We are on lockdown! Wash your hands! Stay Inside! The anxiety is palpable. We are working from home, the delivery guy this morning had gloves on and a mask, there’s a shortage of hand sanitizer, restaurants and bars have shut down, every time you drive out, cops are asking if the trip is worth the risk. My friends are now voices on a phone, pixels on a screen. In order for humanity to endure, humans must isolate themselves from humans. What was normal, is now dangerous. Is it any wonder that mental health in the time of COVID-19 is a trending topic? Mental health coronavirus challenges is what I will spend this article on.
What has been severely lacking in the discourse is relevant information on supporting those that already struggle with mental health challenges/conditions like anxiety or depression. The sense of isolation, the anxiety, the sadness, the terror that we are now feeling as one across the world, have been the normal experience to battle for those with preconditions. Social isolation has been a concern for this group of people, and as mental health professionals, we try to support them to come out of it, to build up their internal resources so that the benefits of socialising can be reaped. We are now in a world where social isolation is the only way to protect ourselves and others. For those with depression, it is like prescribing the poison, not the antidote.
Possibly the most anxiety provoking and unnerving aspect of it is that it is indefinite.
Realistically, this is going to last a while, and it's not going to get easier. There may be breaks along the way, but for now it seems pretty downhill. These feelings are just going to rise and it has the potential to be catastrophic for those already struggling.
I’d like to stop here for a moment and just talk to you about what social isolation can do, just in case you aren’t following all those sources posting about mental health.
Regardless of the causes of social isolation and the groups who are affected by it, being alone is not good for one’s mental and physical health.
Being alone most of the time is associated with increased weight, poorer diet, decreased exercise, alcohol abuse, greater risk of sickness, and even a shorter life span. Cognitive functions decline, possibly as a result of a few verbal interactions. Added to this is the emotional pain of being lonely.
Social isolation is not just loneliness, it is also the habits that we now have to adopt. Screen time for the average individual is already on the rise due to work from home conditions and will only increase as the lockdown continues. This has already been previously linked to anxiety, depression, insomnia, and an inability to focus. To those already struggling with mental health, this could exacerbate the symptoms.
The thing with depression is that a lot of high functioning people have it and they are majorly at risk right now. What supports highly functional depressive people is having a routine, places to go, things to do, people relying on them. Most of that has now been taken away. What about the ones that were a few steps away from socially isolating themselves anyway? It’s like a push into an abyss they were probably struggling to not fall into.
Then there’s the geriatric crowd. Oh boy. Their isolation is already a matter of fact and this brave new world is probably a hell scape for some of them. With limited mobility, and limited support, they will be struggling. They are at high risk for depression if they don't already have it.
The other thing with depression is that people can’t just “snap out of it”. It affects thoughts, behaviour, and physical health. Hormone levels are different, the neural pathways in the brain have been altered, and there is literal emotional pain in organs and limbs. Just because pain is emotional does not mean it isn’t being felt. We, as a species, have worked too hard to separate the body and the mind when in reality, they’re inextricable. How do you know you're nervous? Your body will tell you with increased heart rate, that rising feeling in your chest, sweating, jitteriness, etc. That’s the triumvirate right there, you’ve got the body (sensations felt), the feelings/emotions (nervousness), and the mind (inability to think, blurting out words, shutting down). Once this basic idea makes sense to you, you’ve already accomplished step one of being a caregiver which is empathy and understanding. With that mindset, here are some thoughts to bear in mind and some ideas for supporting those with depression or anxiety around you:
- Since isolation is the concern, reducing that with technology is a good start. Communication is important. Use apps like Houseparty, Skype, Zoom to have conversations. Set up calls and check-ins. There are so many online games that can be played together, no matter what part of the world you’re in. For example words with friends, psych, Fortnite. Set up online activities to do together.
- Rumination (repetitive self-critical thoughts) is something to watch out for with depression and is best countered by engaging, distracting activities. Perhaps you can support your friend/family member to reach out when rumination gets bad.
- Organising and preparing for the day can be useful morning activities. In India, the middle class and the privileged are used to having daily chores outsourced and this is no longer viable. Support your friends/family to organise their day around meals and cleaning up, doing the dishes, dusting, etc.
- Support the person to do just five small tasks in a day – one should be something social (maybe texting a friend/speaking on the phone to someone for a few minutes), one can be something for self-care like brushing or bathing (these are very tell-tale signs of neglecting self-care that is characteristic of those struggling with their mental health).
- Discourage alcohol and drug use. While intoxication may seem desirable, the after effects make the symptoms worse amongst other health problems that could be caused.
- The important thing to remember is that if one’s eating, sleeping, and exercising is managed on a daily basis, their mental health will be more stable. There are times when these are not adequately managed and that’s okay, there is no need to panic. It’s comforting to note that the way out is often by forcing oneself to do these very simple daily things.
- Support them to stretch or exercise with you over video if you can not be with them.
- It is important to remember that those with depression will often reject support. Persevere, even if they don’t pick up your call, try again later but be mindful of not nagging or overwhelming them.
- Encourage them to continue with therapy or to get support as most therapists have now gone online. iCall from TISS has a crowd sourced list of therapists you can find here. They also have a helpline – in case you find the person is withdrawing further, encourage them to make the call or to write in. It is free.
- Creative endeavours are always useful, try supporting them to start quilling, or drawing, learn stippling, painting, paper mache, writing, whatever catches their fancy. Do it with them
- Puzzles and games keep the mind challenged, maybe send them a riddle a day or start an online game of chess. Technology is a wonderous thing if used well.
- Remind them to get some sun – Vitamin D deficiency is linked to low moods.
- Reading helps, have them read out loud to you or vice versa.
According to the SANE report, almost all people with mental health challenges consider social relationships important in helping them manage their symptoms and improve the quality of their life. They said that simply having someone to talk to about how they feel is critical to their feeling better. It doesn’t take many people to diminish the loneliness of an individual. It just takes one.
The views expressed are the author's own.