Keeping Mental Equilibrium

Keeping Mental Equilibrium
We are witnessing the largest collective meltdown in our living memory. What toll is it taking on our mental health?

The Clear and Present Danger

Never before in the history of mankind have entire populations felt intense anxiety as left by COVID-19 in its wake as it has scythed through our lives.  There is a need to fully understand the entire spectrum of this anxiety reaction as it relates to every aspect of our current lives. It spares nothing, ranging from our consumption of news, the way we explain it to our children and deal with the shortcomings in our daily necessities which loom greater with the passage of every day. Experts need to disseminate clear strategies for managing, and turning off the anxiety response at least for short periods.

Fully appreciating the extent of the threat, the World Health Organisation has issued a worldwide advisory accepting that the COVID-19 crisis is generating stress throughout the population, around the world.  The comprehensive guidelines prepared by their Department of Mental Health and Substance Use contains a series of messages that can be used in communications to support mental and psychological wellbeing in different target groups during the ongoing pandemic.

This warning could not have come sooner. While the crisis is still in its early stages,  at least in India and in many other parts of the world, its impact on mental wellbeing is amply clear.

The worst possible manifestation of the mental meltdown caused by COVID-19 are reports of suicides appearing in the media. A suspected COVID-19 patient, isolated at the Safdarjang Hospital in New Delhi jumped to his death before he could be treated. In another incident, a 56-year-old man, who suspected he had contracted the coronavirus infection, ended his life in Udupi district of Karnataka by hanging himself. Thomas Schaefer, 54, the finance minister of Germany's Hesse state, is reported to have taken the extreme step apparently because he was becoming "deeply worried" over how to cope with the economic fallout from the coronavirus. He was found on a railway track, dead.  

Coming to Grips with the Mental Epidemic

The pandemic has plunged the world into a state of uncertainty as we face sickness, financial ruin and even death, leading to an entirely new mental health crisis. While the impact of those with existing mental health conditions can only be imagined, even healthy individuals are now vulnerable.

These are times of informational overload as TV, social media, newspapers and family and friends are flooding us with nothing else but COVID-19. The most common emotion faced by all is; fear, anxiety, panic and is making people say or do things which they may not consider appropriate under normal circumstances.

The best example is trying to make people understand lockdown; it is not a social event or a family outing but a dead serious measure to "flatten the curve" of the virus. Everyone cannot handle social isolation or social distancing. While it may appear quite nice for some time, it soon gets boring, restrictive and leads to frayed nerves and bouts of depression. Imagine the mental state of the international students, and their parents, cut off in foreign lands far from their parents and social support structures, worried about surviving the pandemic and also being torn apart mentally by worries for their parents and loved ones.  Initial days of lockdown, people found it difficult to concentrate, work from home, read books or even watch TV; one only searched for the latest update on the virus, it was virus, virus and more of virus and nothing else.

People who are at the frontlines, the health care workers, cannot escape the pandemic when it is their job to be surrounded by it every minute of the workday.  Social stigma is attached to working with infected persons, and housing societies and landlords are ostracising health workers and harassing them. Of course, in India, the government has passed orders that such individuals will be prosecuted. The health workers are vulnerable to infection, and in Spain, over 15 percent of them have already been infected.  One cannot imagine the emotional stress upon the Doctor who has to make the life and death decision while allotting lifesaving ventilators to one patient at the cost of another. Isolated from their family support group because they cannot go home, and fighting against time, they are the most vulnerable group.

After the SARS epidemic in S Korea, 20-25% of the health workers had heightened anxiety, depression and something akin to Post Trauma Stress Disorder.  Once we have defeated COVID-19, the health workers who will emerge from immense mental pressure will require specialist psychiatric care.

Coping Strategies

People want to know how to deal with it, and experts say, "Stay positive, stay busy, make a schedule and follow it, be involved in the housework and distract yourself from negative emotions by listening to music, reading, watching entertaining programmes, reviving hobbies etc." As per Dr Amir Khan,GP, NHS UK , “Take control over your mind and have a clear structure for your day, allowing worry only at certain times.” Under the circumstances, being distracted, fearful, worried is a normal and understandable situation, albeit a totally new one. How to cope with it?  There are few fears which are universal and common to all; Am I going to catch it? Will my job survive the pandemic? Experts recommend three levels; get your nerves under control, respond to the situation rather than react and do not let lack of knowledge compound your fears.  If we are aware as to how we are going to keep ourselves safe, that knowledge itself is very empowering. Breathing exercises, meditation, yoga, restricting your screen time and the amount of information you are exposed to can be the key to your mental health. Apps, online games and social media platforms are connecting people with friends and support groups, reaching out to vulnerable segments and creating self-help groups. Mobile applications are playing a big role in remote counselling as the existing number of mental health workers are unable to meet the rising demand. Some useful apps in use are Moodkit and Moodnotes, Pacifica and Wysa (created by a Bangalore based company)

The biggest challenge to mental health care is the inability to provide face to face counselling and group therapy. Thankfully, science has a partial solution. AI has enabled remote diagnosis and monitoring.  Researchers in the University of Colorado Boulders are applying machine learning AI to psychiatry.  A speech activated mobile app would be able to categorise a patient as per his/ her mental health state. Peter Foltz, a research professor at the Institute of Cognitive Science, said: "We are not in any way trying to replace clinicians, but we do believe we can create tools that will allow them to better monitor their patients.”

Assessment

  • We must not forget that China and other countries have shown that most of the population remains unaffected and even amongst the affected, only a small percentage got serious enough to be admitted and few die. Most of the people would be fine.  So we have to mentally tell ourselves that we are going to safely emerge out of this pandemic, as long as we adhere to the basic norms of social distancing and self-hygiene.   

  • We are experiencing a phase of change, a phase of disruption, uncertainty and even little panic. With the passage of time, as we settle down in our new routines, we will regain our mental equilibrium and mental wellbeing.  We need to take inspiration from the frontline workers who are stoically and with so much equanimity going about their life saving work. Like the health workers, we too need to adapt to an altruistic frame of mind; how can each one of us visualise our contribution in the larger framework against COVID-19.

  • The human race is resilient; that is how it has not only survived but risen in primacy to rule the planet. It will emerge from this crisis successfully as it always has down the millennia.   

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