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Not a political statement: Psychoanalytic notes on the measures to fight the pandemic and the responses to them

Abstract This article critically examines some of the measures installed to fight the Covid‐19 pandemic, such as the face mask, and the responses these have called forth. It relies on clinical material and on popular culture. The purpose is twofold. First, to exemplify the unique contribution of psychoanalysis for decoding both the political narrative and its reception thus helping understand and better address societal challenges. Second, to inform the debate in the political sciences as to what is a good crisis management strategy. The main argument is that an effective communication, in general, but especially in emergency situations, needs to allow for the unconscious responses to both the danger itself and to the measures imposed to deal with it. Failure to consider this unconscious dimension impacts on the effectiveness of the policy.

autocratic governance of China and neighboring states but also to the cultural wars in several Western countries on issues such as the wearing of the hijab in public spaces or at school.
False analogy, you, the reader, may think-like comparing apples and oranges-and you may be right. Yet emergency situations as exemplified by a pandemic are likely to give rise to extreme forms of anxiety and, consequently, confusion, as societies and governments struggle to figure out how to effectively cope with the new danger. In such an emotional state, approximating paranoia, the mind (or the psyche) reaches backward into its buried underground, the unconscious, for long forgotten or never till now materialized representations to try and make sense of what is going on. In the Project, Freud (1895) referred to this type of thinking as "practical thought" (p. 378) aiming at "identity" (ibid.) as a "primary thought-defence" (p. 382), its ultimate objective to release unpleasure. Unlike critical thought that makes active use of remembering, practical thought operates by association -not unlike the free association that we invite our patients to exercise when lying on the couch, only in the absence of both the analytical setting and the analyst's mind, such mode of thinking follows the pathway of acting out and agitation as a means of releasing anxiety. We all can remember the initial calls of several European leaders at the beginning of the pandemic that "we are at war." In an earlier article (Giorgi, forthcoming), I analyzed the mainstream narrative on the pandemic in the first months of the year 2020 as the actualization of a social defense strategy centering on nationalism and showed that this came at the cost of both multilateral cooperation and legal administrative procedure. Fortunately, this was a transitory phase, in turn confirming what we know from psychoanalytic theory about the fragility of our mature mental state, constantly in oscillation between the paranoid-schizoid and depressive positions as argued by Wilfred Bion using Melanie Klein's theory of mental development. In the present article, I propose to critically examine some of the measures installed to fight the pandemic, such as the face mask, and the responses these have called forth. I rely, in part, on clinical material, in part, on popular culture. My purpose is twofold. First, I wish to exemplify the unique contribution of psychoanalysis for decoding both the political narrative and its reception. Second, I am interested in informing the debate in the political sciences as to what represents good crisis management. Several governments have come under attack in this respect, especially for failing in their communication strategies. My argument is that effective communication needs to allow for unconscious responses without falling prey to them.

| A PANDEMIC STATE OF MIND
From quite early on during the pandemic it could be shown that, in the absence of either medications and/or vaccines, the most effective strategy to contain the pandemic, meaning to slow down its progress besides protecting individuals and health institutions to the greatest extent possible, was the systematic application of hygiene rules besides physical distancing, especially in closed otherwise would-be crowded locations and in high-risk settings such as care homes. In parallel, public health institutions were expected to activate their contact tracing and testing procedures that are part and parcel of the standard approach for dealing with infectious diseases. What turned out to be a huge challenge-elusive for several governments-was the speed of contamination in conjunction with the structural unpreparedness of public health institutions. As a result, regular full or partial lockdowns became the only available methods to manage the pandemic, also with a view to gaining time to set up or upgrade necessary infrastructures and human resources. Citizens and enterprises were compelled to collaborate by decree, besides being offered a combination of reward and punishment measures, the narrative embedded in moralist argument. However, to the extent that the formulas for launching lockdowns or relaxing restrictions were not transparent, nor always commensurate, there has been an upsurge of critique, especially since Autumn 2020, and a growing sense that governments have failed in their risk management strategies-conceptually as well as in terms of implementation.
For individual citizens and groups, the pandemic called forth at the preconscious and unconscious levels elements of a harsh primitive super-ego facing a weakened ego as described by Freud (1930) in Civilization and its Discontents and by Klein (1932) in The Psychoanalysis of Children. Graphically reconstructed: the virus, representing ill-fate, stands in phantasy for the enraged parent that is out to punish its offspring as carriers of aggressive viral load; the state, representing the collective ego, is weakened and begins to function alike by way of reward and punishment. 1 The unconscious sense of guilt invoked by this state of mind is not the same as a mature conscience. It is, on the contrary, more severe. 2 During psychological development, the unconscious sense of guilt gradually gives rise to a more mature conscience-in Kleinian terms, as we move from the paranoid-schizoid to the depressive position. Yet these unconscious levels, positions, parts or frames of mind are never dissipated, even after they have been made conscious.
Under specific conditions they re-emerge and take hold of both affects and deeds-within individuals or at a larger societal scale. This, I argue, is the state of mind created by the pandemic and the measures enacted to deal with it. It was furthermore a state of mind in which we all partook in differing degrees. This includes not only us psychoanalysts and our patients but also political and other elites working "at the front line." The paranoid reactions to the pandemic can also be traced at the microlevel of attitudes and reactions to individual measures. This is what I try to show below by way of the face mask, initially considered irrelevant for protecting against contamination, later affirmed as a core measure. The shift from one extreme to the other contributed to the confusion and frustration about the face mask at the conscious level. Unconsciously the concerns were rather more versatile. In a subsequent section, I address briefly the reactions to the vaccination programs.

| THE UNCONSCIOUS SIGNIFICATIONS OF THE FACE MASK
No other measure introduced during this pandemic has come to signify more potently the restrictions imposed on intimacy but also sexuality and free speech. The three domains are interrelated but also distinct and I suspect individuals (like patients) react variably to these, also depending on the extent to which they have been dealing with the pandemic from the paranoid or depressive position respectively. By itself, as already discussed, the pandemic has tended to exacerbate paranoid reactions especially during the early phase when still little was known as to its risks.
One typical reaction has been the complaint that the mask prevents one from looking at or seeing into people's faces in gatherings or in one-to-one encounters like the therapeutic session (when taking place in a sitting arrangement). People look at each other faces for cues to reassure themselves that they are being understood and not misunderstood, such unconscious mirroring representing a formative aspect of early infant development. But as we know from the psychoanalytic setting with the couch, where the patient is deprived from this form of communication, the face-to-face interaction also serves as a means of controlling the object and forms part of the mechanism of projective identification. People less capable of communicating their emotions verbally or of judging others' emotions from their verbal and acoustic utterances are more likely to feel deprived from this source of information than those with scanning systems that are versatile and not subject to repression. But even the latter will find one channel for the communication of affect cut.
In such a context, unconscious phantasies are likely to become reactivated, and these are mainly paranoid in character: May I trust the object to be positively inclined toward me is the question posed by the paranoid subject facing a masked object. The other common association to the mask as a muzzle expresses the same fear in reverse: one feels unable to speak one's own mind if masked and at the same time fears the masked others are likewise not speaking their minds. At a deeper, more unconscious level, the fear is that the masked state of mind deprives one of all defenses against persecutors and persecutory anxiety.
I think this is also at the core of conspiracy theories surrounding Covid-19. Such theories provide a narrative for containing the anxiety that emerges in connection with the coronavirus and the measures introduced to deal with it. In this connection, it is important to be cognizant of the fact that it is not the coronavirus alone but the virus in the context of the measures that drive conspiracy theories. This is a point that frequently goes missing in contemporary social and political discussions. Conspiracy theories have accompanied politics throughout history, and especially at times of social upheaval and weakened political institutions. Their real target is the state, or specific state institutions, that are judged unable to control risks, real or imagined, or worse, seen as propagating them. Conspiracy theories are also more likely to emerge when political institutions themselves make extended use of manipulative communication techniques to advance their agendas. In political jargon, this is today known as "spinning", the term signifying how political communication has been gradually transformed into political marketing. In former times it was more commonplace to talk about propaganda. 3 In an essay published in Harper's Magazine (1964), Richard Hofstadter, in his lifetime a professor of American history at Columbia University, explicitly referred to conspiracy theories as reflecting a "paranoid style". Such paranoid style is "an old and recurrent phenomenon in our public life", indeed a mentality representing "a persistent psychic phenomenon, more or less constantly affecting a modest minority of the population. But certain religious traditions, certain social structures and national inheritances, certain historical catastrophes or frustrations may be conducive to the release of such psychic energies, and to situations in which they can more readily be built into mass movements or political parties…". 4 People believing in conspiracy theories tend to displace their fears of the virus onto state institutions, turning fear into rage. In some cases, the rage also has the function of enabling its carriers to continue living nearly normal lives. Donald Trump is a prototype of such a person: himself a germaphobe, he has used conspiracy theories and the rage accompanying them as a container for his own paranoid anxieties and was consequently able to run his rallies in person, managing by way of this strategy to mobilize his supporters, who thought of him as a hero. According to Fintan O'Toole in a feature for The New York Review of Books (May 14, 2020), paranoia and the valorization of risk are "two contradictory impulses within the right-wing mindset" that have been successfully used in populist politics. 5 Other reactions to the mask have been less paranoid but no less interesting or informative. One regularly hears how while working in a home office there is less or no need to dress up-it suffices to be in jeans or a track suit-and many people welcome this as a positive aspect of the lockdown measures. Not all are of this opinion, however. Many miss the opportunity to dress and make up. For some patients still coming to therapy in person, the introduction of the face mask in the winter months, appeared to have a similar effect and was accompanied by a depressive or irritated mood swing. These patients felt deprived of something quite essential for their way of being.
Psychoanalytic theory, especially Freud's ideas on sexual symbolism, have informed fashion studies quite extensively. Less interest has gone into the role of dress in everyday life as well as in the context of the clinical setting, despite the rich anecdotal evidence on this. We all have had the experience at some point or another in the context of a clinical presentation of hearing ourselves or someone else ask what or how the patient looks, or how they dress, while out of the ordinary impressions mediated by colorful or shrill dress, remarkable hairdos, or being unkempt often make it into clinical reports notwithstanding the caution exercised by most analysts if and when advancing such statements considering the subjective but also cultural capital dimensions of taste and related impressions (cf. Bourdieu & Passeron, 2000[1970). What often is only remarked in silence-and rarely spoken about in publications-is how some patients demonstratively dress up-or indeed the opposite, that is, demonstratively underdress-when attending their analytic sessions. Such patients are likely to be unconsciously using dress (and make up) to relate to their objects. Seductiveness or rather the wish to seduce, lends itself as a useful explanation for this type of behavior, especially from a Freudian perspective, but Klein's interpretation of dress, also lending instruction for Joan Riviere's (1929) work on masquerade in connection with femininity, provides an alternative explanation. The two approaches are not contradictory but complementary. Writing about young women, Klein (1932, p. 191) notes how they experience "the adornment of her person and home" in phantasy as an act of reparation vis-à-vis their own body and the body of their mother at the same time. It is a behavior aiming to modify their sense of guilt for attacking the mother, again in phantasy, or wishing her dead, as well as their own persecutory anxiety linked to the unconscious conviction that the mother (or the analyst) will retaliate and attack them back. From this perspective, the seductiveness or allure of hysteric (wo)men is less symptomatic of their interest in the (fe/male) object but rather a protective armor, shielding them in phantasy from the object's attacks.
To return to the face mask. For these patients, the mask is experienced as depriving them of this defense mechanism, rendering them less pretty or attractive, and is, therefore, experienced as signifying exposure of their aggressiveness. By contrast, patients who systematically come unkempt to analysis, thus assuming in phantasy the dependent-masochistic position of the soiled child anticipating a cleaning or a beating, will experience the mask as this, that is, cleaning or beating, such inevitable enactment on the part of the analyst providing the opportunity, if recognized, to reflect on this aspect of the patient's personality.
My third lead on the unconscious signification of the face mask comes from popular culture. Sascha Baron, the British comedian and filmmaker known for his sexualized, vulgar, and politically critical films, recently launched a poster to advertise his new movie Borat 2 showing himself wearing a mask in the form of a bikini, that is, to say a mask bikini covering his penis. This poster is one of the few media outputs to have been explicit about the coronarelated health risks linked to sexual intercourse. While Covid-19 is not a sexually transmitted disease, sexual intercourse does represent a risk due to the impossibility, when engaging in it, to uphold physical distancing. Prostitution as well as online dating are therefore directly impacted by the restrictions related to the pandemic and explain one widespread phenomenon during this time, namely what I call monogamous dating: many single people have during the pandemic sought out so-called corona partners to share house and bed during the lockdowns and maybe for longer. 6 It would even seem that individuals, who otherwise have been quite inhibited with respect to either dating or going steady with someone, have apprehended in the lockdown measures a possibility to overcome their resistances and make a new start. 7 Whether these relationships can be sustained in the long-term, that is, under normal conditions, remains to be seen.
In this case, the face mask stands for that that is not explicitly talked about during the pandemic, in other words, sexuality. It is an interesting omission considering how our societies pride themselves with respect to sex education, enlightenment, and liberal values. I am here referring to Western societies especially, where also the opposition to the face mask has been greatest. In this light, such opposition could be understood as fueled by the unwillingness to comply with restrictions imposed on sexuality, and, especially, sexual promiscuity. But I think another aspect is even more telling, namely the conspicuous avoidance to address this issue explicitly while at the same time showing little shame and no inhibitions when otherwise intruding into peoples' private lives, including into such vital domains like the play of children, providing emotional support to the elderly living in care homes, going to Church, or attending funerals. I am not suggesting here that the state should prescribe to people how to live their sexual lives; but pointing to the fact that the only domain that has survived the state's inroad into privacy during this pandemic, at least at the level of narrative, has been sexuality. This is not necessarily proof for the sexual liberation of modern societies. I think the opposite is the case, and modern individuals remain sexually inhibited and perhaps even prudish despite the extreme sexualization of Western culture. This may explain the severity of the narrative accompanying the restrictions otherwise. In other words, because inhibitions surrounding sexuality prevail, we resort to a severe super-ego when related anxieties are actualized (as in a pandemic), but insofar as this ambivalence is unconscious, the object of wrath of the super-ego is displaced at the moral level (cf. Freud, 1908Freud, , 1924. Thus, sexual curiosity is gratified and at the same time repressed.
To conclude, the face mask has become a symbol, in some cases a reification, for anxieties and the defenses against these. These are not directly or even primarily linked to disease or contamination, and the virus as such.
Rather the pandemic activates the fear of death and annihilation-material and social-and calls forth persecutory anxiety and guilt. Under specific circumstances, such anxiety can undermine the capacity to comply with measures implemented to address the health risks associated with the pandemic.
As this article was being written, vaccination against the novel coronavirus was slowly being launched in several countries around the world. The vaccination plans announced at this stage foresaw a near-total population vaccination by the middle or the end of 2021, whereby most countries did not go as far as enforcing compulsory vaccination. This is in part due to the anticipated production bottlenecks, but it also reflects the concern that a compulsory vaccination program would aggravate the already-existing negative mindset regarding vaccines that currently prevails in many countries despite the role of vaccines over the last two centuries for fighting infectious diseases in children and in adults, thus increasing life expectancy. In an article for Encyclopaedia Britannica, Emily Brunson writes that this mindset has two origins: first, claims that vaccines are responsible for certain conditions such as autism or inflammatory bowel disease as a result of a mercury-containing compound used as preservative in some vaccines-"those claims have been discredited", she adds-and second, that "most individuals in countries where vaccination is widespread have never personally experienced vaccine-preventable disease … the focus of concern [shifting] from the negative effects of vaccine-preventable disease to the possible negative effects of the vaccines themselves". 8 I would add that the sense of complacency exhibited by many governments in this field, resulting in less attention paid to durable and targeted raising-awareness measures, has aggravated these concerns, facilitating their spread to larger segments of the population.
The fears regarding the Covid-19 vaccines as reported by patients are of three sorts. First, there is an egosyntonic supposedly rational fear concentrating on the little time available for testing the vaccines. This goes together with a certain unwillingness to understand the particulars of the scientific method. This fear exists sideby-side with a more instinctive aversive reaction toward presumed greedy-for-profit pharmaceutical companies. At the more concrete level, frequently occurring mostly harmless side-effects are feared equally as rarely occurring serious outcomes.
Such opinions are to be found across population strata. In some countries, they are quite widespread even among medical professionals and nursing personnel. Trying to make sense out of such fictional constructs is unlikely to be effective; likewise trying to speak sense into those cathecting such constructions with the power of belief. In psychoanalysis, we are often confronted with such constructions and know how long it takes to decode them, even longer to undo them. Yet, as we also know from psychoanalysis, it is sometimes useful to speak to the underlying emotions of fear and, especially, mistrust. As already noted at the beginning of this short article, the pandemic state of mind is characterized by paranoid anxiety and the supremacy in phantasy of a primitive and harsh superego. To the extent that institutions in charge of implementing strategies to fight the pandemic come to resemble this harsh superego by making use of narratives that incite and feed paranoid anxieties, we may anticipate declining compliance with measures, especially over time as fatigue sets in, undermining natural risk aversion behavior. Against this background, even seemingly innocent catchphrases like "it is not a political statement" are counterproductive. The (conscious) objective of this specific motto has been to encourage individuals across political divides to wear a face mask and to underline the importance of national unity and collaboration in times of crisis. After all, it is claimed, the virus does not differentiate between Republicans and Democrats, left and right, black and white, heterosexuals and homosexuals, old and young, or rich and poor. Leaving aside that this latter statement is not true-the virus does affect some individuals and some groups more than others for a variety of reasons-once a certain object has assumed either a political or a psychological meaning and comes to stand for something, this linkage will not disappear by invocation.

| BY WAY OF CONCLUSION: THE CHALLENGE FOR POLITICAL COMMUNICATION
The invocation rather confirms that the discourse is toxically politicized and may be experienced by opponents as a provocation.
It is useful to recall how, often, less is more. This applies equally to the media. The reporting about Covid-19 during the last year has assumed exaggerated proportions and has been characterized by repetition compulsion focused on few benchmark data mostly presented out of context, providing little breakdown or differentiation.
Even otherwise serious media channels have tended during this time to highlight the imminent dangers of contamination and death. At first, this type of communication may have been driven by genuine panic among journalists and politicians alike. Later, it increasingly came to be based on a certain assumption about citizenry, namely, as a (consuming) public, the idea being that only by way of repetition or overstatement it is possible to catch and hold this public's attention thus ensuring compliance with recommendations. In this context, the borderline between risk communication and fear mongering quickly becomes blurred and communication ends up aggravating rather than containing the paranoid anxieties the pandemic gives rise to. At the same time, it distracts attention away from the public policy mishaps and structural deficiencies exposed (not created) by the pandemic.
It is important in the realm of politics to attend to the fact that a pandemic will give rise to paranoid and persecutory anxieties in many population segments and even among professionals. The role of politics is to contain and manage these anxieties, not to mirror them either by way of hyperbole recognition or by way of denial-two sides of the same coin. Central to a risk management strategy is maintaining a working environment of containment and cooperation across different institutional levels, internationally, regionally, as well as between social and political institutions and between science, media, and society. Only this paves the way for overcoming the real hardships of this crisis as well as for mourning for that and those lost. The role of political communication is to impart complex information and avoid oversimplifications. By implication, this means refraining from treating individuals and groups as a public to be alarmed, pacified, or entertained. Instead, they must be acknowledged as a collective of citizens that are inclined and able to receive and process knowledge, despite being at the same time or for a period of time prone to madness.

Liana Giorgi
https://orcid.org/0000-0002-7894-6686 ENDNOTES 1 For a clinical case demonstrating this dynamic, see the paper by Claudia Frank "Therapeutic Zeal versus Epistemophilic Enquiry in Corona Times," presented at the UCL Conference "Contagion, Containment and Staying Connected: A Virtual Conference," 27-29 November 2020, https://www.ucl.ac.uk/psychoanalysis/events/2020/nov/contagion-containmentand-staying-connected 2 In Civilization and its Discontents, Freud elaborates on the distinction between the sense of guilt that is unconscious, the consciousness of guilt, conscience and remorse-referring to Melanie Klein's work in this connection. There are two origins for the unconscious sense of guilt: "one arising from fear of an authority, and the other, later on, arising from fear of the super-ego. The first insists upon a renunciation of instinctual satisfactions; the second, as well as doing this, presses for punishment" (Freud, 1930, p. 128). This sense of guilt leads to a feeling of remorse that exists regardless of whether a deed has been committed or just thought about: "Whether one has killed one's father or has abstained from doing so is not really the decisive thing. One is bound to feel guilty in either case, for the sense of guilt is an expression of the conflict due to ambivalence, of the eternal struggle between Eros and the instinct of destruction, or Death." (p. 132). The description matches the pandemic state of mind quite well. 3 As such, it was criticized already in the 1940's by George Orwell (Nineteen Eighty-Four: A Novel, 1949) and in the 1960's by Herbert Marcuse (One Dimensional Man, 1964). A more recent fictional commentary on conspiracy theories is Umberto Eco's book, The Prague Cemetery (2011). This brilliantly captures the toxic dynamics between the political and the social that underpins the emergence and diffusion of conspiracy theories. The book's main character Simone Simonini makes his living by forgery, spying, and the production of false documents-today we would say fake news. This he does for all political governments of his time: the Italian, the French, the Prussians, and the Russians. Umberto Eco's character has never existed as a real person; the subject matter of Eco's book rather is to show how the fabrications weaved into ideological movements in the 19th century, leading onto the atrocities of the twentieth, were interconnected and often made use of similar sources or narratives. 4 See https://harpers.org/archive/1964/11/the-paranoid-style-in-american-politics/, last accessed December 30, 2020. 5 The feature by Fintan O'Toole also refers to Trump's germaphobia, something he himself talked about in his first press conference as president-elect in 2017. See https://www.nybooks.com/articles/2020/05/14/vector-in-chief/, last accessed 10 April 2021. 6 The Austrian Chancellor, a young man himself, explicitly encouraged this at the onset of the Winter lockdown, albeit without mentioning online platforms explicitly. 7 An interesting clinical case on this has been explored by Jane Milton in her paper "Love, persecution and reparation during the pandemic" presented at the UCL Conference "Contagion, Containment and Staying Connected: A Virtual Conference," 27-29 November 2020, https://www.ucl.ac.uk/psychoanalysis/events/2020/nov/contagion-containmentand-staying-connected 8 https://www.britannica.com/science/vaccine/Benefits-of-vaccination#ref324475 (last accessed 19 January 2021).