Isolation and mental health: psychological impact of lockdown
Azera Parveen Rahman
The Hindu, Apr 4 2020
A review published recently in Lancet, which studied the psychological impact of quarantine during previous epidemics such as SARS, found proof of a range of conditions.
It is past noon and Mehtaj, 39, a teacher in Assam, is doing her “second round of disinfection”. Wiping her car keys with antiseptic, she says, “I can’t stop thinking about coronavirus and whether we’ve let it in by mistake. I am petrified.”
The teacher and mother of one is not alone in her phobic reaction. The isolation and fear in this lockdown era is driving an escalating nervousness among many people. Not just those with pre-existing conditions like anxiety, depression and OCD (obsessive compulsive disorder), but also the elderly who are struggling with new levels of loneliness and helplessness.
“I try not to read all the WhatsApp forwards,” says Mehtaj, even as she obsessively continues to disinfect door knobs, furniture and kitchen appliances. “I wash my son’s toys in Dettol; I put everything in the sun, even vegetables and groceries.” As this goes to press, 16 people have tested positive for coronavirus in Assam.
In her apartment in east Bengaluru, Saroja Chakravarty, 84, lives alone. She has kept herself busy with cooking, cleaning and Netflix. She talks to her daughters over the phone. “But I haven’t stepped out of the front door in days,” she says. As susceptible as the elderly are to COVID-19, people like Chakravarty are also acutely psychologically vulnerable at this time. “I miss talking to real people. I miss my walks,” she says.
“These are strange times,” says Pratima Murthy, head of department, psychiatry, at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru. “What we generally prescribe for the elderly is social interaction for their emotional wellbeing. And now they’ve been told the opposite: to physically distance themselves, even from their grandchildren.”
As you grow older, says Dr. Murthy, a routine becomes important and any disruption leads to anxiety. In Hyderabad, Zubair Ahmed, 71, and his wife Rahima, 65, find the comfort they drew from their daily walks and chatting with friends all but lost. “It’s been seven years since our son left home; but it’s only now that we feel lonely,” says Ahmed.
A review published recently in Lancet, which studied literature on the psychological impact of quarantine — the separation and curtailed movement of people potentially exposed to a contagious disease — during previous epidemics such as SARS, found proof of a range of psychological conditions, from post-traumatic stress symptoms to confusion, anger, depression, stress, insomnia and emotional exhaustion. “Activating your social network, albeit remotely, is not just a key priority, but an inability to do so is associated not just with immediate anxiety, but longer-term distress,” says the paper. Communicating, even remotely, with family and friends, is “essential,” it adds.
That’s what Bonoshree (name changed on request), 25, is trying to do. Diagnosed with depression two years ago, Bonoshree works in a publishing house and lives alone in Delhi. She used to walk or step out for coffee to keep her spirits up; now all that’s stopped.
Her worried parents video-call her three times a day. “I have to create a facade to keep them from worrying. But the truth is, I am extremely lonely. I am hardly ever hungry and I can’t sleep well.” Work keeps her busy in the mornings and a friend checks up on her, “but nothing replaces human connect, you know,” she says. She has reached out to her counsellor to see her through.
For those with anxiety disorder, it might be worse. Bengaluru-based psychotherapist Natasha Vijay talks of one of her clients who is struggling to cope with the distress of facing this ‘invisible enemy’. The pandemic has been very hard on this woman, the psychotherapist explains, because all she hears constantly are health warnings and alerts.
Such paranoia can be prevented by communicating the right information about the pandemic, says Sanjeev Jain, professor, psychiatry, at NIMHANS. “There’s no mystery; we must encourage people to be rational in their response, rather than panic.”
While NIMHANS has set up a helpline to reach out to patients, States like Kerala have set up helplines to tele-counsel people in quarantine. The calls have been increasing: last Saturday, for instance, 7,000 calls were made, and the government has employed an army of over 700 counsellors. “People in quarantine grapple first with stigma, then anxiety about getting infected; then of course with the stress of loneliness,” says Kiran P. S., State nodal officer for the Mental Health Programme that runs the helpline.
“What is important is to understand the difference between physical distancing and social distancing,” says Dr. Jain. “Distancing should not be interpreted as social or emotional disengagement. Fostering a sense of social togetherness — whether on the phone, or through acts of altruism by helping people in the neighbourhood — is essential at this time.”
One doesn’t have to be ill to suffer during these stressful times. In Jaipur, Rubina Shah, a homemaker, is physically and mentally drowning. With her children and husband at home all day, her chores have increased manifold. “My children are five and eight; keeping them busy all day while keeping the house in order is exhausting,” she says. Shah’s husband, a PR executive, works from home and does help, but the bulk of it falls on Rubina. “I barely get any break,” she says, “It’s making me irritable.”
One of her blessings has been that her parents are within reach and she talks often to them. Others don’t have this luxury. Yet, as Bombay-based mental health expert Prakriti Poddar says, staying connected even via digital platforms becomes vital at such times. The Ahmeds are not comfortable with video calls or chats, but their son Rohan calls them three-four times a day from Bengaluru, asking if they’ve eaten, suggesting exercises for his diabetic mother, and movies on TV for the evenings. “They are praying more; it’s their way of seeking solace,” says Rohan, “But I worry. What if something goes wrong and I cannot reach them on time?”
Staying close to family, however, doesn’t mean the same for everyone. For people with dysfunctional family dynamics, such as an abusive partner or domineering parents, staying at home is a trigger for anxiety. “It has left many susceptible to relapse of clinical depression,” Kolkata-based psychologist Charvi Jain says.
In such times of uncertainty, the only way forward is to accept that while we don’t have control over everything, there are some things we can do. Avoiding information overload from social media, avoiding speculation about the pandemic, keeping busy with activities, playing games, engaging with books, music, dance and movies — all this helps. Now is the time for those cat videos.
WHO recommends focusing on positive news, like news of people recovering from the virus, to get hope. “We can take this as an opportunity,” says Dr. Poddar, “The earth is recuperating, and so can we.”
(With inputs from Divya Gandhi & Shyama Rajagopal.)
The writer is a Jodhpur-based freelance journalist.