Abracadabra! In the second century AD, Serenus Sammonicus, a sage and physician to the Roman emperor, wrote in Liber Medicinalis that wearing an amulet of parched paper with a triangular encryption of this word at the top and just an ‘A’ at the bottom tip would drive away lethal diseases. It was widely practised to ward off malaria at that time.
Even during the Great Plague of the 17th century, many Londoners pasted the amulet on their doorways to ward off evil and illnesses. With improvements in hygiene and scientific understanding, abracadabra got relegated from its supposed role in preventing diseases to a loud utterance by magicians while pulling out rabbits from hats.
The relentless march of COVID-19, despite significant knowledge about the mode of its spread, makes one wonder whether the amulet of yore has to be revisited. Proper use of a simple cloth mask that covers the nose and mouth, along with physical distancing, is the most effective means to stall the spread of the virus. Instead, the mask is often worn round the neck, like an amulet. The reasons for such a strange adornment varies from excuses such as “can’t breathe” to reassurances such as “nothing will happen and don’t be scared”. Psychiatrists have an explanation for this behaviour — denial.
DABDA method
In 1969, Elizabeth Kubler Ross, a Swiss-American psychiatrist, described five stages of response to the stress of grief — denial, anger, bargaining, depression and acceptance, or DABDA. On hearing bad news or an adverse diagnosis, patients and their immediate relatives often go through the DABDA stages.
While dealing with heart attacks, doctors try to navigate quickly from the first stage of denial to the fifth of acceptance and get an “informed consent” to start treatment. Staying far too long in denial with statements such as “Doctor, are you sure?” and “No, it can’t be, let’s wait for more relatives to come” will cause more damage to the heart muscle with each minute of delay. Most doctors are sensitive to the DABDA responses, while some patients wish for a quick magical solution, akin to abracadabra.
Extrapolating the stage of denial to the current pandemic, non-compliance with effective measures of prevention such as masking and social distancing is letting the virus spread far and wide. The high recovery rate is reassuring, but the virus wreaks havoc on the elderly and those with co-morbidities. The pandemic has strained healthcare facilities and prevented appropriate treatment of other illnesses.
Faced with the stress of the pandemic, many experience anger and bargain with alternative modalities. In the eastern States of Bihar, Jharkhand and West Bengal and in Uttar Pradesh, people perform rituals to appease corona devi and corona mai , a clear manifestation of fear and despair triggering superstition. Even among the literate, the initial novelty of spending more time at home, doing household chores and sharing it on social media have given way to despair and depression.
As the saying goes, “When the going gets tough, the tough get going.” Novel avenues for staying connected in the virtual world through watch parties, karaoke groups and Web meetings have a stabilising effect and keep the mood upbeat. The faint-hearted should avoid unnecessary exposure to disturbing and repetitive information from television channels; instead focus on building mental and physical stamina through online classes for dance, yoga or exercise.
While breaking bad news, the doctor is able to communicate effectively when the patient reaches the stage of acceptance. Recovery is faster and better in patients who pull themselves up, accept the situation and prepare to move towards the best solution possible. Applying the same coping mechanism to the COVID-19 pandemic, the sooner we accept the proven preventive measures and prepare for the “new normal”, the better it is for everyone. It is high time we all said, “exit abracadabra”, and moved forward collectively from “denial” to “acceptance”.
(The author is a cardiologist
based in Jamshedpur)
vijayacardio@gmail.com
