Pandemic fatigue is a recurrent topic in the narration of the mental effects due to the pandemic. It is generally described inerms t of self-exhaustion or tiredness, lack of attention, difficulty in carrying out the operations of everyday life, anxiety and loss of hope. It affects, in different ways, those who are particularly exposed to the distress of COVID-19 (health systems operators) and ordinary people. Being a discomfort rooted in the existential frame, pandemic fatigue cannot be interpreted only as a sole cluster of psychological/psychiatric symptoms or syndromes.
By Primavera Fisogni
Pandemic fatigue affects, in multiple ways, the persons who are particularly exposed to the distress of COVID-19 (health systems operators) and ordinary people. Being a discomfort rooted in the existential frame, pandemic fatigue cannot be interpreted only as a sole cluster of psychological/psychiatric symptoms or syndromes.
Philosophy can fruitfully suggest an interpretative path for understanding pandemic fatigue in terms of a systemic condition, that's to say: we should interrogate how pandemic fatigue works, not just about what it is.
From a theoretical perspective, this means a change of paradigm, precisely a turn from linear thinking (the processes that lie beneath the mental exhaustion of pandemic fatigue) to the scrutiny of systemic thinking (Urbani Ulivi, 2019; Minati, 2019). It moves from the 'what is' to the 'how it works' question. Perturbation, dissipation, and coherence are the steps to be investigated. Each process will be discussed in dialogue with the phenomenological results, in order to integrate them. It will be noticed that, far from being a symptom of failed hope, pandemic fatigue proves the necessity for human subjects to be resilient, especially in such dark, unprecedented times.
Limits of the Definition
Pandemic fatigue has become a popular term in everyday speech since the World Health Organization coined it in March 2020 (WHO, 2020), when the pandemic outbreak kept shuttering our lives. In a wide sense, it could be interpreted as the most contagious side effect of COVID-19. It is even more viral than the pathogen, because it affects, in several ways, even those who have avoided infection. It refers to the lack of motivation to follow recommended protective behaviours that gradually emerge over time and is influenced by multiple emotions, experiences and perceptions.
Although a basic definition has been sketched, and people easily grasp the semantic roots of pandemic fatigue, any effort for defying it immediately shows its limits because of the multifaceted profile of the phenomenon. For melting together both physical symptoms (fatigue, difficulty in carrying out the operations of life) and psychological traits (stress, demoralization, melancholy, depressive states), pandemic fatigue would be better understood as an existential syndrome. As Badre assumes, facing it is undoubtedly a conceptual challenge with powerful social repercussions because “it is not one phenomenon and likely stems from several causes”. (“Scientific American”, 2020)
The aim of this paper is to move from the definition provided by the WHO to the systemic processes that lie beneath pandemic fatigue, in order to clarify the topic not by telling what it is but focusing on how it works.
From a theoretical perspective this means a change of paradigm, precisely a turn from linear thinking (definition) to systemic thinking (dynamics).
A short account of this philosophical approach is due. According to GST (Urbani Ulivi, 2019) objects and events are considered in term of open systems; they are not mere aggregations or sums of parts, but primarily dynamic units, to which pertain qualities that depend upon many interactions and processes, internal or external to the system, within the frame of a continuous exchange with the environment that gives rise to systemic properties (or II type systemic properties).
According to Agazzi, we can speak of “an order of interrelated parts whose characteristics depend both on the characteristics of the parts and on the web of their interconnections” (Agazzi, 2019: x). Each system, then, might be explained as a simple and complex unit that interacts with the whole. Nevertheless, the idea of a system is not really new, especially for natural sciences. It dates 1632, when Galileo published the Dialogo sui due massimi sistemi, however in was in the contemporary age that Austrian biologist von Bertalannfly developed an original systemic paradigm (General System Theory, 1967), assuming also models elaborated in cybernetics.
System thinking proved to be able to grasp a variety of topics about which reductionist approaches have generally revealed unable to provide responses. It should also be noted that, according to GST, traditional conceptual frames could be relaunched while new terms, derived from biology or computational sciences (auto-organization, emergence, equivalence, dissipation, balance) have been forged and successfully applied. Through the lenses of system thinking I’ll argue that pandemic fatigue is the result of the interaction among systems/subsystems, macro and micro environments so that it could be properly speak of a II type systemic property.
Three Phenomenological Aspects of Pandemic Fatigue
Before moving into the dynamics of pandemic fatigue, I’ll highlight on three essential traits that identify such a tangled existential phenomenon: 1) it belongs to the domain of ‘fatigues’, it presents 2) a familiarity with chronic diseases or conditions and 3) it makes concrete the border-line experience of the void.
Systemic at heart, the notion of pathological fatigue is described as an “overwhelming feeling of tiredness and exhaustion” (Penner and Friedmann, 2017: 662) that affects a wide number of diseases, neurological as well as psychological/psychiatric. It may be described as a predictor of psychiatric disorders (Taylor and al., 2003). Poorly understood, despite its broad diffusion, fatigue needs always to be carefully examined because it depends on number of causes. For example, in multiple sclerosis, a link between fatigue and sleep disturbance or with low levels of dehydroepiandrosterone1 have been proved (Stanton, Barnes and Silber, 2006; Téllez and al., 2006). Persistent fatigue also occurs in psychiatric disorders co-morbidly (Harvey and al., 2008).
Fatigue enters the coronavirus pandemic frame in two ways, as a listed symptom of COVID-19 (Huang et al., 2020; Nicola et al. 2020; Sohrabi et al., 2020; Tian et al., 2020; Wang et al., 2020), and as a consequence of the prolonged exposure of the individuals to the outbreak (“it occurs for people who are ostensibly on board with societal attempts to control spread of the virus”, Badre, 2020). This second trait was brought to light in March 2020 by the World Health Organization that coined a prior definition of the phenomenon: “a demotivation to follow recommended protective behaviors, emerging gradually over time and affected by a number of emotions, experiences and perceptions” (WHO, 2020: 4).
Thus, since the very beginning of pandemic, this type of behavioral fatigue associated with the close adherence to COVID-19 restrictions, although “an expected and natural response to a prolonged public health crisis” as WHO underlines, has been immediately felt as a part of the problem, in virtue of the systemic interactions with society, social rules, preventing measures.
Pandemic fatigue (not to be confused with the psycho-physical fatigue felt in the post-illness phase) also combines both the motivational decline and the condition of "burnout", the sense of exhaustion primarily due to “the implementation of invasive measures with unprecedented impacts on the daily lives of everyone, including those who have not been directly affected by the virus itself” (WHO, 2020: 4).
Among existential fatigues, strictly related to chronic situations, I recall “Aids fatigue" and "combat fatigue", which present also commonalities with pandemic fatigue. “Aids fatigue” (different from HIV fatigue2) is related to a general desensitization to the safe issues for preventing Aids after receiving continual messages about the danger over a long period of time (Fauci, 2007), and “combat fatigue” is due to a prolonged exposure to the stress of a conflict in the battlefield (Helmus & Glenn, 2005).
For both Aids and corona virus, the metaphor of war has been recurrent in the discourse (Fisogni, 2021). Furthermore I wish to notice how some aspects of COVID-19 fatigue are superimposable to the “concentration camp fatigue” (Nathan et al., 1964). Passivity, difficulty in coping with the simplest operations of life, lack of attention, a sense of isolation were noted by Etty Hillesum (1914-1943), the Dutch intellectual who died in Auschwitz, after having spent one year and a half in Westerbork camp (Fisogni, 2019). The prolonged exposure to a frustrating situation, within the frame of strict rules due to the threat of being attacked by the enemy – in a conflict, as well as in the concentration camp and in the pandemic outbreak – is going to limit the life-space of the individual. Such a condition has been widely experimented for several times during the repeated lockdowns that occurred worldwide: a continual self-isolation reinforces the systemic discomfort of the human subjects. Differently from the (physical) fatigue experimented as a physiological reaction of the body, which lasts until the organism is restored, pandemic fatigue is an effort that cannot be released.
This existential state of distress is also often related to the experience of void: it’s a loss that depends on grief and sorrow, in many cases; a waste of energy that should be carefully taken in consideration before framing the processes of the phenomenon.
The Deepest Void
A peculiar experience of void recently related to Covid-19 pandemic is the experience of the loss of relatives, friends, colleagues and beloved ones (Fisogni, 2020). This fatigue is emphasized by the impossibility to be next our loved ones’ for both the risk of the contagion and the fact the other family members were recovered from COVID-19 or isolated at home for the quarantine. The deceased from corona virus were mourned in isolation, because no one could also be around them for the anti-contagion rules.
A double faced loss, then, was experienced in the pandemic era: a severe restriction for family visits, which could not allow the relatives to accompany their beloved ones to final moments of life and the impossibility to see, in person, the dead or to celebrate the mourning offices. The only chance for the patient’s family members to spend some time with relatives was given by the phone or video chat provided by the nurses. The distance from the loved one in the last step of the existence, and the impossibility to witness his/her death makes basically impossible the experience of grieving. As a response to the loss of someone who died, to whom we are linked through an affective bond, grief is complex process of adaptation that moves from the rupture of a relationship. If this point of departure is not given, and the deceased is absent, as it happens very often in the COVID-19 pandemic, it will never begin, making impossible any response to grief and loss. Collective funerals and other ceremonies have been promoted worldwide in order to make memory of the deceased from the infection. They are valuable efforts for recovering, through a virtual celebration, the deceased in person.
Only at that moment those who suffered from the loss of a beloved one become veritable grievers and can start the process of adaptation to grief. The imagery makes shorter the physical distance that the COVID-19 rules imposed; memorialization allows the loss to transform from an absence to a living memory of the deceased. On the other side, a severe consequence of the coronavirus is the impossibility to adapt to the loss, a condition that is expected to impact life in a negative way.
Processes Within Pandemic Fatigue
After having sketched summarily three main traits of pandemic fatigue, we are now in the condition to move into the processes that lie beneath this condition. From a phenomenological point of view, which is highly revealing of the phenomenon in itself, it has been noted a link between this peculiar fatigue and the self-exhaustion of the individual. Loss of motivation, lack of concentration, sense of isolation, waste of energy, loss of beloved ones, etc. are part of the problem and a fruitful point of departure into the systemic investigation.
The first dynamic to be explored, then, is perturbation.
Perturbation is the process that derives from a shock inflicted on a living organism (death is the highest grade of it). The pandemic outbreak shuttered our fragile social balance and a microscopic pathogen assaulted the world, basically unprepared to cope with such a traumatic upset. When a perturbation occurs, it is properly the balance of the system to be fractured: in the case of chronic situations, the general instability is amplified. The long-term unpredictability, in physical dynamics as well as in fluid dynamics – two domains from which systemic thinking borrowed the term perturbation – is a typical behaviour of deterministic or non-deterministic chaos.
* This dynamic step could be found at the beginning of pandemic fatigue: it corresponds to the exposure to the outbreak. The never-ending red alert about the pathogen spreading, reinforces the instability of the person, making all its functions more vulnerable.behaviour
With dissipation - a term that systemic thinking has received from the “dissipative structures” introduced in thermodynamics by the Nobel Ilya Prigogine - a double simultaneous movement occurs, characterized by the coexistence of change and stability. This process is strictly linked to perturbation because it originates in non-equilibrium conditions, that’s to say in systems where a shock (or another cause) gave rise to instability. In classical thermodynamics, the typical movement of dissipative systems is rooted in the ability to transfer a large amount of energy to the environment. It’s properly the production of entropy to guarantee the stability of such systems. It’s properly in the process of releasing energy that new configurations or "emergent properties" develop and reach the surface. As Minati notes: “The attribute dissipative refers to systems where energy dissipation in non-equilibrium conditions allows the emergence of ordered structures” (Minati, 2019: 23).
* This step corresponds, in the phenomenological description of pandemic fatigue, to the symptoms of distress suffered both physically and mentally by the individuals. If fatigue as a physiological reaction of the body to an effort finds its balance very quickly, through rest, the exposure to chronic stress originates a non-transient state of exhaustion. To figure out a similar phenomenon of non-living structures Minati suggests “a vortex in a flux of running water” or atmospheric phenomena such as hurricanes.
Dissipation is a process that focuses on the very heart of fatigue. Unlike the almost negative vision with which fatigue is perceived, this process suggests a flourishing for the individual. In fact, it calls for the reaction of the whole system, physical and spiritual. In this perspective, the loss of hope that seems so frequent in pandemic fatigue should be replaced by a positive thought: a new coherence is going to be built throughout self-exhaustion.
The self-organization of dissipative systems is at the origin of the emergences or systemic properties (or II type systemic properties), which result from the interactions within systems and between systems and environment. Emergences should be seen“as continuous and irregular, but coherent, e.g. dynamically correlated, variable in the acquisition of new structures and non- equivalent processes of self-organization” (Minati, 2019: 3).
* Pandemic fatigue, as well as fatigue in general, dwells this place in the interplay among systems (virusesit, individuals, society, safe issues et.). The difficulty to define it depends upon the reason that it cannot be reduced to a symptom, nor it can belong to the sole physical or psychical domain: it surpasses all of them although being deeply interwoven with both.
Another consequence of self-organization of perturbed systems the search for “coherence”. This phase supports the unitary and integrated response of the system to disturbances/perturbations, avoiding isolation or the independent organization of some parts or functions. The loss of coherence clarifies why a process of emergence may be extinguished as the consequence of an inconsistent organization.
This process is visible in the social response to the pandemic outbreak. It corresponds, in the social environment, to the immunization process of the organism. It’s an effort of the whole person, a challenge of transformation/adaptation. When people were locked down in order to avoid the spreading of the virus, people had to leave abruptly apart jobs, daily activities, and interpersonal relations with relatives and friends. Despite these changes, life was going although individuals were forbidden to leave their houses. People continue to work at home, through the connection with their offices, connecting with colleagues on video chat; online educational portals gave children the possibility to feel once again at school; we could go shopping through specific digital networks.
* As an effort, although a positive way to cope with a major shock, this phase asks for a deep interplay with the environment (other individuals and communities) because it is properly this step to reinforce demotivation in following the rules. Sharing reasons behind restrictions, making the audience able to acknowledge the decisions is, at this stage, the most powerful challenge. Only the highest level of fairness in recommendations and restrictions can reduce the “fatigue of coherence”
Conclusions
Pandemic fatigue is a main topic for mental health: systemic at heart, it could be considered a multifaceted existential syndrome. This paper, by focusing on the processes of the phenomenon, was intended to provide a philosophical frame to neurologists, psychologists, psychiatrists. Systemic thinking makes accessible several levels of knowledge within the systemic hierarchy, by gaining a unitary vision of complexity. Through these lenses, pandemic fatigue may be understood as a II type systemic property, not as an isolated phenomenon. Thus, any approach to the discomfort should be multidisciplinary. Furthermore, grasping the dynamics of such a tiredness invites us to look at pandemic fatigue also in the positive term, as a process of transformation, whose various steps establish a new posture for the individual.
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1 Aka androstenolone, is an endogenous steroid hormone precursor.
2HIV fatigue is the type of fatigue related to the virus