‘Look Out for Changes in Behaviour’: Encephalitis Lethargica and COVID-19

Kate McAllister reflects on parallels between COVID-19 and the early twentieth century epidemic of Encephalitis Lethargica

Over the last eight months, COVID-19 has become associated with a growing list of long-term problems and symptoms, feeding into the emergence of the ‘patient made’ category of Long Covid in formal healthcare and policy channels.[1] Such concerns have yet to filter down to children and young people, who are generally believed to experience mild symptoms, recover quickly, and are therefore able to resume normal life. In relation to these groups, attention has focused more on ‘the long-term mental health impact’ of social restrictions, which are believed to be exacerbating ‘problems such as self-harm and anxiety’, and feeding into rising suicide rates.[2] Current government advice encourages parents, carers and young people themselves to ‘look out for any changes in behaviour’, which are in turn becoming tied to and viewed as common responses to the particular challenges and circumstances of life in the era of COVID-19.[3]

Concerns regarding changes in behaviour also characterised the early twentieth century medical and psychiatric discussions regarding the mental after-effects of Encephalitis Lethargica (EL) in children and young people, indicating a potential similarity and point of comparison between these epidemic/pandemic diseases.[4] In considering these possibilities, this short blog seeks to expose the conditions underpinning the separate and contingent emergence of changes in behaviour in relation to EL and COVID-19, which were and are bound up with and informed by their political and economic context. Drawing analogies between these categories therefore provides no easy lessons or predictions regarding the potential impact of COVID-19 on young people, in terms of social restrictions or with regard to the virus itself. Yet, in mapping out the conditions of possibility which underpinned the links between EL and changes in behaviour, it becomes possible to begin to understand the ‘coming into being’ and use of these ‘scientific objects’ in relation to COVID-19, acknowledging how they validate current policy decisions but are also underwritten by a narrative of individual responsibility. Such comparative analysis therefore reveals the ways in which political and economic priorities continue to interact with and inform our discussions and understanding of mental ill health.

The argument that scientific objects emerge, evolve and fade away in line with contextual conditions is widely accepted amongst historians of medicine, psychiatry and science, and exemplified by the work of Lorraine Daston. In 2000, Daston defined these objects very broadly, highlighting dreams, atoms, the self or tuberculosis, and traced the ways in which they ‘come into being and pass away as objects of scientific inquiry.’[5] She argued, moreover, that these objects reach their ‘heightened ontological status’ and become more real by producing results, implications, surprises and explanations, and are therefore ‘stabilized for some historically bounded period.’[6] In the remainder of this blog, I will use this theoretical framework to trace and contextualise the emergence, use and function of a particular scientific object in relation to EL, viewing changes in behaviour as both real, in the sense that they were identified and ‘woven into’ early twentieth century medical, psychiatric and scientific ‘thought and practice’, and historical, in that they were also bound up with and shaped by contemporary political and economic concerns.[7]

How and why did changes in behaviour become linked to EL?

As part of an international epidemic, EL was first identified in England during March and April of 1918 and viewed as a ‘physical’ illness, which caused severe lethargy and unusual eye movements in adults who nonetheless recovered quickly.[8] In line with developing bacteriological and neurological knowledge, whilst clinicians initially identified similarities with other diseases such as poliomyelitis and influenza, they quickly established that the symptoms associated with EL were caused by a distinct virus which attacked and damaged the central nervous system. By 1921, the view of this disease as ‘acute’ had been subsumed by a recognition of the emerging, long-term impact on the ‘mental condition’ of children and young people.[9] In 1922, medical officer G.A. Auden highlighted that many displayed an ‘irritability of temper or an intolerance of control’ which rendered them ‘difficult or impossible to live with’, and yet, as measured through the technology of mental testing, seemed to maintain their intellectual capacity and came from families who were ‘careful and intelligent’ and ‘hardworking’.[10]

Describing, grouping and categorizing these changes in behaviour and linking them to ‘inflammatory conditions’ in the brain caused by the virus allowed physicians like Auden to begin to explain these cases, whose symptoms closely resembled those traditionally associated with mental deficiency or insanity.[11] These links therefore challenged engrained eugenic and moralistic ideas, but also generated questions regarding the value of institutional provisions geared towards long-term legal control and supervision. In contrast, Auden argued, these cases required hospital-based medical care and treatment to facilitate their recovery. This view of such changes in behaviour also buttressed the developing interwar mental hygiene movement, which marked a shift away from ‘the old asylum system with its punitive, poor law associations to a service oriented towards the community’, in order to allow people to adjust to the ‘complex social pressures’ of modernity, and therefore to achieve ‘greater human happiness and greater social efficiency’.[12] In the early 1920s, then, these changes in behaviour emerged through particular contextual conditions of possibility, becoming used to explain and address local, practical problems regarding care and treatment, but also in line with the political and economic priorities which shaped interwar British medicine and psychiatry.

Image credit: Kate McAllister

Considering parallels with COVID-19

Contextualising the uses and functions of the changes in behaviour associated with EL underlines the need to avoid drawing simple parallels with such problems and their emergence in relation to COVID-19. It is worth acknowledging that unlike EL, the changes in behaviour linked to COVID-19 are not viewed as a product of the virus itself, but of the social restrictions implemented to curb the spread and impact of this disease on the population. Linking these problems to social distancing or lockdown measures validates policies which sanction the return of young people to school, college and university on the basis of their mental health. Nonetheless, it is important to note that they are also grounded in a narrative of individual responsibility, wherein young people are advised how and expected to monitor their mood and practice self-care to mitigate and deal with their experiences of anxiety or depression and therefore, their changes in behaviour.[13] These relationships in turn transfer responsibility for any further anxiety or ‘negative thoughts’, which may be generated by and within the ‘socially distanced classroom’, to the young person and their individual practice of self-care, directing focus away from the role and impact of these policy decisions.[14] Whilst these dynamics require much more intensive, contextual analysis, I hope to have given some sense of the questions we should be asking, and of the ways in which these particular changes in behaviour might be interacting with, and becoming characterised, sustained and powered by current economic and political priorities.

Recently, the National Institute for Health Research argued that ‘ongoing COVID-19 symptoms are experienced by all age groups, from the youngest children to the oldest people’, therefore warning against the assumption that ‘groups who are at low risk of life-threatening disease and death during acute infections are also at low risk of living with COVID-19 long term.’[15] This research offers a counterpoint to the powerful belief that young people are unlikely to experience Long Covid, suggesting that at the very least, it is important to recognise that much is still uncertain. Moreover, unravelling the relationships between scientific objects such as changes in behaviour and contemporary political and economic priorities in contemporary medicine and psychiatry, helps us to begin to understand the significant role they play in determining what we believe about diseases such as EL and COVID-19, and the ways in which they impact different minds, bodies and lives in the short and long-term.

Kate McAllister is a third year PhD student in History at the University of Sheffield. Her thesis uses Encephalitis Lethargica as a lens through which to trace and contextualise the changing medical, psychiatric and psychological conceptions of antisocial behaviour in Britain from 1918 to 1959. Twitter: @KateMc993.

 

References

Auden, G.A., ‘Behaviour changes supervening upon Encephalitis in Children’, The Lancet, Oct 28 1922, 901-904

Callard, F, and E. Perego., ‘How and Why Patients Made Long Covid’, Social Science and Medicine, Oct 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539940/

Daston, L., ‘Introduction: The Coming into Being of Scientific Objects, in Lorraine Daston, (ed.), Biographies of Scientific Objects, (2000), 1-14

Hall, A., ‘Epidemic Encephalitis’, British Medical Journal, Oct 26 1918, 461-463

Iacobucci, G., ‘Suicide rates continue to rise in England and Wales’, British Medical Journal, Sept 2020, 370

‘Living With Covid19’, National Institute for Health Research, 15 October 2020, https://evidence.nihr.ac.uk/themedreview/living-with-covid19/

‘Looking after a child or young person’s mental health’, Every Mind Matters, https://www.nhs.uk/oneyou/every-mind-matters/childrens-mental-health/

‘Mental health and self-care for young people’, https://www.nhs.uk/oneyou/every-mind-matters/youth-mental-health/

Paterson, D, and J.C. Spence., ‘The After-Effects of Epidemic Encephalitis in Children’, The Lancet, Sept 3, 1921, 491-493

Roxby, P., ‘Covid: What is the mental health cost to the young?’, 9 October 2020, https://www.bbc.co.uk/news/health-54449149

Toms, J., ‘MIND, Anti-Psychiatry, and the Case of the Mental Hygiene Movement’s Discursive Transformation’, Social History of Medicine, May 2020, 622-640

 

[1] Felicity Callard, Elisa Perego, ‘How and Why Patients Made Long Covid’, Social Science and Medicine, Oct 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539940/

[2] Philippa Roxby, ‘Covid: What is the mental health cost to the young?’, 9 October 2020, https://www.bbc.co.uk/news/health-54449149; Gareth Iacobucci, ‘Suicide rates continue to rise in England and Wales’, British Medical Journal, Sept 2020, 370

[3] ‘Looking after a child or young person’s mental health’, Every Mind Matters, https://www.nhs.uk/oneyou/every-mind-matters/childrens-mental-health/

[4] G.A. Auden, ‘Behaviour Changes Supervening upon Encephalitis in Children’, The Lancet, Oct 28 1922, 901-904

[5] Lorraine Daston, ‘Introduction: The Coming into Being of Scientific Objects, in Lorraine Daston, (ed.), Biographies of Scientific Objects, (2000), 1

[6] Ibid., 10-12

[7] Ibid., 1

[8] Arthur Hall, ‘Epidemic Encephalitis’, British Medical Journal, Oct 26 1918, 461

[9] Donald Paterson, J.C. Spence, ‘The After-Effects of Epidemic Encephalitis in Children’, The Lancet, Sept 3, 1921, 492

[10] G.A. Auden, ‘Behaviour changes supervening upon Encephalitis in Children’, The Lancet, Oct 28 1922, 901

[11] Ibid., 901

[12] Jonathan Toms, ‘MIND, Anti-Psychiatry, and the Case of the Mental Hygiene Movement’s Discursive Transformation’, Social History of Medicine, May 2020, 625, 626

[13] ‘Mental health and self-care for young people’, https://www.nhs.uk/oneyou/every-mind-matters/youth-mental-health/

[14] Ibid.

[15] ‘Living With Covid19’, National Institute for Health Research, 15 October 2020, https://evidence.nihr.ac.uk/themedreview/living-with-covid19/

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