seventy-two-year-old Wulf Rössler studied medicine and psychology in Heidelberg. For many years he was Director and Head of the Psychiatric University Hospital in Zurich and Professor at the University of Zurich. Now he is a Senior Professor at the Charité in Berlin, teaches at the University of São Paulo in Brazil and is Executive Medical Director of the Küsnacht Practice near Zurich. His research focuses on psychiatric epidemiology and health services research.
NZZ am Sonntag: How have you personally experienced the extraordinary situation since last Monday?
Wulf Rössler: As a doctor, I had contact with people who were infected with the virus. That’s why I’ve been at home for two weeks. I went out with my dog a couple of times and was amazed that it was almost as usual. I met groups of mothers with children.
NZZaS: Part of society struggles to accept the restrictions that are placed on it.
WR: We live in an individualistic and also hedonistic society. The idea that you can’t pursue your hobbies for a certain time seems very difficult for many. It is remarkable. It is different in countries like South Korea.
NZZaS: In what way?
WR: South Korean society is strongly oriented towards public spirit; the individual takes a back seat. The discipline in implementing the measures ordered by the authorities was therefore great from the start. Many of us do not want to accept the purpose of the restrictions. I don’t just mean young, but also older people. In my environment, I hear people saying: “And if it should happen to me now – I had a good life.” It is an attitude that is difficult to understand. For self-interest, however, they oppose the fact that the Corona crisis needs to be brought under control as quickly as possible.
NZZaS: But fear is spreading among many people.
WR: I would differentiate between them: there is rational fear that stems from the threat to one’s existence. Thousands of people suddenly no longer earn anything and do not know how to get through the coming months financially. Then, some people are susceptible to psychological problems and now react fiercely. One of my patients currently lives separately from her husband – he is abroad. She is at home with the child and works from her home office. For the first time in her life, she now has panic attacks. The load adds up. In this context, there is an essential psychological construct called the “locus of control”.
NZZaS: What does that mean?
WR: In stressful situations, people react with fear. Those who have a so-called internal orientation tend to say: “I control my life. I am a master of my destiny.” Others think: “Control is completely outside of me.” Such people feel exposed to stress to some extent. They are now more at risk. That is about 10 to 20 percent of the population, who are vulnerable to stress.
NZZaS: Loneliness is increasingly seen as a problem in our society. Now you should stay at home by order of the government.
WR: I like to be by myself. However, many people find it challenging to be alone. This is particularly true for older citizens, some of whom live on the periphery of society. It would be good if they responded to the helpfulness that is now shown everywhere. I live in Zurich Oerlikon, where people distribute leaflets that say: “We’ll do the shopping for you.” In Switzerland, there is also neighbourly help and care in urban areas.
NZZaS: Other people now live closer to family members than they would like.
WR: After Christmas, the number of separations increases because people can’t stand each other. Some people react with aggressive behaviour to the fact that they have to spend the whole day with their wife, husband or children. But something else can also happen: more intimacy. Maybe there will be a baby boom in nine months. The society is now subjected to a stress test. After the Corona crisis, one will analyse how society overcame it. How significant the damage is – or not?
NZZaS: The Federal Council tries to encourage people to behave correctly. How do you best do that?
WR: You ask me something. The Federal Council strongly appeals to reason. The instructions are rational to understand. However, many people are not guided by reason; they fail to put individualistic needs behind. I have just read that the number of traffic fatalities in Switzerland fell to less than 200 last year. That was only possible with the constant threat of sanctions, with speed limits and penalties. The discipline that society must now apply to break the chain of infection of the coronavirus can only be brought about with more stringent measures. That is why the Federal Council has now ordered a general ban on meetings.
NZZaS: What happens if there are so many patients in intensive care units that the doctors have to decide whom they treat and whom they don’t?
WR: That is a tough matter. Rationing in healthcare is a taboo in Switzerland. In Basel-Stadt, a health director was crashed out who wanted to decide on the need for expensive therapies. If it now happens that those affected are not treated because they lack the medical equipment, fierce reactions can be expected. In Switzerland, restrictions on medical treatment are not accepted. That is social consensus. If a close relative dies because they cannot be treated, people do not say in this country: “This is fate.”
NZZaS: But we are heading for a crisis.
WR: Yes. However, I hope that the triage between treatment and non-treatment can be limited. Hundreds of ventilators have been ordered. The army is involved. Switzerland is now trying to activate everything that is possible in the healthcare system. The problem is that we are actually not equipped adequately for treatment peaks – because the costs would be very high.
NZZaS: What does it mean for society if everyone works at home? Do people have the self-discipline to do this, or are they loitering on the sofa?
WR: I asked around: Many employers are suspicious and control employees; they ask them every three hours what they have achieved. But, I see possible positive effects: The high number of commuters in Switzerland could be reduced if the home office is better developed, with video conferences and other things. On the other hand, many people appreciate the social interaction in the office. A home office is not easy; it takes self-discipline.
NZZaS: How do you interpret the panic purchases in the shopping centres?
WR: Apparently, the crisis activates deep-rooted fears in some people. I am puzzled about toilet paper because the virus does not cause diarrhoea. In Maslow’s pyramid of needs, elementary needs are at the bottom: enough food, securing of life. We move to the top of the pyramid in standard times; it’s about autonomy and self-actualization. Some people are reacting to the crisis by purchasing elementary needs excessively that are not at risk for us. It makes sense that you shop less frequently, and therefore buy more items. But piling up stocks of pasta – there’s no reason for that.
NZZaS: Most people support the orders of the Federal Council, even if not everyone adheres to them. How long will it take for the general public to be fed up with it?
WR: The restrictions imposed on people begin to falter when the number of new illnesses drops sharply. It is crucial that the Federal Council can make the population plausible as to why and for how long the restrictions apply. It strikes me that politics is based on science, as it is rarely the case. Many believe that science comes to clear conclusions – but this is often not the case. So, the scientists did not agree whether it was good to close the schools or not. Politics still takes the lead over decisions. The decisions must be well explained.
NZZaS: What are the long-term consequences of the crisis for society?
WR: It depends on how we manage to deal with the crisis. If we go back to normal after two or three months, the events of this spring will remain an episode. But, if many relatives die, if companies go under in rows – trauma can remain with people. However, one should not forget positive effects such as the increased effort to be helpful. This creates a feeling of togetherness. The crisis can activate both the bad and the good in people.