Violence and Death: Perspectives of Emotional “Immunity”

In the past few months, media outlets have overflowed with updates concerning the novel coronavirus outbreak. As the virus attacks the world and impacts the futures of every individual, ethical concerns about the disease and its treatment have been brought to light. In particular, there have been many concerns surrounding the training and exacerbation of healthcare providers and the impact it has on patient treatment. On April 21, Laura A. Stockdale presented her study in regard to social learning theory, a theory stating how we learn from models in the world around us. In specific, in her paper “Emotionally anesthetized: media violence induces neural changes during emotional face processing” focused on understanding the relations between emotional face processing and exposure to violent media. Based on the findings and discussion of this article, I became interested to see if the same affects could be seen in doctors in global pandemics. In these scenarios, with health systems overflowing due to the infection rates of the disease, I was curious to see if the prolonged, continuous exposure to grave illness and death impacted emotional face processing and depressive behavior in healthcare providers and its impact on their delivery of empathetic patient care.

In her study, Stockdale hypothesized that media violence exposure would cause increased aggression and decreased social behavior, thus implying that media violence leads to desensitization to facial recognition and emotional processing. Participants were either shown a violent or nonviolent film clip and then asked to complete a gender discrimination stop-signal task using emotional faces. Using scalp electroencephalography (EEG), Stockdale et al. found changes in event-related potentials (ERPs) following exposure to violent media. They saw a decrease in amplitude in P300 when processing violent images, suggesting that repeated exposure to violence decreased neuronal emotional processing. They also observed a bilateral decrease in N170 ERPs, which suggested changes in holistic facial detection. Altogether, the results of the study illuminated increased aggressive behavior and ‘emotional anesthetization’ or “a reduction in cognitive resources allocated to processing emotional face expressions” (Stockdale 2015) after short-term exposure to film violence.

With the ongoing coronavirus pandemic, we have witnessed the horrors and heroic efforts of healthcare workers across the globe. With shortage of PPE, exposure to the contagious virus, and fear of their own lives as well as the morbidity of their patients, many HCW have expressed the exhaustion of overworking, characterizing it as a “burnout”. In the CDC’s Emerging Infectious Diseases journal, “Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak”, Robert Maunder and his colleagues studied the long-term impact of hectic work conditions and work-related trauma on HCWs during the 2003 SARS outbreak. HCWs were given 2 surveys questioning at-work stress and its impact on their personal and work lives. The results of the studied showed that regardless of the resiliency of many HCWs, “significant emotional distress was present in 18-57%” (Maunder et al. 2006), due to economic depression, job stress, isolation, fear of contagion, increased death rates, and prolonged exposure to the gravely ill. Many HCWs documented traumatic experiences working in pandemic conditions. The findings further showed records of burnout, variance of posttraumatic stress, anxiety, depression, and maladaptive coping that ultimately lead to decreased face-to-face patient contact, decreased work hours and increased smoking, drinking, and maladaptive behavior following the SARS outbreak.

Based on the findings in Stockdale’s study, I believe it is important to notice the correlation in behavioral observations following exposure to violent media and real-life tragedy. In both studies, exposure to “detrimental” scenarios resulted to emotional “numbing” and aggressive/depressive moods. While both studies differ greatly in the type of scenarios presented (real and media-based), I believe that the parameters of this study would be useful and interesting when applied to HCWs following the COVID-19 pandemic. I believe through Stockdale’s methods of EEG, could detect similar decreases in N170/P300 ARP amplitudes which could simulate similar behavioral differences and facial recognition delays. These findings would further demonstrate the heavy impact of these amplitude deficits on patient care and continued empathy when treating patients during the trying times of global outbreaks.

I find both studies to be crucial in understanding behavior and social learning/absorption surrounding day-to-day scenarios. Based on the current state of the world, I believe it is important to experiment and observe the neural changes in healthcare workers due to prolonged exposure to depressive scenes and the ‘emotional anesthetization’ that occurs with increasing infection and death rates. In order to ensure preparedness for future outbreaks and proper training for physicians, it is important to observe these neural changes and manners to decrease them in the future to provide the best quality of care for patients and healthy mental states for healthcare professionals.  

Works Cited

Maunder, Robert G, et al. “Long-Term Psychological and Occupational Effects of Providing Hospital Healthcare during SARS Outbreak.” Emerging Infectious Diseases, Centers for Disease Control and Prevention, Dec. 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC3291360/.

Stockdale, Laura A., et al. “Emotionally Anesthetized: Media Violence Induces Neural Changes during Emotional Face Processing.” Social Cognitive and Affective Neuroscience, vol. 10, no. 10, Sept. 2015, pp. 1373–1382., doi:10.1093/scan/nsv025.