‘SYNDROME DE L’ESCARGOT’

As lockdown eases and socialising beckons, many of us are wondering how to reconnect. We have spent so much time alone that many of us have forgotten how to be with other people. And it is making many of us anxious.


The Spanish call it the ‘síndrome de la cabaña’ (the syndrome of the hut or cabin). The French prefer the ‘syndrome de l’escargot’ (the syndrome of the snail). We English favour the less poetic ‘re-entry syndrome’, or ‘reverse culture-shock’. Whatever the name, feeling nervous as we emerge from our shells or cabins to re-enter the COVID world and re-engage with other people is real.


At first, this concern might seem counterintuitive. Surely we should be celebrating the easing of lock-down, being reunited with friends and returning to our offices and jobs, for those of us lucky enough to have them still? Yet it turns out that this exact moment can coincide with heightened anxiety.


The concept of ‘re-entry syndrome’, or ‘reverse culture shock’ as it is also known, dates to the early 1960s. Two US psychologists, John and Jeanne Gullahorn, observed that after extended periods of travel, those returning home experienced downs as well as ups, readjusting to what was once familiar.


Explorers and expeditions returning from the Antarctic were a case in point. This readjustment is understandably more challenging for those who have experienced some kind of trauma while away - soldiers returning to civvy street from a war-zone, aid-workers returning home or anyone coming out of prison.


Until now, psychological distress about this kind of readjustment has affected relatively few of us. Now it is something with which we are all grappling to a greater or lesser extent, according to Carmine Pariante, Professor of Psychiatry at King’s College London.


He says: “Although most of us have not experienced such geographically remote isolation or traumatic experience, we can’t underestimate the impact that lockdown and social isolation have had on us”.

Pariante says there are many reasons for the dip in our mental wellbeing throughout this period and why we might find it difficult to re-engage with others. “Some of our experiences during the lockdown might have included enhanced time for introspection, a shift in our life priorities, and practical changes in our work situation. Moreover, some of us might have experienced the true trauma of losing someone dear to COVID.”


He continues: “All of this has changed each of us, so that we are no longer exactly the same person that we were before COVID: this is the core feeling underpinning re-entry syndrome.”


Kristen Gygi, an American therapist, says that although we are constantly changing, this period has accelerated this process. “Why is it hard to go home again, after visiting the Artic? Because you are not the same person you were when you left. In fact, you are not the same person you were yesterday, even if you never left your home. But a great adventure is likely to trigger quite a shift.”


Re-entry can be challenging for three reasons. First, there is a generic feeling that we have to a greater or lesser degree been changed by COVID and that we are navigating a new and foreign land. Second, some people are anxious because they experience a lurking worry of catching or spreading COVID, despite the vaccination programme. This is especially true of those with a fear of germs, or OCD. Finally, we have fallen out of the practice of socialising. We can find it difficult to reconnect. This is particularly true for those with social anxiety.

One answer to all these feelings is ‘exposure therapy’, the gold-standard treatment for many anxiety disorders. This means confronting sources of fear safely, so in our new normal, masked and socially distanced. The key is to expose yourself gradually to more challenges little by little – an approach that has been shown to be an effective treatment for many types of anxiety disorders.


James Arkell is a Consultant Psychiatrist working at The Nightingale Hospital in London. He says: “Exposure therapy taps into a very basic function of the human brain. We very quickly make associations between things, like Pavlov’s dog (he rang a bell every time he fed the dog and soon just ringing the bell on its own made the dog salivate in anticipation of food). This is called classical conditioning. If you close your eyes and visualise sucking a lemon, you will feel your salivary glands tingle!”


For exposure therapy to work well, Arkell says: “You need to stay out of the house long enough for the anxiety to fade so that you can make a new positive association between relaxation and being out of the house. It is all about the way our brains make associations.”


The alternative to exposure is avoidance. When we avoid what we fear we can feel temporary relief. The problem is that we feel the anxiety more keenly the next time we confront what worries us.

We are all adjusting to this new normal. Slowly, we are beginning to venture out again: the first coffee in a café; the first socially distanced gathering of friends; the first meeting back in an office. But like snails, and given all we have been through, we are allowed to take our time to emerge from the cabin.


Rachel Kelly is a British writer and mental health advocate and member of the Speakers Collective. Her latest book is Singing in the Rain: An Inspirational Workbook

https://amzn.to/2QlqI8p


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