Syndemic Syndrome and the New Now
Zachary Green
Do not be daunted by the enormity of the world’s grief.
Do justly, now. Love mercy, now.
Walk humbly, now. You are not obligated to complete the work,
but neither are you free to abandon it.
-The Talmud — attributed to Rabbi Tafron
When Merrill Singer, a medical anthropologist out of the University of Connecticut, coined the term syndemic in the 1990’s, her prescience could not have been more precise for finding a single word that envisioned the turbulent times of 2020. A syndemic is the concurrence of multiple epidemics that interact to amplify the effect of each. Dr. Ellis applied this thinking to research that revealed HIV and tuberculosis often form a syndemic. When the immune system is weakened by HIV, it increases the risk for TB. These disease processes are further exacerbated by the social conditions of vulnerable populations. Those with limited access to health care, unsanitary living conditions, and close proximity of inhabitation face factors that contribute to an accelerated rate of devastation from the multiple contagions. According to an article by Jason Daley in Smithsonian Magazine those who are refugees and migrants, as well as those who are imprisoned and live in poverty are particularly likely to experience the perils of a syndemic.
The New Now of a Syndemic
The rest of us are not immune to the current syndemic. While it is well-documented that the coronavirus is especially lethal to the elderly and those with underlying health conditions, the death rates among African American, Latinx, and Native American groups point to socio-historical patterns of oppression playing a role in the pandemic. Given the disproportionate presence of obesity, diabetes, and cardiovascular disease in these same populations, coupled with marginal healthcare and minimal economic security, the conditions for a syndemic are met and have been devastating.
Yet, this syndemic is not stopping in black and brown communities. Multiple vectors of experience that impact a range of populations accompany the coronavirus pandemic. What makes these conditions a syndemic is the different factors that are combining as a system to create misery and suffering for millions upon millions. Further, the synergy of symptoms often have seemingly unique faces and phases depending on where the syndemic is centered. As a consequence, the current syndemic takes on more of the character of a syndrome because of the multiplicity of its expression. What is common irrespective of location or population is that the syndemic leads to a significant decline in health and well-being, is fueled uncertainty and volatility, and results in a pronounced susceptibility and potential lethality of social, emotional, and physical disease processes.
Syndemic as a Syndrome
The syndemic as a syndrome is already touching all of us. We are in this moment — together. More specifically, what is termed the Syndemic Syndrome begins when we are being impacted directly or vicariously by one or more of the global disruptive processes that are happening right now. The symptoms physical, social, emotional, economic, spiritual, political, and environmental. What makes this moment a Syndemic Syndrome is that these disruptive processes are being experienced in mutative multiplicity and chaotic complexity all at the same time.
Characteristic of the early state of the Syndemic Syndrome is a wish to simplify what is going on so as to create an illusion of certainty, to imagine a return to normalcy, and wish to will into existence a definitive end point to these disruptions and the corresponding devastation. Understandably, we seek to do anything but that allow ourselves to apply the fullness of our awareness to what we are all facing — but face it, we must. This largely psychological defense serve us well so as not to be overwhelmed by the current circumstances.
Unfortunately for us all, the Syndemic Syndrome disrupts the tightly bounded ring around our circle of influence. As our personal and social defense erode under the constant rush of the syndemic, we are more prone to flooded in a variety of ways, emotionally and physically. If we have even a modest level of compassion for the wider circle of concern that now engulfs us all, we may begin to notice our emotional resilience begin to collapse.
Under the weight of worries about the state of the world and abundant evidence of existential threat, a symptom of the Syndemic Syndrome is a constant yet previously uncharacteristic experience of being on edge. By its nature, a Syndemic Syndrome is present when the potential of contracting something symptomatic in some way is all but a certainty. The defense of denial then comes crashing down upon us as we descend into doubt and depression about when and if the state of things as they are will come to an end.
Yet, when that “end” does not come — when the syndemic morphs before our eyes and presents itself in yet another noxious and toxic form, our fear of succumbing to the syndemic in one or another of its presentations is no longer hypothetical. The urgency is real. The threat to life is real. These words, while likely unsettling, are not hyperbole. It is our current reality.
Nature of the Syndemic Syndrome
The Syndemic Syndrome is more like a tsunami. Though the ground below us has already quaked, we may not yet be ready for the torrent that approaches or the subsequent wake. In more concrete and less metaphoric terms, we see the Syndemic Syndrome in:
- The ongoing impact of the coronavirus pandemic nationally and globally; especially given the relative absence of unified and aligned strategies to stem the spread of the disease
- Intermittent but persistent social unrest ignited by an awakening to systemic racism; extending to other protests and clashes globally against oppression and extremism
- Evidence of an ever-increasing wealth divide that is exposing greater economic inequity; placing the most marginally employed in great vulnerability on various dimensions of social determinants
- Mental health issues that are increasing as the capacity to cope collapses. Issues such as loneliness, loss of touch, loss of boundary between personal and occupational life are leading to increased interpersonal agitation, anxiety depression, and addiction. In extreme cases a sense confinement and perceptions of an assault on personal liberty are contributing to a dramatic increase in alienation, homicide and suicide.
- Polarization amid political uncertainty that serves to fuel intense animosity and acrimony; threatening to undermine core principles of democracy and rule of law
- Unchecked erosion of global climate change agreements that place in jeopardy collective efforts to avert the catastrophic impact of human activity his having on life on the planet; revealing generational divides on priorities and urgency for action
- Personal and professional dynamics that are exacerbated and impacted by any combination of the above; dealing with vulnerability to the disease in our immediate circle, homeschooling support for our children while attempting to maintain a precarious job; facing our own attitudes on race and our place in such conversations; finding time for ourselves to find ourselves; needing physical tenderness and touch; caring for the planet as our common home.
Syndemic Syndrome Symptoms
The Syndemic Syndrome is more than being or having been diagnosed as COVID-positive, though it may begin there. By its nature, any combination of the above vectors of experience can yield symptom patterns in us ranging from subtle to severe. Those who have a history of trauma of any form may be more vulnerable and disproportionately predisposed to experience symptoms related to the Syndemic Syndrome. Yet, none of us are immune.
The hypothesized symptoms of the Syndemic Syndrome appear when there is an erosion of the normative physical immunity and emotional coping threshold. Unfamiliar patterns of unhealthy functioning in relating to self, others, and the environment are evident. We are likely experiencing the Syndemic Syndrome when two or more of the following conditions are present:
- A past or present diagnosis of the coronavirus and/or underlying conditions where contracting the virus is potentially more lethal
- Direct or indirect trauma related to and/or activated by systemic racism and/or other experiences of social oppression
- Persistent anxiety and/or depression or increased addictive behavior and/or substance abuse not directly attributable to sources other than the conditions imposed by coronavirus restrictions and/or direct vicarious identification with the sources of social unrest
- Stress related to employment and economic uncertainty over a period of two or more weeks that strains the capacity to cope
- Pervasive sense of ill ease, listlessness, ennui, indifference, inertia, and/or depression and hopeless that lasts for more than one week
- Recurrent vague physical symptoms that are atypical yet do not reach the threshold to seek professional care
- Strained interpersonal relationships and/or a steep decline in occupational functioning; including furlough and unemployment
- Spiritual crisis of purpose and/or loss of faith and hope; characterized by indifference and inertia on issues that were previously imbued with meaning and were the source of energy and passion; akin to but not limited to compassion fatigue
- Return of the repressed, where old unresolved issues and difficult memories that may or may not reach the threshold of being traumatic rush into consciousness; made more available by the erosion of defenses and range issues being managed psychologically all at once.
- Perception by others of a change in character and/or personal recognition of dramatic shift in mood; including but not limited to thoughts of self-harm or harm to others
- Overwhelming worry about the state of the world and/or the health of the planet; persistent and pervasive sense of dread; ongoing experience of existential threat
While these may be among many of the manifestations of the Syndemic Syndrome, these symptoms are not exhaustive. What is most important is for us to learn how the Syndemic Syndrome is living in us and through us in these times. We all likely feel many of these symptoms. The challenge of it being a syndrome is that we are likely having some combination of experiences concurrently. The symptoms become conflated whether or not we are consciously aware of it or dare to admit it. Yet, when we do dare and stare right at the reality through eyes of compassion, we see ourselves, we see each other, and we realize we are not alone. It is when we are earnestly able to see that we are in this moment together, then there is hope — then we can cope.
Calling to Consciousness
In the Syndemic Syndrome we encounter various combinations of complex, chaotic and caustic realities. Our role is to see the world as it is right now. We are invited to a call to consciousness. Our role is to see our place in the world right now-a precarious present moment where we stand on a perilous precipice. We each have work to do; not some of us, all of us. Persistence and resilience are needed as never before. Compassion for ourselves and others is a must. The option of being other than engaged with care for self, care for others, and care for the planet is not an option. We have a calling to embrace this new now. We must actively abandon any abdication of accountability to one another. In this syndemic we are called to contribute to the healing of the whole.
When we have the resources and capacity to do so —
When we have not succumb nor are currently consumed by the syndemic ourselves —
When we are ready and steady, we must find our part to do just.
It need not be much, but what we can do, we must.
Just is enough.
