“It has been 5 weeks already. I don’t know how to take care of my kids and continue working from home. Besides, my parents and my husband are stranded at different locations and I hardly get to talk to them due to network difficulties. I don’t know how many more days I can continue like this…”
“Even things like food and groceries are so difficult to get. Every time I go out, I am afraid and guilty that I might bring the infection home. I could not contact my superiors at work for quite some time. I am even unsure of my job. I just don’t know what I am going to do if I lose it…”
Such excerpts are quite common in the conversations that we’ve been having with our clients over the last one month. This ranges from loneliness, job insecurity, safety of oneself and one’s family, apprehension about the infection and finally basic requirements like food and personal safety. The nationwide lockdown imposed roughly three weeks back in an attempt to contain the Coronavirus disease 2019 (COVID-19) has been a necessary but sudden ‘psychological experiment’ for the masses. Such an unprecedented situation was totally unprepared for, as billions stay isolated in the confinement of their homes either quarantined alone or with their family.
The COVID 19 pandemic has quickly emerged into a global public health threat, swiftly bringing down the world to its knees. With more than two million affected all over and more than twenty thousand in India alone, the numbers are rising as we speak. In the absence of a biological cure so far or a vaccine, the three-pronged strategy by the World Health Organisation (social distancing, hand and respiratory hygiene) stands as most effective to fight the virus. The infection is highly contagious, with very high human-human transmission. The lockdown might have staggered the growth, but we do not know the aftermath that lies beyond.
The most worrisome crisis of such situations is beyond just the physical health: it is the mass-hysteria, chaos and uncertainty that follows such a biological disaster.
Pandemics are far from just medical phenomena. They affect us socially at a large, having immense psycho-social impact.
Economies get slashed, travel restricted, borders closed, jobs uncertain, interpersonal relationships strained and what not. Most importantly, the essential aspect of human life is disrupted, ‘a daily structure’. Though work from home has been a justified replacement for many, it’s far from ideal with its own unique challenges.
Isolated away and devoid of social meetings, loneliness becomes rampant which can give rise to stress and eventually mental disorders.
Panic related to essentials, travel and the pandemic itself gives rise to health anxiety, unnecessary hoarding of medical equipment, increase in misinformation and a nation-wide state of chaos. Those with already pre-existing mental health disorders tend to miss medications, reviews and hospital visits with exacerbation in illnesses like depression, psychosis, obsessive compulsive disorder, panic disorder, generalised anxiety, etc. The chronic stress created by the pandemic crisis and consequential lockdown can arouse fear and apprehension, igniting somatoform disorders, illness anxiety, chronic stress, insomnia which in the long run can lead to adjustment and post-traumatic stress disorders. Ironically, when the whole world is struggling to deal with the statistics of the infection and chasing an effective anti-viral to pursue the cure, the mental health aspects of this growing pandemic, no matter how ominous, are largely neglected.
Lessons from previous pandemics like the Spanish Flu, Asiatic Cholera, Severe Acute Respiratory Syndrome (SARS) and Influenza outbreak have taught us that the psycho-social effects form the central-most part of the public health impact.
Unpreparedness for such crises can further snowball distress and eventually it is the public-chaos that exerts pressure on the already overburdened health-system in a populous country like India.
Following are some of the effects we need to be worried about:
Chronic stress, fear, apprehension and anxiety related to the pandemic (‘a new illness with an unknown cure’)
Increase in Obsessive compulsive symptoms secondary to repeated instructions of rigorous hand washing and hoarding of essentials (this can lead to competition in health care, public agitation and violence). It further contributes to ‘self-medicating’, with harmful effects.
People who are quarantined can face loneliness, anxiety and depression. Isolation itself is also a risk factor for same. Loneliness is a known contributor to many mental disorders.
At the initiation of lockdown, alcohol withdrawal symptoms were on the rise with increase in Delirium Tremens, one of the known complications of sudden alcohol stoppage in chronic users, that can be potentially fatal if untreated.
Rise in suicides occur due to the fear and guilt of contracting the infection, craving for substances in addiction problems and loneliness. Multiple such cases have already been reported in Kerala, Andhra Pradesh, Tamil Nadu, Bihar, Maharashtra, Gujarat and Delhi.
There have been marked increase in child-marriages, domestic and elder abuse in families as many members have been forced to be stranded together for increased times, where these social evils were perhaps pre-existing.
Uncertainties of job, fear of unemployment, work-life balance, risk of infecting the families and worry about livelihood in the aftermath of the lockdown are major concerns as multiple small-scale industries have shut down with steep rise in unemployment, especially in the private sectors.
Social disconnection, an essential component of human survival, has been distorted by the lockdown, that makes us more segregated and ‘by ourselves’ at such difficult times.
Excessive use of technology leading to COVID-19 turning into ‘infodemic’, as people are glued to social or digital media consistently, being fed with plethora of statistics each day about the outbreak. This gives rise to panic, tension and misinformation that can further impact the precautionary measures and lead to faulty treatments based on ‘faith and belief’. Such rumour mongering can often snowball, affecting millions in a short span of time.
Finally, the vulnerable population like the children and elderly have unique challenges altogether. They can suffer much more from isolation, cut off from their social circles.
Children tend to lose routine and stay at a risk for academic decline and technology addiction, while seniors are stigmatised and lonely, already being physically susceptible to the virus.
Certain other marginalised groups like the homeless, daily-wage workers and migrants have very different mental health needs as ‘distancing’ means little in their overcrowded and impoverished places.
Basic living amenities, shelter and dignity become the prime necessities, as hunger is a bigger fear than COVID-19 for them.
So, here we have presented a plethora of challenges that can occur during this pandemic. As the lockdown progresses, these unique problems tend to grip us all the more. None of us are sure about the fate of this outbreak or the aftermath of the lockdown. Mental unrest can not only affect the quality of life, but also impact immunity indirectly increasing the vulnerability to the virus. What can be done in such dire situations?
Take Care Of Yourself
Loving oneself and taking the necessary precautions is probably the best first step. Respecting the lockdown and following the hygiene measures can help you stay well and also prevent infection-spread to others. Safety tends to bring about a lot of mental peace.
Physical But Not Social Distancing
Please stay connected with your loved ones, it is vital for your mental strength. Digital connections, increasing daily, can make you feel that ‘you are not alone in this’. Even a casual chat with your neighbour or friend from your balcony or exchanging a simple smile goes a long way in sharing comfort when everybody shares similar anxiety.
Personal Growth
Let us use this ‘locked down’ time to its best. It has been long that we have spent enough time with ourselves or with our families, isn’t it! Let us take time off from the ‘digital screen’ and involve ourselves with our parents and children. Relationships can be mended, hobbies can be revised, new skills can be nurtured: whatever way we grow, is retained beyond this pandemic. COVID-19 has ultimately given us a chance to have a new angle to life, let us live it while we stay confined to our homes.
Distance From Social Media
The virus has hijacked our daily lives much more than our bodies, courtesy the social media. It hasn’t been a day for the last two months that memes, forward, messages or videos were not related to COVID-19 content. As much as staying updated about the pandemic situation is important at such times, bulk data about cases, fatalities and other stuff related to outbreak makes little sense to the masses.
The content is mostly portrayed as ‘threatening’ and constant consumption will just add to the already existing fear and tension.
Get involved with yourself more than the media. Use authentic sources of public health information like the WHO or CDC websites.
Structure And Discipline Your Day
Scheduling your daily life is extremely important. None of us have been used to these times and having an indoor structure to your day helps in organising your work. This helps work-life balance and your personal chores, preventing them from overlapping. Maintain the habit of exercises or Yoga indoors and if possible daily walking in your proximity, definitely with the necessary precautions. Also have a healthy diet and timely sleep. Please avoid discussing COVID-19 related news late in the day, as that often hampers sleep. All these healthy habits eventually add to your immunity, which is all the more essential now.
Take Care Of The Vulnerable
Elders need to be involved in decision making, precautions explained, and safety ensured. Any form of stigma related to ‘ageism’ is best prevented. Children need to have a structure, online classes can be scheduled and continued with parental involvement at home. Their energy has to be channelized through familial participation, with age-appropriate explanation of the crisis situation outside.
Those with mental illness should be taken care of and at the earliest sign of any behavioural distress, please seek relevant help with your physicians.
Various national helplines (NIMHANS, AIIMS, PGI-Chandigarh, etc.) have been operating for this purpose, including the Ministry of Health and Family Welfare (MoHFw). The front-line workers against COVID-19 ranging from health-care staff, the police to the sweepers are at increased physical and psychological risk: they need our support, empathy and help.
Social Integration
We are all together in this. Let us take care of the ones who are less fortunate than us and try to help their needs. Random kindness to persons associated with your daily life like your newspaper vendor, domestic help, security personnel, etc. will not only give them happiness but also help you feel connected and at peace. The touch of humanity is probably all the more crucial during these times.
Take Help If Needed
There are times when we all need help. Let us sensitise ourselves and others in understanding that these are tough times and have never been faced before.
If things get ‘over and above the edge’, please DO NOT hesitate to take help or ask for help in relation to others.
This understanding can help fighting stress and trauma for the greater good. Grief, depression and death wishes are warning signs and need immediate help. Professional help is always available and welcome! Prevent all forms of abuse and report them, if detected!
'COVID' Free Time
Let the virus not infect you psychologically. Please keep some time each day, to enjoy yourself or with your family, keeping the viral threat away from your mind. It is immensely soothing!
Look Forward
The pandemic will eventually cease, and life moves on. Let us think beyond the current threat, beyond just COVID-19. Certain losses cannot surely be revived (like a lost person or a job) but let us use this time in isolation to have some future plans of ‘coming back at it’. Given time, new opportunities will surely rise!
Lastly, let us all accept the stress. It is but natural to feel your nerve tickling during such times, when the world itself is frozen in a viral threat. However, human resilience can be remarkable with mutual support and history has proven that no matter how difficult times can get, humankind and life have always triumphed beyond it. We can keep holding hands all throughout these tough times. Hopefully COVID-19 will resolve in the near future, and we can come out of it stronger and more resilient than ever before.
(Dr Debanjan Banerjee is a psychiatrist with NIMHANS, and Life Fellow, World Association of Mental Health)
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