Classical psychiatry distinguished two types of factors in the production of mental disorders, which it called “endogenous” and “exogenous”. Exogenous factors were environmental factors, therefore, external to the individual, which, by acting on him, ended up altering his psychic equilibrium. Endogenous factors, on the other hand, were characterized by being internal to the individual. In addition to this, they were traditionally considered unknown, although this has been changing as a result, above all, of advances in biochemistry and genetics. In classical psychiatry, this gave rise to the division of mental disorders into two major chapters, known as “psychoses” and “neuroses”. It is true that psychoses included not only the so-called endogenous psychoses (schizophrenia, manic-depressive psychosis), but also others of exogenous cause, such as those produced by alcohol, drugs, certain microorganisms such as Treponema pallidum, or some heavy metals. But the psychoses par excellence were the endogenous ones. Exactly the opposite of what happened in neuroses, in which the cause of the disorder was always in conflict with some element coming from the environment.

The virus causing the current pandemic does not seem to produce psychiatric disorders per se, as was classic in the paradigmatic case of Treponema pallidum and progressive general paralysis. The current virus has not been proven to be the triggering cause of any major psychiatric disease, although, as we shall see immediately, this does not prevent it from contributing to the development of psychiatric disorder [17]. The fundamental disorders diagnosed throughout this pandemic belong rather to the field of what in classical terminology were called neuroses, disorders due to nosogenic factors of the environment that end up altering the mental equilibrium of people.

The COVID pandemic has significantly altered the living environment of human beings. It has forced rigorous confinement for months, disrupting family relationships as well as professional and work relationships. The consequence has been a very significant increase in the number of interpersonal conflicts. When the person was already a carrier of a latent predisposition to suffer from a mental disorder, this crisis has triggered it. Hence, it has also had an impact on the appearance of major psychiatric disorders. But above all, it has increased the number of interpersonal conflicts, triggering exaggerated or abnormal responses. This explains why cases of anxiety, depression, discomfort, self- and heteroaggressions, etc. have increased.

As was to be expected, these disorders have been all the more frequent the “weaker” people are. Situations of “crisis”, and this pandemic has been to a high degree, test the so-called resilience mechanisms, affecting more the weaker personalities, or those who for different reasons are in a bad moment. This is fundamental to take into account. Crisis situations test the psychic strength of people and cause the weaker ones to fail in their response, so that they begin to show exaggerated or abnormal symptoms of discomfort, anxiety, insomnia, anguish, aggressiveness, etc. To help them overcome the situation, psychiatry uses two types of treatment, some pharmacological and others psychotherapeutic. The latter seek to re-educate the patient, strengthening his or her psyche and providing him or her with mechanisms for coping with crisis situations. These mechanisms, by improving the patient’s relationship with his environment, will allow him to reduce his suffering and attenuate the effect of these life-altering symptoms.

What role can ethics play in this context, and can it be of any use?

A first important observation is that our relationship with the environment is conditioned by our own internal vitality. Ortega y Gasset tells us in a text entitled “Vitality, soul, spirit”, how the level of our vitality is a determining factor in the way we face the environment. Ortega writes: “Who has not experienced it? When we separate from a certain person with whom we have been talking for a long time, we feel invigorated. And not because that person is very intelligent, nor because he has been kind: we owe him neither a teaching nor a favor. However, we come out of our dealings with that person refreshed, full of self-confidence, optimistic, saturated with impulses and plenitude, with a firm faith in existence. If we want to analyze the reasons for this corroboration and increase of vitality, we do not find any concrete one. But there are other people whose proximity, however brief it may be, leaves us battered and exhausted, full of mistrust and as if existence had taken on a sour taste. When we are separated from them, we are less than before and, so to speak, we have lost calories. Indeed, there are two kinds of beings: some are endowed with overflowing vitality, who remain in ‘surplus’; others, with insufficient vitality, always in ‘deficit’. The excess of the former contaminates us favorably, corroborates and nourishes us; the defect of the latter sips life from us, depresses and diminishes us.” [86].

There are people with high vitality and people with low vitality. And, of course, there are also cases in which vitality, both high and low, acquires pathological overtones, as happens in manic and depressive disorders. But leaving aside these clearly pathological cases, it is clear that we all have what Zubiri called a “vital tone”, and that this is very different in some situations and in others. The paradigmatic example of this is the current war in Ukraine. The Ukrainian soldiers are fighting for a cause they consider just and important, and therefore have a high “combat morale”, while the Russian soldiers seem to be fighting for a cause they do not understand and which they find it difficult to assume as their own, or which they openly do not share. The former are demonstrating very high morale, while the latter seem to have their morale in the doldrums. It goes without saying that morale depends on many factors, one of which is education. One fights for ideas and ideals; if you prefer, for beliefs. This, which is so neglected in Western culture, is always fundamental, but especially in crisis situations. A demoralized people will be at the mercy of whichever wind blows the hardest, it will be a toy in the hands of anyone. And the same can be said of the demoralized person.

Hence the importance of morality, i.e. ethics. This is particularly clear in crisis situations. Ethics is the attempt to answer the question that every human being asks himself at some point in his life: “what should I do”. Whoever is able to ask himself the question and has a clear answer, that is to say, who knows what he should do, it is very difficult for him not to carry it out with determination and conviction. And it is also very difficult for him to “burn out” or become depressed in the face of adverse circumstances. In this sense, ethics is a very effective antidote against depression and discouragement, and against not all, but some of the disorders that Benjamin Rush and James Prichard baptized with the name of moral insanity, which French psychiatrists called “folie morale” and which in 19th century German psychiatry was known as “moralisches Irresein”. In 19th century German ethics there was a term that played a very important role. It was “Gesinnung”, a word that is difficult to translate, but which, among other possible meanings, has that of “disposition of mind”. In Kantian ethics it is the fundamental element of the moral life of people.

The disposition of mind has an undoubted biological basis. Among us, López Ibor has dealt extensively with it [87]. But on that basis, let us say, biological or of first nature, there rises the one that we build with our acts, habits and ways of life, that is to say, what the classics called second nature. But not all acts and habits contribute to the same extent to the formation of the basic or fundamental dispositions of mind. The decisive ones are those that are learned, usually unconsciously, during the first stages of life. Hence, between the genetically determined traits and what is acquired in the course of life in contact with the environment, an intermediate space must be found, which German philosophers, especially from Kant onwards, designated with the word “Gesinnung”. “Gesinnung” has to do not so much with concrete acts as with the “attitudes” that the human being learns during the first stages of his life, in the epoch of maximum cerebral plasticity, and which constitute the basis on which the different acts are later based. “Gesinnung”, as the philosopher Max Scheler affirmed, consists in the “orientation” of one’s own life [88] . It goes without saying that this topic goes far beyond the limits of this brief note. But it was important to bring it up in order to point out that the reactions of human beings, especially in crisis situations, are strongly conditioned, and even determined, not only by what was formerly called “temperament”, and today “genetic information”, but also by what in the old terminology was understood as “character”. Temperament is “physical”, whereas character has a large learned, and therefore “moral”, component. Both are put to the test in crisis situations, such as the present one. The human response to crises is not only determined in people by their physical condition, that is, by their temperament, but also by their character, or by what Aranguren called their “disposition”, which defines their moral condition. And this is, in my opinion, the great black hole of the current situation, how neglected is the formation of children and young people in this element, a determinant in much of the character of people and the functioning of societies. In their most deviant forms, these people make up the group of so-called psychopathies or sociopathies. But there remains the other large group of people, those considered “normal”, possessing dispositions with very different degrees of resilience. It is crisis situations, such as the current one, that make this evident, and also destabilize the weakest or worst prepared.