Pakistan Journal of Professional Psychology: Research and Practice Vol. 12, No. 2, 2021

Psychosocial Construction of Fear: A Qualitative Content Analysis of COVID-19

Survivors' Stories Published in Online Newspapers



Rubina Kauser

University of Management and Technology, Lahore, Pakistan

Azher Hameed Qamar

National University of Sciences and Technology, Islamabad, Pakistan

In  a  brief  time,  COVID-19  has  changed  the  global  picture.  In  the  context  of  this  pandemic,
people are experiencing anxiety and fears. These fears of people are intensified by several factors
such as personal experience of disease, the stigmatization they faced, and rejection they endured.
Different  theoretical  perspectives  explained  the  fear,  ranging  from  death  anxiety  to
stigmatization and from social exclusion to family estrangement. The purpose of this study was
to  understand  how  "corona  fear"  is  psychologically  and  socially  constructed.  24  COVID-19
survivors'  stories  were  selected  from  known  e-newspapers  such  as  Arab  News,  Times  Herald,
Express  Tribune,  Dawn  News,  India  Today,  BBC  News,  and  Aljazeera  News  of  different
countries:  Pakistan, China, South Korea, Argentina, South Africa, Nigeria, and Michigan. Using
conventional qualitative content analysis, the narratives were analyzed. The results showed four
major  themes:  Risk  perception,  death  anxiety,  social  stigma,  and  psychological  crisis.  It  was
evident  that  corona  patients  bore  double  pain;  physical  pain  due  to  the  disease,  and  emotional
pain  due  to  social  rejection  and  discrimination.  Health  care  authorities  can  join  hands  with
mental  health  professionals  to  implement  programs  resolving  psychological  crises  and
stigmatization which can help overcome such elements. By this study, we assume that a socio-
linguistic  analysis  of  the  narrative  accounts  of  COVID-19  patients  and  their  caregivers  can
provide rich data related to language situated in pandemic contexts.

Keywords: the language of fear, the psychology of fear, psycho-social construction of

fear, COVID-19 fears, COVID-19 survivors

‘Nothing spread like fear’ (Burns & Soderbergh, 2011)

The outbreak of coronavirus disease (COVID-19) in Wuhan (China) spread in several

countries within weeks and with the increase in the number of affected population and death toll,
a variety of fears haunted people across the globe (Casanova et al., 2020; Li et al., 2020; Wang et
al.,  2020).  The  world  is  not  facing  a  contagious  disease  for  the  first  time,  as  it  has  witnessed
damages  done  by  severe  acute  respiratory  syndrome  (SARS)  and  the  Middle  East  respiratory
syndrome coronavirus (MERS) in the beginning of the twenty-first century. However, COVID-
19  is  highly  contagious  and  a  severe  phenomenon  which  can  cause  a  healthcare  disaster  in  the
whole world (Lum & Tambyah, 2020; Su et al., 2015). Since the situation is becoming serious,
fear of this ‘unseen’ threat is causing anxiety. In such circumstances, we are advised to cope with
anxiety by washing away ‘corona fears’ in 20 seconds of hand-washing, detaching socially, and
obeying  ‘do not  touch’  cautions. The underlying message is,  ‘contact  may  be dangerous’. The
Governments are establishing social distance as a ‘temporary norm’, through lockdown. Media is
modifying our social cognition from ‘handshakes, hugs, and kisses to a '6-feet masked' greeting.



Correspondence concerning this article should be addressed to Ms. Rubina Kauser, School of Professional

Psychology, University of Management and Technology (UMT), Lahore.
Email:rubinakauser.psychology@gmail.com

KAUSAR AND QAMAR

Gradually,  we  are  ‘learning’  to  fear  the  COVID-19  threat  and  protect  ourselves.  Uncertain
situations,  rapidly  spreading  disease,  confusion  about  information,  sensational  news,  and
countrywide  shutdown  are  increasing  fear  among  people.  On  the  other  hand,  in  addition  to
corona  fears  among  front-line  healthcare  professionals  who  are  exposed  to  the  disease  (Amin,
2020), electronic and print  media  are reporting stories of  COVID-19 survivors who share their
traumatic  fears  this  ‘incurable’  disease.  These  stories  provide  narratives  of  negative  thoughts
related  to  the  helplessness  they  experienced  during  disease.  In  this  paper,  we  are  interested  in
these  narratives  to  explore  the  language  particularly  related  to  the  fear  experienced  by  the
affected patients.

The ‘Corona Fear’: A Psycho-social Construct

DSM-5 suggests ‘fear’ is a response to the threat that is approaching towards us and

‘anxiety’ is a response to future threats (American Psychiatric Association, 2013). When people
perceive  something  as  uncontrollable,  unexplained,  and  difficult  to  cope  with,  they  experience
fear that causes anxiety. In the context of the COVID-19 outbreak, we experience both fear and
anxiety. Over time, we have become sensitive to its presence around us. At the same time, we are
concerned about our future in many ways under the prevailing uncertain and alarming situation.
One  way  or  another  we  are  experiencing  an  internalized  sense  of  fear  and  anxiety  cultivated
through discourses of fear presented by media, politicians, economists, healthcare professionals,
scientists,  and  people  in  our  neighbourhood  (such  as  our  social  media  network).  For  example,
‘stay at home’ is a message strongly conveyed to protect us from the highly contagious effects of
coronavirus. However, at the same time, this message is a ‘package’ of precautionary measures
and  fears  related  to  coronavirus.  Consequently,  the  way  it  is  communicated  may  cause  Corona
collateral damage syndrome that is caused by the fear of visiting hospitals or healthcare service
centres in the current situation (Stock et al., 2020).

Fear of getting infected by COVID-19 is a learned fear that shatters our sense of

preservation and endangers our survival. On one hand, scientific information about COVID-19,
its  rapid  infection,  incurability,  and  novelty  cause  fear.  On  the  other  hand,  the  media  plays  its
role  in  multiplying  the  fear  by  using  words  such  as  "lethal  virus",  "outbreak",  "alarming
condition".    The  infodemic  of  this  viral  disease  through  different  sources  of  the  media  further
worsens the situation. Thus, the most common reaction of any human to this situation would be
fear, anxiety, and depression which ultimately reflects in their narratives.

Risk Perception

Risk perception is a subjective psychological construct that differs from individual to

individual  and  country  to  country  depending  upon  the  cognitive,  emotional,  social  and  cultural
factor  across  nations  (Douglas  &  Wildavsky,  1983;  Joffe,  2003;  Kasperson  et  al.  1988;
Loewensteinet et al., 2001; Leiserowitz, 2006; Slovic et al., 1982; Sjoberg, 2002; Slovic, 2010;
van  der  Linden,  2015;  2017;  Wildavsky  &  Dake  1990).  Risk  perception  is  a  factor  that  causes
fear in the general public and hence, more risk perception and greater precautionary measures. It
is  a  combination  of  the  cognitive  evaluation  of  the  risk  and  emotional  response  that  often
overcome  or  exaggerates  the  cognitive  evaluation  presenting  fear  as  blocking  rationality  of
situation  or  problem.  Even  though  cognitive  evaluation,  in  this  situation,  depends  a  lot  on
information  sources  and  how  frequently  people  follow  it  for  awareness;  the  risk  perception  is
flooded  by  emotional  responses  in  the  form  of  fear  (LeDoux,  2015;  Loewenstein  et  al.,  2001;
Slovic,  2010).  Risk  perception  depends  upon  several  factors,  such  as  trust  in  the  authority,

PSYCHOSOCIAL CONSTRUCTION OF FEAR AND COVID-19

familiarity, dread of the situation, uncertainty on the part of officials, and personal risk of danger
(Ropeik & Gray, 2002). van der Linden’s (2015; 2017). Risk perception model includes a cluster
of variables that determine the degree to which an individual will perceive the event as a serious
hazard. These variables include: Cultural traditions, emotional and experience traditions, socio-
cultural paradigm and individual differences. Cultural traditions refer to cultural knowledge and
understanding of the risk. Personal experience with the hazard lays the basis of emotional
traditions towards a risk. Cultural magnification of a risk, cultural values, trust, and theory are
socio-cultural cluster variables of risk perception. Gender, personal beliefs, and education level
are individual factors of variation in risk perception. All of these variables holistically determine
how an individual will perceive the risk.

Death Anxiety

Death anxiety prevails in society when death is seen as predestined, and thus leads to fear

of  dying  (Khalek,  2005).  Thanatophobia  is  an  alternative  term  used  for  death  anxiety  that  is
closely connected to the fear of the dying process. Uncertainty about life after death, the pain of
dying, family concerns after death, losing a chance of doing good, and preservation are some of
the fears related to death anxiety. Templer (1970) presented a two-factor theory of death anxiety
suggesting  two  factors  contributing  to  death  anxiety;  a  person’s  mental  health  state  and
experiences  related  to  death  in  real  life.  He  argued  that  the  actual  process  of  death  anxiety  is
more  complex  and  could  not  explain  why  humans  fear  death.  Nevertheless,  in  the  context  of
COVID-19  breakout  there  are  internal  (such  as  risk  perception)  and  external  factors  (such  as
infodemic,  precautionary  measure  campaigns)  which  are  negatively  affecting  the  mental  health
of  people.  With  this  mental  health  status,  people  who  experience  the  disease,  mostly  face
psychologically  and  socially  constructed  death  anxiety.  Many  researchers  used  the  mortality
salience  to  approach  the  study  of  death  anxiety  and  found  that  death  anxiety  causes  several
mental  health  issues  (Menzies  et  al.,  2020;  Strachan  et  al.,  2007).  One  study  used  a  clinical
sample  of  OCD  and  found  that  mortality  salience  leads  to  compulsive  hand-washing.  Death,
reminding doubles the time spent on hand-washing (Menzies & Dar-Nimrod, 2017).

Social Stigma

Another external cause of COVID-19 fear is stigmatization. People experience

discrimination  based  on  their  diagnosis  of  this  infectious  disease.  Stigma  theory  describes
observable discriminating behavior towards a person based on characteristics, such as skin color,
body type, ethnicity, and religion (Goffman, 1984). COVID-19 is not an observable disease, and
we  cannot  say  who  is  infected.  However,  once  diagnosed  with  COVID-19  by  healthcare
professionals,  the  labeling  of  'contagious'  and  stigmatization  begins.  This  is  the  main  reason
people  avoid  hospitals  even  for  a  routine  check-up  or  for  chronic  diseases.  Once  labeled
'affected’, we cultivate the fear of contagion as an expression of avoidance towards the patient.
Earlier studies that reported fear of AIDS explored the fear of contagion as a public response to
stress  by  marginalizing  patients  to  take  extreme  precautions  (Bennett,  1998;  Meisenhelder  &
LaCharite, 1989).
Hence, we have:



Cognitive appraisal of the stressful situation influenced by our active thinking

process and passive learning behavior



Emotional response to the situation that is often triggered by innate fears and

reinforced by irrational thoughts about the external situation



Socio-cultural context where narratives of fears are grounded.

KAUSAR AND QAMAR

There is no sufficient empirical data available on experiences of COVID-19 patients.

There  is  a  dire  need  to  study  the  COVID-19  survivors’  stories,  the  painful  experience  they  go
through,  the  stigmatization  they  faced,  the  rejection  they  endured,  and  the  psychological  crises
they suffer. The purpose of the present study is to explore the psycho-social constructs related to
fear  as  it  appears  in  the  stories  of  COVID-19  survivors.  Keeping  in  mind  the  limitations  of
current lock-down situation and associated risks in Pakistan, we decided to investigate the stories
published in online newspapers pursuing the following research question; How do the COVID-
19 survivors describe the fears they experience during COVID-19?

Method

Research Approach and Sampling Strategy

A qualitative research approach was used to explore the COVID-19 survivor stories

published in online newspapers. A purposive sampling technique (Patton, 2002) was used.

Sample

Twenty-four COVID-19 survivor’s stories from Pakistan, China, South Korea, Argentina,

South Africa, and Nigeria were collected from the e-papers of Arab News, Times Herald,
Express Tribune, Dawn News, India Today, BBC News and Aljazeera News.

Procedure

Using conventional qualitative content analysis, we extracted significant statements from

the  data  relevant  to  the  research  question.  Each  statement  was  read  several  times  to  get  a
familiarity with the description of fear in these narratives. Each verbatim account was used as a
meaning unit; words and phrases to fear were underlined and labeled with pertinent codes. The
codes  were  then  clustered  into  conceptual  categories  (sub-themes)  and  finally,  sub-themes
emerged  into  core  theoretical  categories  (themes).  A  reverse  examination  of  the  data  analysis
was  conducted  using  emerged  themes  as  anchors,  tracing  back  to  the  accounts  for  words  and
phrases  used  by  the  storytellers.  Ambiguities  were  removed  by  both  the  researchers  with  the
consensus on each step of the data analysis. A sample of meaning units and emergent codes were
developed (Table 1).

Ethical Considerations

The survivors’ narratives were in public access so informed consent was not required

from  COVID-19  survivors.  There  was  no  direct  or  indirect  psychological  or  physical  harm
involved  to  the  participants  as  the  narrative  analyses  of  the  COVID-19  survivors’  stories  were
conducted from online newspapers.

Results

Table 1
Content Analysis of Narratives and Examples of Meaning Units and Emerging Codes

Meaning Units

Codes

“I  am  still  ostracized  by  my  family  members,  despite
recovering  from  coronavirus  infection  over  a  month
ago.  Back  in  my  hometown,  people  loathed  my  family
for having contracted the virus. After recovering I have

Family  rejection,  social  rejection,
social  hatred,  family  avoidance,
abandonment

PSYCHOSOCIAL CONSTRUCTION OF FEAR AND COVID-19

Meaning Units

Codes

realized that  people still wanted to  avoid  him. None of
my family members are ready to take me in after I have
recovered  from  the  disease.  Even  my  friends  have
abandoned  me,  except  for  one  who  has  arranged
accommodation for me.” (s10)
“There is a general misconception amongst people that
the  surviving  patients  should  be  avoided.  I  understand
that  people  want  to  avoid  me  and  my  way  of  dealing
with the situation is to ignore them.” (s11)

Avoidance, social rejection

"I couldn't sleep, anxiety invaded the room...
nightmares came, death prowl. I was afraid of dying
without being able to cling on to the hands of my family
and friends, despair overcame me."(s13)

Sleep

disturbance,

anxiety,

nightmares, death anxiety, fear of
dying in isolation, hopelessness

"I could not sleep at all. It lasted for two days. I had to
hold a plastic bag at all times because I kept on
coughing up phlegm. Then my face started swelling. I
was scared I might die alone." (s16)

Sleep disturbance, fear of dying in
isolation

"My children put themselves under great pressure, they
want  to  succeed  at  school.  Their  teachers  give  them
work  as  if  the  situation  were  normal.  The  big  one  is
preparing  for  her  end  of  secondary  school  exam  and  I
see her cry when she can't manage and  I can't hold her
in  my  arms,  console  her,  help  her.  My  morale  is  rock
bottom. I can't stop crying..." (s17)

Great

pressure,

helplessness,

cannot touch children, low morale,
crying

“It was terrible, the days I spent at the hospital, no one
could  come  near  us.  I  could  not  touch  or  kiss  my
children.  At  one  point,  I  contemplated  suicide,  as  the
thought  that  I  have  infected  my  children  weighed
heavily  on  my  mind.   I  would  cry  all  the  time;  I  was
sure I was going to die.” (s1).

Terrible

experience,

isolation,

cannot touch children, suicidal
thoughts, feeling of guilt, crying,
death anxiety

The analysis of the narratives yields four major themes as mentioned in Table 2.

Table 2
COVID-19 Survivors’ Stories: Themes, Sub-themes, and Significant Statements

Themes

Sub-themes

Significant Statements

Risk

Perception

Fear of Contagion

“No one could come near us. I could not touch or kiss
my children.” (s1)

Informed Fear

“I recovered in eight days that should give everyone

KAUSAR AND QAMAR

Themes

Sub-themes

Significant Statements

some hope. This virus is deadly” (s3)

Death Anxiety

Fear of Death

“A sense of death stalking the hospital ward, fear of
dying alone, tearful despair and disarray at home,
solitude, anger and the desire to share, or change their
life”. (s13)

Incurable Disease

“I saw with my own eyes that others failed to recover
and died, which has had a big impact on me."(s23)

Social Stigma

Discrimination

“After recovering I realized that people still wanted to
avoid me. None of my family members were ready to
take me in after I had recovered from the disease.”
(s10)

Exclusion

“My photo was all over the social media and I became
a pariah.”(s8)

Rejection

“.. back in my hometown, people loathed my family for
having contracted the virus." (s10)

Psychological

Crisis

Depression

“It was horrible. I was sad, depressed, every day,” he
said. (s4)

Anxiety

“The pandemic had also caused an increase in anxiety
among the people.” (s11)

Trauma

“The trauma can remain once I get home.” (s4)

Stress

“I may also suffer from anxiety and other psychiatric
issues similar to post-traumatic stress after extended
periods of isolation from loved ones.” (s4)

Isolation

“The hardest parts were the nights, alone with my
fears.” (s14)

Risk Perception

Risk perception is defined as a subjective evaluation of a potential hazard. The first major

theme found is risk perception with  two sub-themes; fear of contagion and informed  fear. One
corona survivor story from Pakistan (s1) said; “No one could come near us. I could not touch or
kiss my children.”  It is fear of contagion; we already know how these viruses transfer through
physical  contact,  human  interactions,  and  by  exposure  to  an  infected  person.  “I  recovered  in
eight days that should give everyone some hope. This virus is deadly” said another survivor (s3)
from Pakistan. The survivors already had knowledge and information about the potential danger.
It was the knowledge of all how lethal and life-threatening this virus is. A resident of Swat, (s12)
narrated “I was initially mentally disturbed at the prospect of a crowded and dirty hospital ward,
but after being admitted, I found the isolation ward to be clean and hygienic.” Health care units,
hospitals, and working staff and professionals are at greater risk of developing the disease as they
are frontline fighters against COVID-19. The participant was initially concerned about potential

PSYCHOSOCIAL CONSTRUCTION OF FEAR AND COVID-19

exposure at the hospital and was mentally disturbed because he perceived himself at a higher
risk.

Death Anxiety

Death anxiety is the second major theme which is defined as the fear of losing your life

when death prevails in society due to infectious disease and a higher number of casualties. The
analyses of 24 narratives showed that one fear was common to all the survivors  which was the
“fear of dying” and the “fear of dying alone”. A survivor from Nigeria described that when she
tested  positive  for  COVID-19  the  first  thing  that came  to  her  mind  was  “Am  I  going  to  die?”,
s24 said that she was feared to be one of the dead people. Survivor (s1) from Pakistan said that
“he  feared  he  would  die”.  Another  survivor  from  South  Korea  (s13)  described  his  terrible
experience as; “A sense of death stalking the hospital ward, fear of dying alone, tearful despair
and disarray at home, solitude, anger and the desire to share or change their life. I was scared
that I might die alone”. The survivor (s13) further said that "I was afraid of dying without being
able to cling on to the hands of my family and friends, despair overcame me". Thus death anxiety
was common amongst all the survivors of COVID-19.

Social Stigma

The third major theme revolves around stigmatization associated with this infectious

disease.  Social  stigma  is  here  meant  to  be  a  biased  attitude  of  society  towards  COVID-19
patients  based  on  their  illness.  Different  stories  from  the  world  revealed  how  people  loath  and
discriminate  against  patients  who  become  infected  with  this  disease.  Even  their  families
abandoned  them  although  they  recovered  from  this  deadly  virus.  A  survivor  from  Pakistan
expressed  his  painful  experience  of  family  rejection  and  social  exclusion  as:  “I  am  still
ostracized  by  my  family  members,  despite  recovering  from  coronavirus  infection  over  a  month
ago.  Back  in  my  hometown,  people  loathed  my  family  for  having  contracted  the  virus.  After
recovering I have realized that people still wanted to avoid me. None of my family members are
ready  to  take  me  in  after  I  have  recovered  from  the  disease.  Even  my  friends  have  abandoned
me, except for one who has arranged accommodation for me” (s10).

Psychological Crisis

Psychological crisis is the fourth and last major theme. Psychological crisis is a state of

mental  illness  when  your  coping  resources  are  insufficient  to  handle  a  traumatic  and  stressful
situation.  Increased  risk  perceptions,  death  anxiety,  family  rejection,  social  exclusion,
stigmatization,  and  avoidance  all  contribute  towards  psychological  crisis.  A  South  Korean
survivor (s13) said, "I couldn't sleep, anxiety invaded the room... nightmares came, death prowl.
Alone in  a room”.  A Pakistani  survivor (s3) stated, “I often have nightmares and suffer panic
attacks  after  reading  about  global  casualties  on  social  media”.  A  survivor  (s13)  described  his
pain  as:  “A  sense  of  death  stalking  the  hospital  ward,  fear  of  dying  alone,  tearful  despair  and
disarray at home, solitude, anger and the desire to share, or change their life”. A French woman
said, "My morale is rock bottom. I can't stop crying,” (s17). A Pakistani survivor (s12) said, “It
was not  only painful  but also  very tiresome for  me”. Another survivor (s4) from  South  Africa
stated, “It was horrible. I was sad, depressed, every day”.

KAUSAR AND QAMAR

Figure 1
Codes (words used) Corresponding Fears

Discussion

There have been numerous health crises over the centuries, but none affected the world in

the sense COVID-19 has. Quarantine is the only option left to the world for prevention against
coronavirus.  This  virus  has  changed  the  global  picture  and  forced  people  into  social  isolation.
People's  health  is  deteriorating  because  of  the  coronavirus  and  mental  health  because  of
lockdown. Although death is anticipated, no one ever thought of death as much as have in these
few months. People are anxious about their health and their loved ones’ well-being. The concept
of death and dying is universal, but its anxiety is contextual. The recent condition of the global
pandemic  has  created  an  anxiety  that  multiplies  with  the  increased  death  toll  across  the  globe.
The narrators ‘accounts of the fear they experience provides an insight into risk perception, death
anxiety,  social  stigma  and  psychological  crisis  ingrained  in  our  primitive  response  to
unexplained  threats  and  uncertain  situations  (LeDoux,  2015),  unnecessary  worries  (Davey  &
Levy, 1998), distracted focus caused by cognitive biases (Beck, 1995), and emotional contagion
response. This  situation causes  a psychological  crisis  in  which a stressful  or traumatic event  or
experience exceeds our existing coping mechanisms and resources (James & Gilliland, 2012). In
the  current  lockdown  situation,  people  are  at  high  risk  of  developing  psychological  crises
because  their  psychological  conditions  are  internally  and  externally  compromised  by  future
uncertainty,  fear  of  disease  and  death,  family  concerns,  and  perceived  helplessness.  Ultimately
the four themes reported in this article are interconnected and  yield a psycho-social component
of the language that we use when describing fears and traumatic experiences of life.

Risk Perception
• Fear of

Contagion

• Informed Fear

Death Anxiety
• Fear of Death
• Fear of Incurable

Disease

Psychological
Crisis
• Depression
• Trauma
• Anxiety
• Isolation
• Stress

Social Stigma
• Fear of

Discrimination

• Fear of Exclusion
• Fear of Rejection

Fear of contact
Infection
Hygiene concern
Scaring news

Death
Incurable disease
Recovery failure
Life threatening

Suicidal thoughts
Sadness
Panic attacks
Loneliness

Social rejection
Abandonment
Hatred
Avoidance
behaviour

PSYCHOSOCIAL CONSTRUCTION OF FEAR AND COVID-19

Figure 2
Psychosocial Construction of Fear

Content analysis provides a list of expressions and their conceptual categories

(constituting the psycho-social construction of fear) that emerged from the significant statements
of the narrators when they shared their fears.

The given figure (Figure 3) represents the frequency of clusters in different categories of

the themes. It is evident that the psychological crises was the major theme which emerged from
the data. It is also evident that stigmatization and fear of death contributed to the psychological
crises.  Stangl  et  al.  (2019)  provided  a  comprehensive  framework  on  how  the  stigmatization
process is facilitated and driven by social and structural pathways. They highlighted the factors
that  explain  what  the  drivers  and  facilitators  of  such  stigmas  are.  For  example,  drivers  of
stigmatization always exhibit negative traits such as fear of infectious disease, social judgment,
and blame.  In our study, we also  found  drivers of stigmatization such as  fear of contagion  and
fear of getting infected with an incurable disease. So, these negative drivers are further mediated
by facilitators which could be positive or negative, availability or unavailability of the protective
materials in healthcare centers can increase or decrease such stigmatization. These stigmatization
processes  lead  towards  a  range  of  stigma  experiences  i.e.,  lived  experiences,  and  practices  i.e.,
attitudes,  beliefs,  and  actions.  These  stigmatized  behaviors  are  severe  such  as  withholding
benefits  and  facilities  based  on  health  condition,  race,  gender,  and  sexual  orientation,  to
moderate  such  as  verbal  abuse  or  gossiping.  One  of  the  survival  stories  from  Pakistan  reflects
these incidents of discrimination. He reported that even after recovering from illness his family
rejected him. Associative stigma was  experienced by  his  family,  when the family was  verbally
abused and blamed for becoming exposed to the infectious disease i.e., COVID-19. Apart from
the  stigma  experienced  by  him  and  his  family  he  also  experienced  a  range  of  stigma  practices
such  as  social  exclusion  and  rejection  (stereotypes),  discriminatory  behavior  of  people

Death

Incurable Disease

Discrimination

Exclusion

Rejection

Depression

Obsession

Helplessnes

Isolation

Informed Fear

Fear of Contagion

Language of

Fear

Social

Stigma

Psychological

Crisis

Death

Anxiety

Risk

Perception

KAUSAR AND QAMAR

Fear of Contagion

Informed Fear

Fear of Death

Fear of Incurable Disease

Fear of Discrimination

Fear of Exclusion

Fear of Rejection

Isolation

Anxiety

Depression

Trauma

Stree

ept

ion

ath

Anxie

ocial

tigm

syc

hologi

risis

Stress

Psychological

Crisis

Social
Stigma

Death
Anxiety

Risk
Perception

(prejudice), avoidance by family and friends (stigmatized behavior), and loathing by family and
friends (discrimination).

Figure 3
Frequency Chart of Themes and Sub-themes

Figure 3 also clearly depicts that death anxiety was higher among COVID-19 survivors

followed  by  fear  of  stigmatization.  Almost  all  the  survivors’  stories  reflect  this  fear  of  death
termed death  anxiety. Survivors  reported that  the first  thing that came to  their mind when they
tested positive for  COVID-19, was “Are they  going to  die?” The most evident reasons for this
fear of death are the construction of fear by social media, electronic media, and the influence of
this pandemic from  all sources  of information.  One of the survivors  from  Pakistan said that by
hearing the world casualty rates in the news he panicked when he heard about his own positive
diagnosis of coronavirus. He said he was sure he would die too. The media has propagated and
constructed  this  fear  of  death  in  public  by  giving  breaking  news  after  every  hour  about  the
increasing death tolls in the world. Terror management theory (Greenberg, et al., 1997) based on
the work of Ernst Becker, an anthropologist, explains why humans fear death, and what defense
mechanisms  they  used  to  overcome  this  fear.  This  theory  is  based  upon  the  assumption  that
humans  have  a  great  desire  to  be  alive  and  humans  are  cognitive  beings,  and  use  a  different
mechanism  to  buffer  against  this  crippling  fear  of  being  mortal.  Cognitive  abilities  of  human
beings help them overcome this anxiety by accepting cultural worldviews and self-esteem. Belief
in  life  after  death  provides  humans  a  ‘symbolic  immortality’,  which  buffers  death  anxiety  and
tries  to  give  meaning  to  human  existence.  Being  a  useful  member  of  society  also  boosts  self-
esteem  and  gives  hope  that  one  will  be  remembered  with  good  words  after  death  (Greenberg,
2012).  Survivor’s  depiction  of  this  fear  of  death  is  reflected  in  their  stories.  It  greatly  impacts

PSYCHOSOCIAL CONSTRUCTION OF FEAR AND COVID-19

their psychological health and the result was panic attacks, anxiety, depression, and stress, a state
of psychological crisis. Many studies reported this relationship between death anxiety and mental
health conditions such as PTSD (Martz, 2004), depression, anxiety, and stress (Menzies et al.,
2019).

The risk perception of this virus was lower among the survivors of this fatal disease

(Figure  3).  The  huge  number  of  casualties  around  the  globe  also  suggests  a  dire  need  to  study
this risk perception in public regarding this infectious disease (van Bavel et al., 2020). Dryhurst
et  al.  (2020)  argued  that  people’s  perception  of  risk  of  contracting  COVID-19  infection  is  an
important determinant of practicing protective measures. The picture around the globe indicates
that people’s risk perception of this fatal disease is  low. Protection motivation theory (Rogers,
1983) argued that individual adoption of protective behavior for health is dependent upon several
factors of the environment and the individual. These factors either encourage or discourage these
precautionary  measures  influenced  by  a  person’s  cognitive  processes.  A  COVID-19  survivor
from Pakistan greatly undermined this risk by giving ceremonial burial to his brother-in-law, first
COVID-19  patient  in  Pakistan,  and  the  results  were  that  more  than  70  members  of  his  family
including his children and spouse were affected by this disease. Although the authorities warned
him  about  the  expected  risk,  he  refused  by  saying,  “I  have  to  offer  my  responsibilities”,  an
environmental  pressure  generated  by  the  cognitive  process  of  a  sense  of  responsibility.
According  to  the  protection  motivation  model,  he  uses  inhibition  of  action  coping  method  and
does  not  engage  and  adopt  protective  behavior  and  the  consequences  drastically  resulted  in  a
feeling of guilt about infecting his children and helplessness for not being able to take care of his
children.

Conclusion

This research article was an effort to understand the fears and stigma people experience

based on their COVID-19 diagnosis. The corona patients bear double pain; physical pain due to
disease and emotional pain due to social rejection and discrimination. The stigmatization against
COVID-19 should be stopped to help them recover from the psychological crisis they experience
even after recovery. Moreover, life and death are two sides of the same coin. The high number of
casualties around the globe is creating death anxiety. Thus, health care authorities can join hands
with  mental  health  professionals  to  implement  such  programs  against  psychological  crises  and
stigmatization  that  can  help  people  to  go  through  this  difficult  time  with  dignity.  In  this
connection,  understanding  the  language  of  fear  is  important  in  both  the  ways  it  is  conveyed  in
medical and social campaigns to motivate people to stay safe and in the way people express their
fears in their everyday language. Through this study, we conclude, that a socio-linguistic analysis
of the narrative accounts of COVID-19 patients and their caregivers can provide rich data related
to language situated in pandemic contexts.

Implications of the Study

The stories reported in this research paper were taken from different newspapers across

the globe. The sample variation and stories reported provide a global picture of fears related to
COVID-19  among  infected  patients.  Their  description  of  fear  and  content  analysis  provides
useful  findings  and  interconnections  of  different  psychological  constructs  when  they  are  put
together in the conceptualized framework of ‘fear’. We assume that the findings may be useful
for  formative  research  investigating  COVID-19  related  healthcare  issues  and  the  psychological
wellbeing of the patients.

KAUSAR AND QAMAR

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Contribution of Authors

Sr. No. Author

Contribution

Rubina Kauser

Introduction, literature review, methodology, analysis and
discussion

Azher Hameed Qamar

Conceptualization, analysis and discussion