Suicide in covid-19 times: Possibilities of understanding in the light of Heideggerian ontology

Azevedo, Ana Karina Silva; Dutra, Elza

doi:10.22491/1678-4669.20200045

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Estudos de Psicologia (Natal)

versão impressa ISSN 1413-294Xversão On-line ISSN 1678-4669

Estud. psicol. (Natal) vol.25 no.4 Natal out./dez. 2020

https://doi.org/10.22491/1678-4669.20200045

10.22491/1678-4669.20200045

SOCIAL AND COMMUNITY PSYCHOLOGY AND MENTAL HEALTH

Suicide in covid-19 times: Possibilities of understanding in the light of Heideggerian ontology

Suicídio em tempos de covid-19: possibilidades de compreensão à luz da ontologia Heideggeriana

Suicidio en los tiempos de covid-19: posibilidades de entender a la luz de la ontología Heideggeriana

Ana Karina Silva Azevedo^I; Elza Dutra^II

^IUniversidade Federal do Rio Grande do Norte
^IIUniversidade Federal do Rio Grande do Norte

Endereço para correspondência

Abstract

The purpose of this theoretical study is to understand suicide in times of a pandemic, based on Heidegger's ontology. The sufferings experienced in a scenario like that of COVID-19 announce that the suicidal risk can be increased in the face of a pandemic's emotional impact. Heidegger's ontology, based on living and boredom, allows us to reflect on the historical horizon of our existence today. One of the possible reflections in the face of the reality that COVID-19 announced to us was the threat to the illusion of our control over life. For many, this finding generates pain, accentuates existing helplessness, and can reveal the absence of meaning for living. It is vital to research the subject and help design strategies that bring us closer to the population's suffering in a pandemic and after it.

Keywords: suicide; phenomenology; Heidegger; COVID-19.

Resumo

O presente estudo teórico, objetiva compreender o suicídio em tempos de pandemia, a partir da ontologia heideggeriana. Os sofrimentos vivenciados num cenário como o do COVID-19, anunciam que o risco suicida pode ser incrementado frente ao impacto emocional trazido por uma pandemia. A ontologia heideggeriana, a partir de noções como habitar e tédio, permite refletir o horizonte histórico de nossa existência na atualidade. Uma das reflexões possíveis frente à realidade que o COVID-19 nos anunciou, foi a ameaça sobre a ilusão do nosso controle sobre a vida. Para muitos, essa constatação gera dor, acentua desamparos já existentes e pode desvelar a ausência do sentido por viver. É importante investir em pesquisas sobre a temática e que ajudem no delineamento de estratégias que nos aproximem do sofrimento da população em uma pandemia e após ela.

Palavras-chave: suicídio; fenomenologia; Heidegger; COVID-19.

Resumen

Este estudio teórico tiene como objetivo comprender el suicidio en tiempos de pandemia, basado en la ontología de Heidegger. Los sufrimientos vividos en un escenario como el COVID-19, anuncian que el riesgo suicida puede incrementarse ante el impacto emocional que trae una pandemia. La ontología de Heidegger, basada en nociones como el vivir y el aburrimiento, nos permite reflejar el horizonte histórico de nuestra existencia hoy. Uno de los posibles reflejos ante la realidad que nos anunció el COVID-19 fue la amenaza a la ilusión de nuestro control sobre la vida. Para muchos, este hallazgo genera dolor, acentúa el desamparo existente y puede revelar la ausencia de sentido de la vida. Es importante invertir en investigación sobre el tema y ayudar a diseñar estrategias que nos acerquen al sufrimiento de la población en una pandemia y después de ella.

Palabras clave: suicidio; fenomenología; Heidegger; COVID-19.

"An Indian committed suicide convinced that he was infected with the new coronavirus."¹

"In Italy, a 34-year-old nurse committed suicide when she discovered that she had been infected with the coronavirus."²

"In Brazil, actor Flavio Migliaccio ³ committed suicide and left a letter to the family in which he says that humanity 'did not work.'"

Amid the pandemic resulting from COVID-19, news such as those that start this manuscript invite us to think about the silent suffering of people who, in a pandemic scenario that affects the world and decimates thousands, are mobilized and question the very existence. Suicide has already been considered a severe public health problem by the World Health Organization - WHO (2018). The numbers are increasing worldwide, revealing the concern with the mental health of the population. However, what makes people during a pandemic context want to stop living? In this direction, trying to understand suicide in times of a pandemic, the present theoretical study intends to problematize. Therefore, WHO (2020b), the World Health Organization, declared on January 30, 2020, that the outbreak of the disease caused by the new coronavirus (COVID-19) constitutes a Public Health Emergency of International Importance - the highest level of alertness of the Organization. According to the Pan American Health Organization - PAHO (Organização Pan-Americana de Saúde [OPAS], 2020), 3,588,773 cases of COVID-19 were confirmed in the world by May 6, 2020. On March 11, 2020, WHO (2020b) characterized COVID -19 as a pandemic, a term that refers to the breadth of its geographical distribution. Since then, measures of isolation, social distancing, and, in some countries, the lockdown have been applied to contain the virus's spread. Many locations in the world, including Brazil, have been quarantined, bringing to the population social changes, economic impacts.

Regarding the emotional impact of experiencing a pandemic, OPAS (2006) warned that, from the point of view of mental health, a significant epidemic implies a psychosocial disorder that can overcome the possibility of facing the population affected by it. In a scenario like this, one can even consider that the entire population suffers tensions and anguish to a greater or lesser extent. Therefore, the Organization estimates an increase in the incidence of psychological disorders, reaching between one third and half of the exposed population, which may suffer some psychopathological manifestation, according to the magnitude of the event and the degree of vulnerability.

In history, other pandemics were experienced: the Spanish flu, which spread around the world between 1918 and 1919, and the Severe Acute Respiratory Syndrome (SARS) in 2003. Among the emotional impacts of a pandemic, the risk of suicide appears as the unveiling of unbearable population's suffering experience due to the vulnerability of a large proportion of pandemic. In an article published by Barreira (2020), already in the Spanish flu experience, there were suicides associated with the epidemic. On a commentary posted online on April 21 of this year, 2020, in The Lancet Psychiatry, members of the International COVID-19 Suicide Prevention Research Collaboration warned on the possible increase in suicide rates as the pandemic spreads. Moreover, its long-term effects on the economy, the general population, the most vulnerable groups become clearer. Young et al. (2020) predict that, in the city of Michigan, due to the COVID-19 pandemic, there may be a 32% increase in suicide rates if nothing is done to face this reality.

Gunnell et al. (2020), in their article on suicide risk in times of pandemic, highlight that evidence points to an increase in suicide deaths during the Spanish flu in the USA, as well as in the elderly, in Honk Kong, during the SARS epidemic. This study highlights that the pandemic has different effects on the population's mental health in general and on people with mental illnesses exacerbated by fear, isolation, and physical distance. The risk of suicide can increase in both patients and their families with the stigma caused by the diagnosis of COVID-19. This vulnerability present in the pandemic can also cause worsening symptoms in people with some mental illness and others who may develop depression, anxiety, and post-traumatic stress.

According to Velásquez (2020), in 2003, several psychiatric comorbidities were reported at the beginning of the SARS outbreak, including depression, anxiety, panic attacks, psychomotor agitation, psychotic symptoms, delirium, and suicidal tendencies. According to this author, in several studies, particularly in a review of quarantine's psychological effects, adverse psychological effects are described, including symptoms of post-traumatic stress disorder (PTSD), confusion, and anger. The author also states that the impact of the quarantine increases according to its duration. Many of the symptoms are related to the fear of becoming infected, frustration, lack of supplies, incorrect information, financial losses, and, above all, stigma. Furthermore, it also states that quarantine is an unpleasant experience for those who experience it with feelings of separation, deprivation of freedom, uncertainty, and boredom. Quarantined people are even more likely to report exhaustion, detachment, anxiety, deteriorating performance, and resistance to work.

Recently, the Brazilian Psychiatric Association ⁴ surveyed with its associates from 23 states and the Federal District and found that 47.9% of doctors noticed an increase in the number of visits since the beginning of the pandemic. Also, 67.8% responded that they received new patients after the pandemic, which had never had psychiatric symptoms before. At the same time, 69.3% of psychiatrists interviewed reported that they treated patients who had already been discharged and had a recurrence of symptoms. For 89.2% of interviewed doctors, a worsening of the patients' symptomatic condition was monitored due to the COVID-19 pandemic.

Besides, a Fiocruz document (2020), reflecting on mental health and psychosocial care in the COVID-19 pandemic, highlights that "social isolation measures, although based on scientific evidence and essential for protecting the health of the population, can impact the mental health of those who experience them" (p. 2). This document also points out that the social distance measures, such as those adopted in many Brazilian states, produced a sudden change in the population's daily activities, which can cause suffering and insecurity in the face of the unpredictability of the future. Social detachment also comes with a feeling of emotional isolation and deprivation of freedom. This impact can be accentuated by essential factors such as fragility in socio-affective networks, job instability, and financial difficulties, or the impossibility of having an adequate place to maintain social distance. For Fiocruz (2020), studies have revealed other recurrent psychological symptoms in social detachment situations, such as loneliness, hopelessness, anguish, exhaustion, irritability, boredom, anger, and a feeling of abandonment. There is a greater probability of occurrence of sleep disorders, abuse of psychoactive substances, and suicidal ideation, as well as worsening of existing mental disorders.

Such a finding of the emotional impact of quarantine in times of pandemic has triggered a recent call for the issue of suicide in times of COVID-19, as Brooks (2020) and other experts remind us, so that suicide prevention is considered urgent.

Notes on suicide from a hermeneutic phenomenological perspective and the pandemic

Suicide does not only occur nowadays. It is a phenomenon that happens throughout the evolution of humanity. How it is conceived and approached varies according to the time and culture, prevailing in the context in which it occurs. Historically, suicide has been considered taboo, as it involves religious, moral, philosophical, and psychiatric conceptions. (Azevedo & Dutra, 2012; Palhares, 2003). Each field of knowledge has its conception of this act, but for Camus (1989), suicide is a philosophical problem, as it raises questions about the meaning of life. Because it still represents a taboo topic, there is little talk about suicide, and we often have contact with this phenomenon through news announcing someone's self-inflicted death. However, we understand that, the understanding of suicide that prevails in the modern world, in general, to psychopathology, since, in most cases, this act is considered a consequence of a mental disorder commonly associated with depression (Reis, Bezerra, & Rei, 2020). In this regard, WHO (2020a) states that severe depression can lead to suicide, but not all suicides would necessarily result from a depressive state. With that, the question remains whose answer evokes a cause: why do people kill themselves? This is the recurring question that is asked when a suicide occurs. Often, there is an attempt to answer it by calling up causes for such an act. We can think that attributing a reason to the decision to self-exterminate, in a way, alleviates the anguish of the one who asks, since understanding suicide reveals the complexity of factors involved in it (Cassorla, 1991; Dias, 1991).

According to Dilthey (2011), the natural sciences would be those that seek to explain the phenomena, while the sciences of the spirit seek to understand them. As psychiatric diagnoses are based on the scientific paradigm, suicide is usually placed at the center of interest to obtain a conclusive truth that can explain the cause that caused voluntary death. The consequence of this thought will almost always be finding a diagnosis of mental disorder associated with depression, a delusion, or any other that will inevitably place suicide in the psychopathological dimension of human behavior. However, from a different perspective, it is possible to understand behavior that traditionally would be situated in the dimension of mental disorder, such as suicide, from a look at existence.

Fuchs (2018) poses a question: "why does the man get sick psychically?". This is a highly timely question in pandemics, such as the one we live in and which has favored psychic illness, as seen before in this work. Based on this questioning, the author suggests that one can think about "the conditions of possibility for man, in general, to be psychically ill" (p. 7). In this sense, the author points to the idea of "existential vulnerability (emphasis added), namely, as a particular sensitivity to the contradictions and limit situations of the Human Condition" (p. 7). For him: "In the words of Karl Jaspers: 'In the case of man, his unfinishedness, his openness, his freedom, and his inconclusive possibility are themselves the foundation of a sick being'" (Jaspers, 1965, p. 8).

Based on this idea, it is impossible to treat psychological suffering or psychic illness with objectivity and generalization in the scientific assumptions that underlie medical knowledge, mainly when referring to human subjectivity and existence. Human existence transcends any measurement and objectification. As the philosopher Martin Heidegger (1927/1999) already said, in being a being-in-the-world, Dasein exists being in the world; therefore, its existence is at stake in every situation that presents itself to it in the world. It is not possible to say that the COVID-19 pandemic is affecting people in the same way. Some may experience this moment of crisis, manifesting anxieties, depression or psychosomatic symptoms, or even PTSD (Post-Traumatic Stress Disorder). In others, social isolation, loneliness, and the absence of social interaction may favor suicide. On the author mentioned above, each one's existential vulnerability can measure and how the psychological suffering will manifest itself. However, one certainty we can emphasize is that a crisis like this, which we refer to here, certainly affects the entire world population. What is certain is that because we are beings-in-the-world, as Heidegger (1927/1999) thinks, we exist in a historical horizon that promotes sedimented senses, which we adopt as ours. To exist is to be outward; it is ek-sist, that is why we have a world, in the sense that we are not only inserted in a web of meanings that is our existence, but, above all, because we are thrown into the facticity, that is, we are beings worldly, and we are constituted in the world; we are, therefore, affected by everything that happens not only in our surroundings but in global terms.

When taking a phenomenological hermeneutic perspective as a horizon, such as that adopted in this study, eyes now turn to another direction regarding understanding the deeds of wanting to die. They do not seek to explain them but to understand them without establishing a causal relationship.

Suicide usually provokes innumerable questions, mainly related to the act's why, the cause responsible for the suicide, and if it could be avoided. These are some of the questions that commonly arise when such a death occurs. However, Dutra (2018, p. 107) takes another path and asks:

what living conditions have the world offered so that a person would prefer to leave it? How to think about existence in a world that, while offering material and knowledge conditions to achieve happiness, to have a "good life," more people are getting sick, suffering, and killing themselves.

For Heidegger (1927/1999), the being of man, which he calls Dasein, consists of a notion that points to the inseparability between man and the world, both in the ontological sense of the term, as well as in the ontic and concrete world, which it leads us to consider that man's ways of being, as well as his sufferings, would be produced by the determinations of the world and the senses already sedimented, which man adopts as if they were his own and originated in his experience of existing. It happens that when we are born, we are thrown into a world that has already been constituted and with its senses sedimented. When launched into the world, man is absorbed by him and takes his senses as true, and in doing so, he falls into impersonality. Thus, it becomes what it is not, and generating, through life, suffering due to the anguish of not being and restricting Dasein's capacity to be-able.

Two Heideggerian notions are themed by Dutra (2018) when reflecting on suicide: boredom and dwelling. For Heidegger, boredom is a fundamental affective tone and means indifference to existence and the person himself. Langerweile (boredom) is a German word that means "long time." Boredom involves the notion of temporality, of an extended period, which is revealed in the absence of historicity, in which the perspective of the past and the future does not exist. For the philosopher, "Boredom indicates a relationship with time" (2006, p. 97). In boredom, the finitude of being-there appears in being-to-death, and boredom is characterized by temporality. In it, time creeps; that is, there is no transcendence, there is no project and, then, there is no sense. At this point, it is worth remembering the pandemic experience. The notion of boredom, in Heidegger (2006), as it is possible to perceive, faithfully reflects the experience that many people are living in this moment of crisis: being in social isolation, deprived of freedom and experiencing routine occupations, aggravated by the uncertainties of a future and the imminence of death. This can happen at any time, just by being infected by the virus, still as unknown as the ways of contagion and cure. In the experience of being isolated, characteristic of a pandemic, sometimes experiencing loneliness, we experience a temporality that announces a paralysis of existence. We emphasize that it is freedom at stake. We postpone the future since the present is paused. This atmosphere, favored by the pandemic and social isolation, can have an excruciating effect on people who live such an experience as unbearable suffering.

Dwelling represents another Heideggerian notion that helps us think about man's suffering in the current pandemic and culminate in suicide. Like the world today, the pandemic caused by COVID-19, during which the planet has almost wholly paralyzed, people find themselves isolated in their homes, their homes, more than ever it is opportune to ask: How are we inhabiting the world in this moment of crisis? Nevertheless, what does it mean to inhabit?

Heidegger (1954/2001), in the search for the origin of the word inhabit, finds meanings that point to build and inhabit, and affirms: "To be a man says: to be like a mortal on this land. It says: dwell. The old word bauen (to build) says that man is as he lives" (p. 127). Tracing the origin of the word inhabit in three languages, German (bauen), Saxon (wuon), and Gothic (wunian), Heidegger (1954/2001) understands that they all bring the meaning of "safeguarding" and "freedom," as he says:

freeing oneself means properly protecting ( ) freeing oneself for peace from a shelter. To live, to be brought to peace in a shelter says: to remain pacified in the freedom of belonging, to safeguard everything in its essence. The fundamental feature of living in this protection. The protection permeates inhabiting in all its amplitude. It shows itself as soon as we are ready to think that to be a man consists of inhabiting and, this, in the sense of a de-dwelling of mortals on this land. (p. 129).

It happens that, when a man does not live, that is, in the impossibility of dwelling on things, we can think that there is an uprooting when then man does not feel that he belongs to the world. It would be a feeling of being out of the world, of belonging to nothing, of not being able to dwell on the things of the world. Reflecting on the distance and social isolation needed in this pandemic, as well as all the implications brought by this moment, we think: if such an experience does not suggest that the world has paralyzed and if there is something that transcends man - such as a virus - as then feel rooted in the world, since the planet itself and the lives of men have no guarantee of shelter or feeling of protection? At that moment, the provisionality of human life is emphasized, in which the feeling of hospitality in the world emerges with intensity, favoring an experience of helplessness and abandonment. It is worth remembering that the social and, mainly, political conditions that Brazil is going through at that moment will affect, with more intensity, the existential vulnerabilities and the human condition of inhabiting the world as its home, in the sense of belonging.

As already explained in this manuscript, a pandemic affects everyone's mental health, at different levels and in different ways, and can be aggravated if there is a social and political environment that does not favor security, hope, and confidence that life is being preserved, as seems to be the case in Brazil. Thinking about these issues is relevant, in particular, because they already have scientific findings that show the impact of aspects related to public management in times of pandemic and the mental health of the population. Brooks et al. (2020) highlight that, in several studies they reviewed, many participants cited that inadequate information provided by public health authorities was considered stressful, as well as a lack of transparency perceived by health and government officials about the severity of the pandemic.

The economic crisis, along with the other factors highlighted here, also needs to be considered in the world scenario that forsakes and displaces the existence and, therefore, may have its relationship with suicides in times of pandemics. In a study by Kawohl and Nordt (2020), the risk of suicide was considered high by 20-30% when associated with unemployment between 2000 and 2011, including the economic crisis of 2008.

In addition to what has been exposed so far, data point to the fact that suicide in Brazil, in the year 2020, is already presenting a worrying number. Recently, the State Secretariat of Health of Pernambuco ⁵ pointed out that the first three months of this year showed a 50% increase in the number of suicide attempts with the same period of the previous year, totaling 845 cases of suicide attempt in that period. In the lowlands of Cuiabá ⁶, only in the first two months of 2020, compared to the same period in the previous year, there was an increase of 116% in the suicide rates. There is a reference ⁷ to increased suicide by military police in São Paulo during the pandemic period, with three suicides among public security professionals reported between the end of April, this year, and May. In the city of Natal, in Rio Grande do Norte, in records from the Epidemiological Surveillance Sector of the Municipality of Natal ⁸, there was an increase, in this first four-month period, of 137% in suicide attempts compared to the same period in 2018.

On the reflection of suicide in the days of COVID-19, Ammerman, Burke, Jacobucci, and McClure (2021) developed a study in which they interviewed almost a thousand people about their mental health in the last month, focusing on possible suicidal thoughts and their relationship with the current pandemic. Among those interviewed, 18% of people reported suicidal ideations in the last month, and 5% even engaged in such behavior. Among them, 65% said that the coronavirus appeared in these thoughts at least part of the time. One in ten survey participants admitted to having purposefully (and unnecessarily) tried to expose themselves to the virus in order to die.

The existence in quarantine times

In the book "A peste" by Albert Camus (2014), the author invites us to think about a city - Oran, affected by the death of countless mice and, in sequence, the death of countless citizens. Deaths as a result of what was called the plague. Throughout his reflections, the author, thinking about the quarantine measures to contain the disease's proliferation in the population, says that "the first thing that the plague brought to our fellow citizens was exile" (p. 71). For him, exile brought emptiness, the desire to go back or to speed up time. He also points out that the exile resulting from the quarantine brings us closer to prisoners' condition, reduced to the past, and in renouncing the possibility of experiencing a future. A pandemic announces unpredictability. The author describes the sensation of living in exile as an intense suffering: "And so, stranded halfway between these chasms and these peaks, they floated more than they lived, abandoned to days without a destination and sterile memories, wandering shadows, unable to strengthen themselves unless accepting to take root in the land of their pain" (p. 72). In a specific passage, Camus (2014) tells us about being "impatient with the present, enemies of the past and deprived of the future" (p. 73). The quarantine experience in a pandemic forces us to live in another temporality since it presents us with the indeterminacy of life, the uncertainty with what is to come, the unprecedented unveiled in what is unknown to us. The pandemic announces amid this temporality our finitude, the certainty that we are mortal. Finitude from which the modern man flees.

For Heidegger, temporality is a fundamental dimension for the reflection of the human being's sense of being. "It is the temporality that shows the ek-static movement of existence, that is, the movement outside of itself and towards itself." (Cardinalli, 2015, p. 251). For this philosopher, being is time, being rearticulates itself through our time. In this sense, Dasein is always in the process of becoming, that is, changing historically. In this web of temporality, Cardinalli (2015) reminds us that temporalization involves three ecstasies: the future (coming), the past (Retrovir) and the present (presenting). For Nunes (2002), Dasein only comes back (the past) coming (future) to you; and because it comes back when it comes, it generates the present.

The past, the present, and the future are not presented sequentially, as they are interdependent, interrelated. Due to the fact that Dasein exists as a possibility, in becoming, there is thus, for Heidegger, a highlight for the future, as Cardinalli (2015) points out to us "since the temporalization of understanding (being able) is based on the future, although it is also determined with equal originality by the past and the present. The future may be revealed through the existential projects that the being-there requests for its realization, but as a project, it has not yet come to fruition, and thus, it may or may not happen." (p. 251).

In this way, Dasein is not restricted in its consciousness to the present moment. It projects itself into the future, but it does so by going back to the past. For this reason, Dasein is temporal. Its temporality makes the world genuinely temporal, opening world-time and revealing a world that endures (Inwood, 2004). However, we must emphasize that this original time is finite and ends with death. Since we are, as Heidegger reflects, beings-to-death. How, then, in the face of an uncertain future scenario in a global illness scenario that marks a pandemic, do we temporalize our existence? As sufferings are unveiled in the face of the impossibility of controlling time or knowing the date that life returns to its normality, or even if we will live any normality? How can we deal with the finitude that is announced by the death figures revealed by the statistics of a pandemic such as that of COVID-19, and that makes us think about the possibility of losing those close to us or even our own lives?

In our temporal existence, which marks our existence, how can we exercise our character of being-able in a quarantine scenario that, in addition to announcing such demands, calls us to deal with the deprivation of our freedom? We pay attention to the reflection from Heidegger's philosophy to thematize this scenario to think in what historical context we can reflect on the appearance of suicidal behaviors in the face of such an intense scenario of vulnerability to exist. We have been discussing the impact of social isolation that marks quarantine. With that, we set out to theme, in this manuscript, in particular, about how the scenario announced by COVID-19 impacts our freedom, be it with regard to our coming and going, or for that freedom that always makes us power decide on what to do and when to do it.

Quarantine, induced by a pandemic, prohibits the choice, including some used to do in our daily lives. Our choices are curtailed by government decrees that make the deprivation of our power to choose law freely. How to think, then, of this act, to a man, as Heidegger thought, who has entrusted himself with the task of having to be and realize his existence?

Leão (1996) writes that for Heidegger, freedom is present in the original appropriation of the historical destiny that reveals us. Philosophically, freedom, for existentialists, is not social or personal freedom. As Holzhey-Kunz (2018) reminds us, it is immanent to our existence. For Heidegger (2012), human freedom is to the extent that it erupts in man and takes him for himself. Freedom is what makes man responsible for his existence, for having-to-be, which leads, as Feijoo (2011) points out, to the indeterminate character of existing. Nothing is given to man, and he is not a finished project. Because it has to be, it happens every moment. Being responsible for its existence anguishes man.

Moreover, it makes him flee to what is familiar to him, which is usually given in the world's sedimented truths. The world gives us this familiarity to exist, and we take refuge in it, occupying ourselves. Distractions that cause us the feeling of choosing what seems to be correct or what seems to be said to be right and takes us away from the anguish of being the realizers of our existence. Heidegger named such a way of being impersonal. Critteli (2007) thinks that in ruin, de-cadence, the individual deviates from his essential project to look at everyday concerns, thus becoming confused with the collective mass. Falling into impersonality with the world of occupations reveals that Dasein runs away from itself as its power-being and away from the anguish of being the doers of our existence.

In our daily lives, amid a pandemic, we experience personal freedom, which condemns us to prison with invisible bars: the fear of contamination deprives us of exercising many of the possibilities set in the world in our project, from the freedom to undertake physical contact, to leave freely without worrying about measures to avoid contamination. Distractions and everyday occupations end up moving us away from the anguish that reveals us to the more own being-able, from the freedom to assume and choose ourselves, "the free being for the more own being-power, that is, the being -free for the freedom to assume and choose yourself" (Heidegger, 1989, p. 252). As Camus (2014) says in his work A Peste, the citizens of Oran "continued to do business, prepare trips and have opinions. How could they have thought of the plague that suppresses the future, displacements, and discussions? They thought they were free and no one will ever be free as long as there are scourges" (p. 41).

It is important to emphasize that, in addition to the unveiling of anguish for a responsibility to exist, in the midst of a deprivation of freedom marked in the world today, man still has the fact of contact with his finitude. A pandemic caused by a virus with high contagion power and still without a definite cure intensifies the death scenario's announcement as a possibility for everyone. Heidegger, in his ontology, drew attention to the fact that we are beings-to-death. In the appropriation of the condition of being-for-death, it is in consciousness, that is, assuming death as an ontological possibility, that Dasein can wield its most own being. It is in the awareness that we are finite that it is possible to take life with our own hands and guide it, using ourselves as a reference. It is, therefore, from the anguish of being finite and our death that an opening of being to a more own being-power is promoted. Often, in impersonality, in advertising, as Heidegger points out, the awareness of our finitude comes to meet us from the death of the other, but this is a death of the impersonal, it reaches Dasein, but it does not belong to anyone. In the context of a pandemic such as COVID-19, death becomes part of the horizon of existing. The world becomes inhospitable because it carries death as a daily possibility. Death ceases to represent a distant phenomenon, and becomes increasingly close, due to the death of known entities and the numbers of deaths echoed from epidemiological news and bulletins.

How to sustain such a burden? Straying, distracting, chasing away what temporarily shelters us in everyday life; for many, in minutes of surfing the internet, or in the practice of physical exercises, in the act of cooking, reading, watching movies and series, taking care of the house, excessive home office hours or even nothing, giving up living.

Once given over to distractions and everyday occupations, we run away from the anguish inherent in existing and fierce in a pandemic scenario. But what about those whose refuge is not possible from everyday distractions? In addition to the deprivation of freedom of the current pandemic scenario, we have to deal with the inhospitality of the world, as Critelli (2007) thought, who stated that we inhabit an ontological point of view, a world that does not fully shelter us. A world that cannot accommodate us, as it does with natural elements. In this way, being-in-the-world is to live in hospitality. Often the feeling of not belonging to the world is understood by us as an experience of homelessness, of helplessness that we try to overcome and related to the meaning of living, as already discussed in this manuscript.

Thus, as reflected by Santos (2020), a viral outbreak signals human fragility, interrupts the common sense of specific control, and evaporates security overnight. Amid the helplessness caused in a pandemic context, suicide may be a possibility in the face of the inhospitableness of a world that no longer shelters it and that all the security guards that supported it have vanished. As Pompéia and Sapienza (1996) point out, someone who seeks death performs a gesture whose meaning perhaps only those who perform it may know in-depth, but that we can understand that certain pains and despairs may be greater than the possibility of stay living.

Final considerations

The reflections developed in this work suggest that quarantine's psychological impact is broad, substantial, and can be maintained for a long time. The history of the great world crises shows that inevitably they cause significant damage to the populations' mental health, not to mention the economic, labor, and other sectors.

Establishing a relationship between the risk of increasing the number of suicides due to a pandemic such as that of COVID-19 is not possible at the moment, mainly because the pandemic is ongoing. We are living the pandemic and allowing ourselves to think about it. In addition to this necessary reflection, establishing such a relationship does not constitute our objective, under the risk of falling into a causal relationship. In the study of suicide, due to its multidetermined character, it would be a wrong task. This manuscript represents an invitation not to forget to think about welcoming the silent suffering that is, today, in a pandemic scenario, in quarantine: protected from the private world of many. It is silent for being in exile but noisy for those who live it. It is also necessary to think that suicide is announced as one of the manifestations of unveiling suffering that demarcates the historical horizon that we live in, which makes us thematize the current time. With psychologists and medical assistance taking place online, due to the quarantine, physical, mental health care services adjusting their functioning due to the moment lived and the guidelines of health entities, we still do not know how this affects those who think of giving up their own living. News like the one that started this article, reflections in the literature from other pandemics throughout history, call us to incite this debate: talking about suicide is necessary!

Such debate is relevant, in particular, because the fragility of human life is revealed in the context of a pandemic, due to the deaths announced daily, the impossibility of predictability of tomorrow, which has confined men to isolation, and which threatens, physically, our existence and that of those around us. Coping with the impotence and inhospitality of life already mark our living, as discussed in this manuscript, even though we avoid contact with it in everyday occupations that protect us from the feeling of the false security of control over life living. However, the pandemic has made impotence law, introducing the unprecedented: convinced answers could not be given. COVID-19 has threatened the truth we have built about our control over life. For many, this finding generates pain, suffering.

We do not know what statistics and epidemiological studies will reveal about suicide and the number of suicide attempts in times of quarantine and social isolation. However, we remember the phrase by Camus (2013) in which they remind us that "in a universe suddenly deprived of illusions or lights [...] man feels like a foreigner" (p. 21). If, as Heidegger thought, the world gave us the familiarity to exist, how could we think of a world in times of a pandemic? We have lost our familiarity with him. For many, staying in a world that is no longer taken as a shelter is an experience that makes death a possibility.

Investing in research that helps us to get closer to this reality will be a demand that will help in the design of strategies that place us in the suffering of the population in times of pandemic, in particular, due to the fact of studies, such as the one by Brooks et al. (2020), point out findings that reported long-term psychological effects of quarantine, many that can extend years after the pandemic. Thus, thinking about strategies for welcoming the population's mental health, not only during the quarantine period but after its occurrence, is fundamental.

We need to think like Alves (1991) when saying that "The death that comes from outside does not need to be understood. For it is a strange, silent power. But the suicide forces us to talk. It is impossible to be in front of your dead body without hearing the voices and melodies that live in it" (p. 14).

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Endereço para correspondência:
Universidade Federal do Rio Grande do Norte, Departamento de Psicologia – DEPSI
Campus Universitário, Lagoa Nova, CEP 59.078-970, Natal/RN – Brasil.
Email: anakarinaazevedo@hotmail.com