12 MIN READ
As a mental health crisis unravels on many fronts, how do we cope?
In conversations over text, a close friend expresses how a feeling of heavy but diffused sadness has pervaded their life in recent days. They cannot quite put their finger on it. Apart from being at home with family, they have a household well-stocked with food, soap and sanitizers. They are working from home, which means they will continue to earn over the course of this indefinite lockdown. For now, they are safer from the coronavirus than many others. Nevertheless, the feeling persists.
“You are probably feeling grief,” I give their emotion a name.
Even before the coronavirus had turned into a health crisis of unprecedented proportions and was declared a global pandemic, its mental health implications were gnawing at my brain. I had only recently realized that any kind of crisis at some point turns into a mental health crisis.
While medical and financial interventions are heavily discussed, individual precautions are just as crucial to combat the COVID-19 disease. But any response efforts that do not include an intervention on the mental health front will undoubtedly fall short.
Many people already know this. Along with information on precautionary measures and the overwhelming barrage of near-apocalyptic news, there have been posters, pamphlets and writings on how to cope with stress and anxiety that have circulated widely on social media platforms.
Those of you who are reading this, at least for the moment, are likely to be safe from immediate harm’s way. Many may not have as yet contracted the virus, nor experienced the loss of a loved one. And yet many, like my friend, may be experiencing grief. It may seem like an exaggerated response to your current state, but it is not.
In a recent op-ed, therapist Lori Gottlieb refers to the smaller losses we experience which may be less obvious, but which still have an indelible impact on our emotional health. A canceled birthday party, a postponed wedding, a deferred date, and restricted physical access to friends and family may all seem trivial compared to the more pressing dangers of coronavirus, but they are also common experiences of loss for people of all ages. Gottlieb says there is no hierarchy of grief, and to compare one person’s grief to another’s and to deem it illegitimate doesn’t help.
While small losses can accumulate and erode our sense of wellbeing, our everyday lives have also been completely overhauled. Minute, ordinary actions have taken on heightened significance. Pre-corona, when was the last time you paid so much attention to the way you washed your hands, or took note of doorknobs, switches, elevator buttons and keys as you touched them? Many of us may have found ourselves thinking about the worst-case scenarios as we have drastically changed the way we manoeuvre through everyday life. Ironically, playing out the worst-case scenario has been the most effective way to shock and rewire our nervous system into a state of hypervigilance that will keep that very scenario at bay in real life. But imagining such scenarios and living them out in our minds on a regular basis can nevertheless account for very real stress, anxiety and trauma.
Even as we try to prevent the worst from happening, the future has never looked so bleak and uncertain. Entire nations are shut. A third of the world’s population is under lockdown. The few people who risk venturing out are all wearing masks, creating an ominous aura over sparse cityscapes. The number of confirmed cases is slowly rising in Nepal as the global count of deaths increases overnight. The coronavirus is all that news outlets seem to talk about. It is all anyone seems to talk about. A tiny glimmer of hope lies in the daily rise of recoveries.
It is day two of the nationwide lockdown in Nepal, and I have invited some Kathmandu-based therapists I know for an online chat to discuss mental health implications of the corona outbreak and to chart possible response measures. I am eager to understand what’s happening, and what may happen, better. Our meeting begins with how everyone is doing. They talk slowly, pausing, taking time to reflect on their situations, sharing how their lives, too, have significantly altered in the past week.
All of them agree that grappling with future uncertainty can create feelings of helplessness. And because people like being in control, they will try to find or simulate situations that help them feel like they are. Stockpiling food, masks and sanitizers, as many have done, is one way of regaining some measure of control over one’s life. But uncertainty is a necessary and inevitable part of life, and a situation like this can also provide an opportunity to reassess our relationship with an uncertain future. As I listen to them, I suddenly become self-conscious: arranging this meeting with a group of mental health experts has been my way of combating helplessness as well, a way of establishing some semblance of control over a situation shrouded in uncertainty.
They also agree how important self-care is at a moment like this. One of them shares how, aside from catering to clients, many of whom have reported an increase in anxiety due to the pandemic, they’ve been busy at home taking care of family. Another shares how they’ve finally started painting their room, a long-held desire that hadn’t had a chance to manifest until now. I can slowly feel this languid conversation - which addresses the underlying gravity of the situation with moments of introspection, humour and levity - putting me and my sense of urgency at ease.
By now, at a biochemical level, our bodies have already sensed danger. This activates our sympathetic nervous system which initiates our body’s fight or flight response. While our ancestors relied on the release of stress hormones such as cortisol to flee physical danger or fight back, we are expected to defend ourselves against an insidious enemy by washing our hands and staying put at home. According to Bessel van der Kolk, trauma expert and professor of psychiatry at Boston University School of Medicine, in such conditions, stress hormones which are otherwise incredibly useful cannot discharge themselves through action, and instead start accumulating within our bodies, wreaking havoc. The precautionary expectations placed on us right now, which keep us mostly indoors and sedentary, can exacerbate the level of stress and anxiety we experience.
The corona pandemic notwithstanding, people’s capacity to cope with stressors is often already stretched because of the upheavals of everyday life. Additionally, the source of anxiety may not always be the virus itself. The extreme measures being taken to contain it combine with existing injustices in a way that can exponentially increase the trauma people are already living with.
The Guardian reports that for women, children and those in emotionally and physically abusive relationships, lockdowns in Hubei (China), Italy, Spain and Brazil resulted in increased duress under quarantine. When I called the Asha Crisis Center's hotline for domestic violence on Friday, I was informed that so far, they haven’t received calls from lockdown-related victims. Although we do not have more precise data from Nepal, news of domestic abuse during the lockdown has been springing up, suggesting that cases are rising, even as they may go unreported.
Numerous media analyses also report the pandemic is going to hit developing countries particularly hard. Within these countries it will be skilled and unskilled manual labourers and the poorest, often homeless or those living in cramped slums, who will suffer the most. With no access to clean water, health services or job security, these individuals are not only physically more vulnerable to the virus, but will also experience the most devastating impact in terms of psychological and mental wellbeing.
The plethora of interventions, whether they be posters and information circulating on our social media feeds that encourage us to breathe or exercise, or the many online creative projects such as reading clubs, yoga classes, discussion forums, doodling groups, dance parties and journaling workshops that have cropped up in response to nationwide lockdowns are beyond the reach of those without smartphones or high speed internet.
But for people who are chronically under financial stress and find their pockets pinched even further, these interventions may not necessarily be as useful. One idea that my therapist friends stress is how we cannot alleviate trauma and suffering caused by systemic injustices by simply asking people to breathe. To ensure financial security of those who need it most is a mental health intervention of paramount importance during this pandemic.
Another particularly vulnerable group cornered into risk and anxiety that cannot be managed by breathing exercises alone is our medical community. Because of prolonged and repeated exposure to Covid19 patients, doctors, nurses and others employed in hospitals and medical centres are more prone to contracting the virus.
“We haven’t been provided basic protection,” says a Kathmandu-based medical doctor over a WhatsApp conversation. “I took my own surgical mask to my last shift. Acquiring personal protection equipment is a dream for many hospitals. And nobody is following WHO protection criteria. Everywhere, doctors are organizing small protests against the administration.”
I ask them how that makes them feel. “Anxious.”
They admit that with the current low number of Covid19 patients in Kathmandu, the full gravity of what will unfold hasn’t hit the medical community yet, although many have already begun to panic.
“We have predicted an outcome based on the trend in other countries, none of which has been good. Maybe that makes me and many like me anxious. This is compounded by the fact that no one feels safe because basic requirements haven’t been met,” they tell me.
Having worked through the dengue outbreak that hit Kathmandu last year, the doctor says this health emergency is different from other endemic diseases the medical community here has dealt with. One very real concern for most is of potentially transmitting the virus to their families and loved ones.
While medical professionals prepare to work on the front line of this crisis, we may have to brace ourselves for the possibility that things may never return to normal, at least not in the way that we’ve been used to.
It is day seven of the lockdown and the skies above Kathmandu are daringly blue. The call of birds other than crows and pigeons is finally audible. Towards the north, pristine mountaintops glisten; the smoggy distance between us has vanished and they look as if within an arm’s reach. Kathmandu looks eerily beautiful. A part of me feels like it could get used to this, even as another part knows the earth and the sky are breathing at the cost of many people’s livelihoods.
I feel torn between the need to simultaneously be hypervigilant and stay calm, to pause and act urgently, to self-isolate and stay connected, to prioritize self-care and be mindful of the condition of others. Finding balances of several kinds appears to be the call of the moment. It feels incredibly difficult.
As we begin reconciling with our small losses and readjust to a new kind of normal, the worst is yet to come. So far, Nepal has had zero official coronavirus related deaths. But sooner or later this will change.
On Friday, a video of a British man struggling to cope with his mother’s sudden death due to Covid19 began to surface on news websites. In tears, Stuart Hamlin says, “Losing someone is hard enough, but not being able to hold your family close when you do is the most gut-wrenching pain I’ve ever felt in my life.”
Since traditional ways of socialising and seeking emotional support are no longer viable, we will have to learn new ways to cope with the loss of loved ones, invent uncharted pathways for bereavement. Grief will add on to grief. Trauma may pile on insurmountable trauma. Staying connected with people you trust, forging meaningful online communities, ensuring you aren’t alone even in the midst of physical isolation may become more important than ever before.
We will be sitting around, waiting a lot. Waiting as the number of confirmed cases rises. Waiting as the number of deaths rises. Waiting for tests and for results. Waiting for sickness and recovery. Waiting for things to get better, for all of this to end.
As professor van der Kolk notes, just waiting around, not being able to contribute to the safety and wellbeing of others can accentuate our own anxieties. He talks of the phenomenon of people getting out there and helping each other in times of crisis - the response of the public to Nepal’s earthquake is a case in point - and how that physical involvement is a kind of “antidote to the helplessness of the situation, which is so manifest”.
“I think trauma really does confront you with the best and the worst. You see the horrendous things that people do to each other, but you also see resiliency, the power of love, the power of caring, the power of commitment, the power of commitment to oneself, (to) the knowledge that there are things that are larger than our individual survival,” says van der Kolk.
At this point, we do not have the option of getting out there. As we wait, we may have to find ever more creative ways to help ourselves, others around us, and those for whom the coronavirus has much more far-reaching consequences.
Below is a list of services being offered by mental health professionals in Nepal:
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