Expert and WHO consultant Dr Lakshmi Vijayakumar speaks to The Lede about how to keep stress at bay in these trying times
It has been barely a day for the entire country and a few days for many states that have seen a spike in Coronavirus-positive patients. Staying home, working from home, with children around demanding to be amused has already led to some exasperation.
For many, WhatsApp groups of friends and family are on fire – discussing a conspiracy theory on a forwarded message or panicking about whether the world is going to end soon.
Everything has changed in a matter of a few days for everybody in India. It is difficult to venture out for fear of the police booking us. Apartments seem smaller and claustrophobic.
There is an eerie silence on deserted city roads. A cough or a sneeze sends us into waves of panic, wondering whether we have caught the virus after all.
For those in home quarantine, the boredom sets in first and then worry and then constant fear. As is the case with those who have been infected.
And so it is no wonder that experts are alerting authorities to the possibility of a looming mental health crisis as India settles into lockdown with a fast-spreading virus as an invisible Damocles’ sword.
“People are not giving too much importance to mental health right now,” says Dr Lakshmi Vijayakumar, renowned psychiatrist, founder of SNEHA suicide helpline and a consultant with the World Health Organisation (WHO).
When asked about an impending mental health crisis, she agrees it is round the corner. “It is bound to happen and it is already happening,” she says.
Dr Lakshmi goes on to elaborate on how different types of people would react differently to the present situation.
“There are 2-3 categories. The first category is that of people who do not have any kind of existing mental health issues at all. Those people, because of the fear, the uncertainty, the spread and the mortality, experience a higher level of anxiety, worry and depression. This is seen in a majority of the people. At least one-third of them become completely stressed out,” she says.
There is a physical fallout to this mental stress. It reduces the person’s immunity and makes them more susceptible to the virus, she says.
“If you look at the previous epidemics of Ebola or SARS, where studies have been done, we find that 30% of them have what we call PTSD or Post Traumatic Stress Disorder. The research studies that are coming from China show that one third of the general population is exhibiting anxiety symptoms. They did a telephone survey of people in the Wuhan area who are not affected and even among them, one-third had anxiety symptoms. So anxiety, depression and PTSD symptoms are bound to go high in the general population,” she explains.
The second category of people is that of those who are already living with mental health issues.
“Their symptoms are likely to get exacerbated and they may have a relapse,” says Dr Lakshmi. “This is a time when the healthcare system is giving too much time to the physical infection part. People who are already vulnerable can be affected more. Particularly people who are suffering from anxiety, depression. They will be given least priority now so that makes things worse. And this is because they are likely to stop medication since they stop going out and since access to pharmacies may be an issue,” she explains.
“Those who are exposed to the virus are in a state of uncertainty and confusion – for themselves and for their families. Their stress level also goes up,” says Dr Lakshmi.
And it is the same with those who are in quarantine.
“We are all social animals and to be completely quarantined is tough. The fear of getting the virus, contaminating family and friends and the isolation has an impact and stress levels do go up,” she says.
Health workers, including doctors and nurses and other hospital staff who work on frontlines are especially at risk for mental health issues.
“They have an extreme amount of fear,” points out Dr Lakshmi. “The dilemma between your responsibility towards your patients and society versus the responsibility to yourself and your family is constantly there for them. Particularly those who are in the frontlines - studies have shown that their anxiety and depression is very high. So much so that many countries are putting shift systems in place so that one section of people alone doesn’t bear the brunt of it. In Italy there were two cases of suicides of nurses due to sheer stress and fear,” she says.
When queried about what governments and individuals can do to quell stress levels in such times and to ensure that people remain calm, Dr Lakshmi Vijayakumar stated that there were a few ways to mitigate anxiety.
“Studies show that if the government gives accurate figures for your local areas, accurate numbers for help, information on accurate facilities, information on number of infected, what is being done, this helps a lot in keeping people calm,” she says.
As for individuals, we too need to take certain strategic and conscious calls to keep the stress at bay.
“Fortunately, unlike the previous pandemics, we are very connected network-wise now. We have to have judicious use of social media because a lot of rumours are being spread and you have to use social media to connect with your friends. Not for WhatsApp forwards and things like that. Your usage of social media is only to be connected and not to spread rumours,” warns Dr Lakshmi.
“People should stay connected, not physically, but by phone or by WhatsApp. Have a routine for yourself, particularly if you are in isolation. Because a routine always helps reduce anxiety in a human. So tell yourself I have to walk around the house, do these exercises, read the newspaper, give yourself some mental activity, some physical activity and some social activity. Social activity, in terms of digital social activity. This is also probably a good time for people to pick up or learn something that they have not had the time or the ability to do it. People can start cooking, learn a language, draw, paint, learn singing.
With children you have to give them reasonably accurate information but you don’t need to give them gory details. And if you panic, the children will also panic. Now children are used to being completely busy with all kinds of classes so staying at home with parents can be a challenge. For parents too it can be a challenge. You have to have some family moments and then let your children play on their own. Don’t think that you have to entertain your children 24X7. They can be bored. It doesn’t matter if they are bored,” she says.