Dear Mr Spahn,
The ongoing COVID-19 pandemic has strained the capacity of the German health system in unprecedented ways, but it seems to me that one crucial aspect of lockdown measures has been profoundly undermined: the loss of social cohesion and mental health support for children and adolescents. By no means do I want to disregard the isolation experienced by the elderly or the economic insecurity faced by working adults, however, I can only speak from my own experience as a youth worker, older sibling, and anthropology student, which is why I feel strongly about student and children’s mental health. I am writing to you today, because I believe you are uniquely situated to combat this issue as the German Minister of Health.
My little brother is in his penultimate year of high school but has not been physically in school since November. He used to be outgoing, played in the local basketball club, and worked in a nearby café, usually chatty and full of life. That has all changed. His life has been paused, shut down, and reduced to a computer screen. Sometimes he is lying around for hours, minimally responsive, and staring at the ceiling. He reports feeling listless, unmotivated, and tired, without having had any real energy expenditure or physical activity, and he is not alone. Young students across the country are feeling similar and it is clear that health care intervention and resources are needed to not lose a whole generation to an epidemic of loneliness. In Germany, more than two out of five children and adolescents report feeling the burden of isolation and home-schooling negatively impacting their mental health (Ravens-Sieberer et al., 2020). This is manifested in lower health-related quality of life (HRQoL), higher anxiety, increased psychosomatic complaints such as headaches and sleeping problems, and symptoms of depression. Especially youth associated with lower socio-economic background, low parental education, and migrant status were placed at significantly higher risk of being affected adversely.
Ravens-Sieberer et al. (2020) suggest providing targeted mental health care to affected children, mental health promotion and prevention programs, and raising awareness about the negative impact of the pandemic on children. They do not specify what this intervention might look like, but I want to offer what an anthropological understanding of COVID-19, isolation, and loneliness can bring to developing policies and health care delivery systems for improving student mental health.
Anthropologists have argued that the COVID-19 pandemic is not a biological event (Fuentes, 2020). In fact, it is deeply (bio)social: the perceived threat of the virus is shared, processed, and acted upon by human actors in relation to each other; therefore disrupting not only the respiratory organs but also the mind and community (Fuentes, 2020). The very socialness that is now being limited through “social distancing” measures and feared as a pathway for the coronavirus to invade our body, is what allowed for the emergence of the pandemic in the first place (Fuentes, 2020). But not being social is not an option. Sapkota (2020) argues that culture is what holds identity for the people, and by extension grants them their humanity. The harsh limitation of cultural activities leads thus to a loss of humanity and identity for many and subsequently to mental health problems resulting from the perceived isolation from society. Another anthropologist Jean Comaroff (2006) has carried out work among people that were socially excluded in South Africa, due to being infected with HIV/AIDS. Her account tells us, that while being marked by the virus as sexually immoral, poor, and disconnected from cultural activities, the infected were insistent on a positive, meaningful, and future-oriented life (Comaroff, 2006). There are some parallels here to people having to isolate because of COVID-19. Anthropology tells us that we cannot treat the virus as a biological fact and the possibly infected as bare life, but need to contextualise them within historical, economic, and political processes and the students as human beings with a basic need for connection and cultural cohesion.
Now that I have set out how to understand COVID-19 through the anthropological lens, I want to turn your attention to the causes of declining mental wellbeing. Loneliness in the pandemic, which has been strongly linked to mental health problems such as depression, anxiety, and suicidal ideation (Ozawa-de Silva and Parsons, 2020), is arguably one of the main drivers behind the rise in mental health problems seen in children and adolescents. If the basic human need for connection is not met, the body starts to deteriorate and psychological health to falter (Fuentes, 2020). It is important to note that isolation and loneliness should not be conflated, though often occurring in conjunction. A person can be lonely in a room full of people and perfectly well alone by themselves. Ozawa-de Silva and Parsons (2020) argue that loneliness is an inherent part of the human condition – genetically hardwired – but is shaped culturally in its experience, expectations, and expressions. However, loneliness has also been recognized as a public health concern with professionals speaking of a “global epidemic of loneliness”, and it seems like the pandemic has only worsened this.
Loneliness is experienced independently from distinct cultural contexts as a feeling of “being unneeded” (Ozawa-de Silva and Parsons, 2020). Based on a comparison of different ethnographic materials (scientific descriptions of peoples and cultures) loneliness can be tied to a perceived loss of relationships, places, social practices, and not living up to certain cultural expectations of the life course in different contexts (Ozawa-de Silva and Parsons, 2020). Interesting, but how is this relevant again? Well, based on my experiences with peers and children I work with, COVID-19 is afflicting loneliness on all of us. It is not an individual problem that can be treated by psycho-therapeutic sessions, and while some people do require individual clinical treatment, loneliness and associated anxiety and depression symptoms might be a cultural problem, a Volkskrankheit. Instead of pathologizing loneliness and treating it with psycho-therapy – where patients often have to wait months for their first session – we should let anthropology inform psychology and focus on peer support, community service, and creating meaning in life through social (rather than psychological) rehabilitation (Ozawa-de Silva and Parsons, 2020). Where psychiatry seems overwhelmingly focused on neuroscience studies, anthropology can identify the structures leading to mental health problems, address them, and help rethink public health delivery systems based on communal access to care (Kaiser and Kohrt, 2019). Based on this evidence, I want to advocate for a government-funded program that is designed to increase cultural continuity, peer support, and a sense of community, which can hopefully mitigate mental health problems experienced by children and adolescents.
However, this might be hard to do, especially with the current lockdown measures. The internet and social media have proven invaluable when it comes to connecting people during this pandemic. While many people have become more socially interconnected through digital technologies, some were not able to. In my work as a volunteer youth worker, we had to shift all our activities online, but found that many of the children we usually interact with were excluded – they were often coming from a lower socioeconomic background and had migrant status, unable to afford the necessary technology. While there are negative effects associated with internet access – lower social connections, lower mental health, and less physical activities – Kearns and Whitely (2019) suggest that the positive effects on wellbeing and social integration far outweigh those negative ones, especially in economically deprived communities. Their findings show that the introduction of internet access to these communities tends to increase contact between friends and relatives, empowers those living with mental illness, and can help access online education and health care. For this reason, I would further advocate for funding, enabling families to access the internet and digital technologies, to improve overall mental health and wellbeing.
There is extensive literature on the anthropology of social media that could help us understand how we can actively participate in and create programs that boost mental health among youth, decrease loneliness, and help users make meaningful interactions online. Jordan Kraemer (2007) shows in his ethnographic work how ‘friendship circles’ or Freundeskreise in Berlin distinguish online between local, regional and transnational networks, adjusting the way users present, experience, and reshape everyday life at different geographic scales. For example, typical German distinctions made between Freunde (friends) and Bekannte (friendly acquaintances) disappeared on Facebook, imitating American cultural norms, even when interacting in local contexts. This kind of attention to detail when designing online programs is important, especially when trying to appeal to local communities. Understanding behaviour on social media is key to creating a meaningful online presence and anthropology is well equipped to do so.
I am writing this letter because I do think children’s and adolescent’s mental health is not being paid enough attention to. Focusing our COVID-19 policies solely on the biological could cost us a whole generation traumatised by the loss of social connection. Trauma this early in the development of children can not only have life-long effects but also continue to the next generation through epigenetic transmission (Ozawa-de Silva and Parsons, 2020). I strongly advocate for acknowledging how deeply social the pandemic is, creating a program (online) geared towards peer support and social participation to combat loneliness, and funding resources to close the digital divide and provide internet access to the most vulnerable in our society.
- Comaroff, Jean. 2007. “Beyond Bare Life: AIDS, (Bio)Politics, And The Neoliberal Order“. Public Culture 19 (1): 197-219. doi:10.1215/08992363-2006-030.
- Fuentes, Agustín. 2020. “A (Bio)Anthropological View Of The COVID-19 Era Midstream: Beyond The Infection“. Anthropology Now 12 (1): 24-32. doi:10.1080/19428200.2020.1760635.
- Kaiser, Bonnie N. & Brandon A. Kohrt. 2019. “Why Psychiatry Needs the Anthropologist: A Reflection on 80 Years of Culture in Mental Health”. Psychiatry 82:3, 205-215, doi: 10.1080/00332747.2019.1653142.
- Kearns, Ade, and Elise Whitley. 2019. “Associations Of Internet Access With Social Integration, Wellbeing And Physical Activity Among Adults In Deprived Communities: Evidence From A Household Survey“. BMC Public Health 19 (1). doi:10.1186/s12889-019-7199-x.
- Kraemer, Jordan. 2014. “Friend or Freund: Social Media and Transnational Connections in Berlin” Human–Computer Interaction 29:1, 53-77, doi: 10.1080/07370024.2013.823821.
- Ozawa-de Silva, Chikako, and Michelle Parsons. (2020) “Toward An Anthropology Of Loneliness“. Transcultural Psychiatry 57 (5): 613-622. doi:10.1177/1363461520961627.
- Ravens-Sieberer, Ulrike, Anne Wüstner, Christiane Otto, Michael Erhart, Janine Devine, and Robert Schlack. 2020. “Impact Of The COVID-19 Pandemic On The Mental Health And Quality Of Life Of Children And Adolescents“. SSRN Electronic Journal. doi:10.2139/ssrn.3671434.
- Sapkota, Prakash Prasad. 2020. “An Anthropological Study Of COVID-19: Effects On Socio-Cultural Life Of The People“. Dhaulagiri Journal Of Sociology And Anthropology 14: 37-45. doi:10.3126/dsaj.v14i0.32367.