Coronavirus outbreak poses rising mental health concerns, as experts develop therapeutic frameworks to meet the challenge
Unfortunate outbreaks like the coronavirus pandemic are a lesson into public ableism as they provide an empathetic window into the lives of those who already live with psychiatric problems such as severe hypochondriasis (also known as illness anxiety disorder) and obsessive compulsive disorder.
“It has been two weeks now since I have stepped out of the house. It feels like some unknown monster is lurking outside who will get you if he sees you,” says 27-year-old Niharika, the stress in her voice communicating itself over phone. As if struggling with anxiety for two years weren’t distressing enough, the coronavirus pandemic has brought new fears for Niharika to deal with. “I’m following the news, keeping up with prevention measures… but I can’t take my mind off this. I don’t think anyone can.”
As the official number of confirmed cases in India continues to rise, the coronavirus outbreak has also penetrated the public psyche. Like Niharika, many are under its influence, fighting anxiety that comes in various forms. Earlier this month, the World Health Organisation (WHO) released a document addressing psychosocial concerns during the upsurge, advising both the general population as well as healthcare professionals to keep a constant check on psychological distress.
“Pandemics were not simply about some virus infecting people. Pandemics were caused and contained by the way that people behaved, writes Steven Taylor, a clinical psychologist and the author of the book, The Psychology of Pandemics. “In previous pandemics there was racism, panic-buying, the rush of the ‘worried well’ crowding into hospitals, and people becoming distressed about self-isolation and other forms of social distancing. It became apparent that psychology was extremely important in understanding how people cope or react to the threat of pandemic infection.”
For India, the dichotomy is complex: while panic is on the rise with instances of hoarding supplies and racism, there is also a persistent ignorance amongst people about the gravity of the situation where people have violated curfews or have fueled misinformation on social media.
While panicking irrationally may result in further distress, Anjali Nair, a psychotherapist based out of Mumbai considers the importance of placing the panic in a context of deprivation. “People are trying their best to stay afloat and find some sense of safety. Unfortunately, the disadvantaged sections suffer the most. Panic places pressure to take some action, although delayed. Then again, how to sustain adherence to this prevention becomes a challenge. Here, state-sponsored, credible sources of information are required. Inaccurate sources of information are on the rise and this is harmful.”
“Our brain is wired to deal with threats by activating the fight-or-flight system. The current pandemic is a very real, visible threat so it has collectively triggered this system driving us to take measures that include hoarding, fortifying or even express hostility towards others,” says Prachi S Vaish, a clinical psychologist based in Lucknow who establishes that there is no one reasonable way in which we can expect people to react. “Those on the flight response would feel more anxious because it feels too scary to just sit and do nothing,” she says, noting that another response could be: “Some people, overwhelmed by the fear, may use denial as a defense against this anxiety and shall try to convince themselves and others that this is ‘no big deal’.
Anxiety and depressive mood associated with viral illness is evident during such times as noted by numerous studies done in the past. The factors precipitating to this distress caused by social distancing and isolation intersect with the subjective environment of the individual. Vaish exemplifies this connection saying, “One morning, I woke up to a text from a client mentioning how this panic has intensified anxiety about the things he is currently struggling with in life. Somebody who has no choice but to stay isolated with an abusive partner or someone who is agoraphobic and finds relief in taking a walk outside experiences additional hopelessness”.
Nair stresses on socio-political factors that exacerbate the existing psychological crisis. “I believe that an abnormal reaction to an abnormal situation is absolutely normal. But given how testing itself is not accessible enough or being carried out adequately, mental wellbeing of people is extremely concerning. Efforts to provide psychosocial support are limited to urban belts and those with technology,” she notes.
Unfortunate outbreaks like these are a lesson into public ableism as they provide an empathetic window into the lives of those who already live with psychiatric problems such as severe hypochondriasis (also known as illness anxiety disorder) and obsessive compulsive disorder (OCD), a well-known subtype of which involves compulsive cleaning and washing. Dr Anirudh Kala, a psychiatrist and author based in Ludhiana shared his insight over the ways in which the coronavirus pandemic may increase difficulties both for people dealing with existing psychiatric problems and for professionals seeing a high volume of cases:
“Hundreds of thousands of persons with mental illness attend hospital and clinic-based psychiatry OPDs scattered all over the country. I’ve been informed that many persons with anxiety disorders and obsessive compulsive disorders are already showing worsening [symptoms] because of the coronavirus scare and the saturated media coverage,” Dr Kala says.
He also notes that “most psychotropic medications are restricted medicines which are not available at chemists; those for addiction treatment are only available at licensed government and private premises. Stoppage of medication in any of these two categories will lead to almost certain relapse. While telephonic consultations should be used it may not be possible for those who go to government hospitals where a doctor sees hundreds of patients in a day with no computerised records.”
With the likelihood of psychiatric emergencies increasing, steps taken on systemic levels must be prioritised. “OPD timings could be staggered from one shift to three to prevent overcrowding with necessary precautions against transmission such as masks, sanitisation and distancing. Senior doctors should be posted at all emergency units to cater to mental health emergencies,” Dr Kala suggests. “Secondly, temporary flexibility for dispensing of medications for refilling, at private and public settings and remote consultations, should be maintained.”
As concerns over mental health in response to the pandemic are rising, ways to develop therapeutic frameworks have become one of priorities. Vaish has introduced an open form to record the experiences of people about the growing pandemic. “The best way to deal with this is to break the circuit that is activating fight-or-flight. Conscious breathing is the best way to do this. If you feel the panic rising, just stop everything and for 20 minutes just take deep breaths that go down to your stomach (also known as diaphragm breathing).”
Other than relaxation, Vaish suggests evidence-based personal care that includes self-introspection. “Anxiety makes us immerse ourselves in the news and ponder over the crisis. This needs to be controlled by challenging our thoughts — asking yourself ‘Am I really unsafe? Or am I feeling unsafe?’ Our sense of safety can be threatened by ruminating over what could go wrong. It is important to differentiate between solving problems and complying with collective prevention. It would help to direct your thoughts, reflecting that you don’t need to solve the problem but to do as you’re told.”
Responding to the coronavirus outbreak, mental healthcare — like many other professions — have shifted to the online/telephonic mode. Taking into account the inaccessibility of proper care and fewer numbers of professionals on the forefront, Nair believes that traditional methods of psychological interventions remain largely inadequate.
Along with her colleague and a fellow psychotherapist, Lamia Bagasrawala, she is holding an online support group for building individual and community resources to survive the consequences of COVID-19 .
“A situation like this is new and the uncertainty is overwhelming for many,” Bagasrawala and Nair say. “We weekly share a learning platform that brings together individuals experiencing a common distress, concerns or challenges with the aim of co-creating resources and an online safe space that is designed to create space for individuals in order to support collective reflection, build knowledge, perspectives and strengthen hope within the larger social-political context.” As facilitators the two are hoping to collate and document their own experiences as mental health professionals who are navigating through these unprecedented experiences within this time.
Talking about people’s responses to their initiative they observed, “The participants have found these spaces to be helpful in not only recognising their own resources and skills needed to manage the situation but also realising that everyone’s challenges may play out differently and therefore self-care and support may look different too. As they navigated through the many challenges that they face amidst the COVID-19 crisis, they also found hope in each other’s stories.”
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