Cabin Fever

Surviving Lockdown in the Coronavirus Pandemic

Paul Crawford, Jamie Orion Crawford

• Publisher: Emerald Publishing Limited
• Year: 2021
• ISBN:
  9781800713543
• Topic: Medicina
• Subtopic: Psiquiatría y salud mental

This fascinating and timely book examines the distressing psychological syndrome of 'cabin fever' in the wake of the coronavirus pandemic and the greatest confinement of people to their homes in history, offering antidotes for it. Exploring the definitions and social and cultural history of cabin fever, a condition provoked by prolonged isolation, the book will be of interest to anyone concerned about the impact of current or any future pandemic lockdowns, prison life, remote living, or even travelling to Mars.

1

THE GREATEST CONFINEMENT IN HISTORY

This short book discusses the origins, definitions, social and cross-cultural history of the popularly framed condition of cabin fever in relation to what became the greatest confinement in history resulting from the coronavirus pandemic in 2020 (henceforth simply referred to as ‘the pandemic’) as governments imposed lockdown measures – e.g. quarantines, stay-at-home orders, shelter-in-place orders, shutdowns and curfews – to slow the spread of the virus. Indeed, it is estimated that around 4.2 billion, 54% of the global population, were subject to complete or partial lockdowns at the height of the pandemic (IEA, 2020). The book also examines creative individual and community responses to mass enforced isolation in its various forms. In the former, engagement and relationships may be limited, or at best, achieved only in virtual contexts such as through social media. For groups or communities, direct, physical connection presents a different challenge, not least achieving distance from others or wanting a break from them.

The notion of cabin fever and related terms, such as going stir-crazy (derived from the use of stir to mean ‘prison’), has emerged in media representation and raises the very real question of how strongly this features in the current pandemic (Henley, 2020; Kanthor, 2020; Sims, 2020). In an anecdotal report on early lockdown measures, British tourist Peter Grantham commented:

We were also worried about people's mental health. People had been there for a month. And it was a bit of like, kind of, cabin fever I could see happening to a few individuals on site.

(Grantham, 2020)

Are people losing their minds during the great confinement? Are they suffering from cabin fever, going stir-crazy and, if so, how is that evident? How are people managing in the confines of their homes, however large or small, whether in apartments or houses with gardens for weeks, if not months, at a time? Which is worse, to be left on your own at this time or subject to close quarters with other cohabitees, whether members of family, friends or even strangers? These and many other questions need considering if we are to begin to determine how far the concept of cabin fever applies in this case.

During the writing of this book the first author remained in lockdown in a detached urban house with access to a garden in the United Kingdom, with his two younger children staying with their mother and his wife stranded in Taiwan. His son, the second author, took to a remote cottage along the Ottawa River in Canada with his partner who captured their isolation in a painting. In the image, the cloned, replicated images of themselves appear to form a community against a wintry desolation (Fig. 1.1).

Fig. 1.1. ‘On Ice’ by Andrea Wilkin.

Families around the world found themselves within a single dwelling or living separately in different accommodation. The lived circumstances for individuals, families and non-family groups in this period has been diverse, but all those subject to the great confinement, being told stay at home and follow social distancing rules, would have likely experienced a tension between indoor and outdoor life, making difficult decisions based on their work and the need to shop for food, exercise or support others to leave the perceived safety of their homes. In normal circumstances, except perhaps in war zones or areas of high crime, people would have passed back and forth across the threshold of their dwellings without a second thought. In the ravages of the pandemic, each domestic threshold became a borderland of decisions and risk. The outside, social world of the rampaging virus became a palpable and very real threat. Many would have experienced the kind of hesitancy between entrapment and escape conjured up in Holly St. John Bergon's poem Cabin Fever (2009). In her poem, she captures the tension between a call to leave and desire to stay, between the threat of both interior and exterior spaces (Fig. 1.2).

In cabin fever dreams, I've lost my way.

The wind sighs, Leave, and opens wide the door.

Although I want to go, I think I'll stay.

Source: Kwh1050 / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0); https://upload.wikimedia.org/wikipedia/commons/3/35/Piccadilly_Circus_station_during_London_COVID-19_lockdown._Sign.webp.

Fig. 1.2. Stay at Home: Piccadilly Circus Station during London COVID-19 Lockdown.

Never before in human history have so many people been confined to their homes as they have been with the outbreak and spread of the pandemic in 2020, all experiencing the uncomfortable threshold palpable between the inside and outside in Bergon's poem. In this bicentenary year of one of the greatest contributors to public health, Florence Nightingale, billions of people faced an unprecedented scourge that left them self-isolating in their homes through either personal choice or the mandates of state governments globally (Sandford, 2020).

Preventing contagion at home and in hospitals, alongside championing public sanitation and the use of statistics to track disease and mortality, had been at the heart of Nightingale's work. She also suffered prolonged periods of seclusion at home for much of the rest of her life after contracting brucellosis from infected milk while attending to wounded soldiers from the Crimean War (1854–1856). That said, the greatest part of Nightingale's scholarly and epistolary efforts to improve public health were achieved while housebound, as an invalid working from her bed (Crawford, Greenwood, Bates, & Memel, 2020). Her productivity over many years was remarkable despite the confinement that many in lockdown have experienced. She did not find being a prisoner at home at all easy despite the luxury of receiving financial support from her wealthy father. In a draft letter to the crown princess of Prussia in 1861, she writes:

I have passed the last four years between four walls, only varied to other four walls once a year; and I believe there is no prospect but of my health becoming ever worse and worse till the hour of my release.

(McDonald, 2011, p. 621)

Two hundred years after Nightingale's birth in 1820, governments around the world are revisiting her substantial public health efforts, not least in advocating hand-washing and ventilating accommodation to reduce contagion, in their own response to the current pandemic. Voluntary and involuntary sequestering in people's homes, alone or with family members, friends or even strangers, to halt the spread of the virus and the impact on limited health services has provoked anticipation across all major organisations and bodies, not least the World Health Organization (WHO, 2020), as to the mental health challenges of this radical social change. As Holmes et al. (2020) note, social isolation and loneliness are ‘strongly associated with anxiety, depression, self-harm, and suicide attempts across the lifespan’. Furthermore, the authors point out that isolation is exacerbated by the ‘entrapment’ brought by the social distancing initiatives to deal with the pandemic. For those confined to apartments this seclusion was particularly challenging. Some relief could be found on balconies as in the following image from Belgrade, Serbia (Fig. 1.3).

Source: Contemporary photography: "COVID19 on Belgrade streets" by SaraRistic is licensed under CC BY-NC-SA 2.0. https://search.creativecommons.org/photos/a7f5466a-01dc-4715-a7cc-dbafcd90aa9b.

Fig. 1.3. Lockdown.

SOCIAL ISOLATION

Social isolation can be defined as ‘a deprivation of social connectedness’ or ‘the inadequate quality and quantity of social relations with other people at the different levels where human interaction takes place (individual, group, community and the larger social environment)’ (Zavaleta, Samuel, & Mills, 2014, p. 5). Such isolation can be considered to provoke or lead to the distressing emotional state of loneliness (see Hawkley & Cacioppo, 2009). There have been a number of scholars down the years who have examined multiple aspects of social isolation and loneliness. David Riesman in his book The Lonely Crowd (1950) marked a weakening of autonomy in American society as people became more other-directed or obsessed, with popular culture replicating the ‘crowd’ and offering a way to escape the ‘terror of loneliness’ (p. 170). In a further critique of the individualism and isolationism of American society in his book The Pursuit of Loneliness (1970), Philip Slater flagged up the dangers succinctly in a short ‘cabin fever’ story as a preface which starts:

Once upon a time there was a man who sought escape from the prattle of his neighbors and went to live alone in a hut he had found in the forest. At first he was content, but a bitter winter led him to cut down the trees around his hut for firewood. The next summer he was hot and uncomfortable because his hut had no shade, and he complained of the harshness of the elements.

(p. 21)

His isolation brings increasing losses, not least in social perspective. He ends up shooting at intruders and blows off his own foot while sleeping with his gun. In Bowling Alone (2000), Robert D. Putnam extends this concern for the dangers of individualism over community bonds and, more recently, Sherry Turkle interrogates in Alone Together (2011) the risk of technologically mediated social interaction, its illusory companionship, and paradoxical heightened connectivity at the same time as increased solitude and loneliness. In the pandemic, the parameters and, indeed, balance between the individual and community, togetherness and loneliness, and online and offline contact are being revisited. Individual isolation or even the softer realm of solitude is being placed under a durative stress test.

According to Wang et al. (2017) social isolation can be determined and measured in terms of the quantity, structure and quality of an individual's social networks and by appraisal of their relationships from emotional and resource perspectives. We may think of resources in terms of individual or ecological social capital or the assets or supports people have access to in themselves or out there in ‘society’. A lack of these can damage mental health, not least in depression and suicide. Whereas access to such assets can support or enhance psychological well-being.

MENTAL HEALTH

The burden of mental distress has been endemic to humans long before the emergence of the pandemic. Mental distress, or illness, accounts for the second biggest threat to our financial and social stability behind cardiovascular disease (Centre for Mental Health, 2010; WHO, 2005; Wittchen et al., 2011). In the United Kingdom, mental health has been advanced as pivotal to health overall with the slogan ‘no health without mental health’ (Department of Health, 2011). For many years now social isolation and social exclusion in societies worldwide have been a cause for concern. Many people feel they no longer belong to a community (Griffin, 2010). Isolation and loneliness appear to be on the rise (Gierveld, Tilburg, & Dykstra, 2018). As indicated by Holt-Lunstad, Smith, and Layton (2010), social isolation leads to higher premature mortality, not least suicide. Importantly, mental health deteriorates with social isolation (Elovainio et al., 2017) and quarantine (Brooks et al., 2020); it often accompanies mental illness (Beutel et al., 2017) and should be further investigated in the context of the pandemic (Durcan, O'Shea, & Allwood, 2020).

Research on the fallout of social isolation adding to the burden of mental health began in earnest around the world in the early months of the pandemic. For example, there have been studies and reports emerging from the United Kingdom (Allington et al., 2020a; Cowan, 2020; Holmes et al., 2020; Marsh, 2020), United States (Li & Schwartzapfel, 2020; Taub, 2020; Well Being Trust, 2020), China (Allen-Ebrahimian, 2020; Li & Gang, 2020; Liu et al., 2020; Xiang et al., 2020), India (Varshney, Parel, Raizada, & Sarin, 2020), Australia (Department of Health, 2020), Brazil (Serafim, Gonçalves, Rocca, & Neto, 2020; Zhang, Wang, Jahanshahi, Li, & Schmitt, 2020), Russia (Gritsenko et al., 2020; Sorokin et al., 2020), Ghana (Gyasi, 2020) and South Africa (Joska et al., 2020). These reveal increased fear, anxiety, depression, loneliness, violence, suicidal thinking and suicide rates.

The magnitude of the impacts appears substantial. For example, Varshney et al. (2020) during the initial stages of the pandemic in India found that around a third of respondents had endured a significant psychological impact. In the United Kingdom, Allington et al. (2020a) in their survey found that 49% were more anxious or depressed than usual, 38% slept less or less well, 35% had eaten more food or less healthy food than normal, 19% drank more alcohol than normal and 19% argued more with their family or housemates than normal. Of particular concern has been the impact on harmful behaviour of suicide and self-harm. This impact is highlighted in early reports from the United Kingdom and United States (see Holmes et al., 2020; Marsh, 2020; Well Being Trust, 2020). A study at University College London, for example, found that 18% of people surveyed in the United Kingdom alone had considered self-harming or killing themselves during lockdown (Marsh, 2020). Even though this survey was self-selecting and promoted by UK Research and Innovation, such indicative figures are worrying.

Another particularly dark consequence to the enforced isolation of lockdown featured in early research has been increased domestic violence (Li & Schwartzapfel, 2020; Taub, 2020) which chimes strongly with the phenomenon of cabin fever. In Christensen's early article on cabin fever (Christensen, 1984), domestic violence is noted as a possible indicator of the condition. Indeed, forcibly ‘isolating a person from family and friends’ is a tactic commonly used by batterers to establish control and facilitate abuse (WHO, 2012). For women and men subject to domestic violence the experience of cabin fever will be as much about seeking relational escape as that of spatial release.

However, Gunnell et al. (2020) argue that this is not inevitable given national efforts at mitigation. Also, while cabin fever may be a highly plausible driver for increased rates of depression, anxiety and self-harm, other indirect stressors are known such as general economic uncertainty, increased levels of domestic violence as noted above or abuse of children at home. Allen-Ebrahimian (2020) flags up a domestic violence epidemic in China following its lockdown. This corollary of confinement at home is evidenced globally (Graham-Harrison, Giuffrida, Smith, & Ford, 2020). In a most tragic case, two young children were stabbed to death by their father (Karim, 2020). As yet we do not know how far mitigating actions will fully address the mental health challenges of the lockdown. Many commentators are not as sanguine as Gunnell et al. (2020) on this matter. For example, Gregory (2020) reports on how a large number of people are expected to require help following the pandemic in recovering from anxiety, depression and post-traumatic stress disorder.

The likelihood of a significant mental health fallout from the pandemic is further indicated with data emerging only seven weeks into lockdown in the United Kingdom by the mental health charity Sane who reported a 200% increase in calls to their helpline, many of whom were first-time callers (Vincent, 2020). This, among other similar reports, suggests that the isolation behind closed doors is resulting in what, as a folk term, we call cabin fever. A survey that tracks the mood of around 2,000 Britons weekly indicated a significant rise in boredom and fear and a commensurate fall in happiness during lockdown (YouGov, 2020). A Kings' College study identified three groups reacting t...

Table of contents

• Cover
• Societynow
• Title
• Copyright
• Dedication
• Contents
• About the Authors
• Acknowledgements
• 1. The Greatest Confinement in History
• 2. A Brief History of Cabin Fever
• 3. Cabin Fever Cases
• 4. Antidotes to Cabin Fever
• 5. Conclusion
• References
• Index