Taking charge of emotional health during the pandemic– what everyone one can do?
R. Srinivasa Murthy
Professor of Psychiatry,
Formerly of National Institute of Mental Health and Neurosciences,
Bangalore.
We are all now familiar with the word ‘Pandemic’. Pandemic refers to ‘ALL PEOPLE’.
This article refers to the impact of the pandemic on all people and how EVERYONE can address the emotional health during the pandemic.
The feelings during the pandemic
In the next section, two aspects of emotional health are considered. First, how can each of us strengthen our emotional health/immunity and secondly, how we can master ‘ negative emotions’.
There are a wide range of feelings experienced by the population. The responses are very individual. In a recent meeting, the following (Photo 1) were the range of responses exprtessed by more than 100 participants of the general public. As you can see the predominant and frequent feelings are anxiety, fear, helplessness, frustration, painful, uncertainity, worried, exhaustion etc.
Gandhi’s experience with Spanish Flu.
An episode 100 years back illustrate the resilience and opportunity for growth. Mahatma Gandhi, whose 151 birthday was celebrated on Oct 2, 2020, had a brush with the 1918 Spanish Flu, in which nearly 2 crore Indians died. Interestingly (BOX1) as you can see, it was challenging to Gandhiji, but he saw it also an opportunity for personal growth.
BOX 1: Gandhiji’s experience and response to Pandemic in 1918.
Mahatma Gandhi was affected by the gastric variety of flu. At Gandhi’s ashram, several prominent members of the Independence Movement were laid low with flu. Gandhi was too feverish to speak or read; he couldn’t shake a sense of doom: “All interest in living had ceased.” Interestingly, Gandhi’s reaction was: ‘This protracted and first long illness in my life thus afforded me a unique opportunity to examine my principles and to test them’.
Literature from disaster literature
The emotional health of populations exposed to disasters is a well‑recognized public health priority. World Health Report, 2001noted: “Conflicts, including wars and civil strife, and disasters affect a large number of people and result in mental problems and such situations take a heavy toll on the mental health of the people. Between a third and half of all the affected persons suffer from mental distress.
Levels of emotional health impacts
In the current ‘Pandemic’ nearly all of us affected in one or other way. The total population can be grouped under 7 levels, in terms of the emotional health needs.(Box 2). We all will fall into one or more groups during the last few months and in the coming months.
Box 2: 7 levels of Emotional Health needs of the population
Level1: Total population (Community)
Level 2: People affected by the interrupted economy
Level 3: At ‘risk’ population- migrants, living in slums etc
Level 4: Persons with symptoms
Level 5: COVID 19 -Positive patients
Level 6: Frontline care providers
Level 7: People with pre-existing mental disorders .
What is known to help survivors of disasters?
Interventions shown to be beneficial are at the level of individuals, families, communities and at the state(govt) levels. The central goal is to help people, to not decompensate and to find meaning out of the experience. Effort should be to move individuals to think of the disaster situation as ‘transition’ rather than ‘loss’. Psychosocial interventions directed at all the above seven levels are shown to be effective in minimising the long term impact on emotional health.
Total population level interventions are towards ‘Emotional Strengthening’. The following section details EVIDENCE BASED interventions that will strengthen your emotional health and also immunity. (Photo 2)
EVERYONE CAN PROTECT THEMSELVES
During the last 9 months of the ‘Pandemic’, I have been asked frequently:
“Dr.Murthy, similar to wearing a mask, washing hands and keeping physical distance to avoid infection, what can I do to maintain emotional health?”
Positive Emotional health and protection.
Here are 7 things you can make it a part of your daily life to maintain emotional health and immunity.(Box 3)
BOX: Maintaining Emotional Health and Immunity
1. Information- avoid over exposure
2. Exercise- 30 minutes per day
3. Sleep- 8 hours per day
4. Diet- healthy and avoid intoxicants
5. Meditation and relaxation daily
6. Connectedness and Supports
7.Spirituality
There is scientific evidence to support the above ‘lifestyle’ changes. Three recent statements, from scientific journals, given in BOX 4 is representative of the same.
Box 4: Science of lifestyle and emotional health/ immunity
‘Adults with good cardiorespiratory fitness—the ability of the circulatory and respiratory systems to supply oxygen during sustained physical activity—have half the risk of developing symptoms of depression’(2020)
‘Factors we found to be associated with greater risk of respiratory illnesses after virus exposure included smoking, ingesting an inadequate level of vitamin C, and chronic psychological stress. Those associated with decreased risk included social integration, social support, physical activity, adequate and efficient sleep, and moderate alcohol intake’ (2019)
“We have a lot of evidence that if you have an adequate amount of sleep, you definitely can help to prevent or fight any kind of infection,”(2020)
There are the activities that by making it a part of everyone daily life, emotional health/immunity can be improved.
- Knowledge: Reading and knowing about pandemic is important. Correct and full information will allow you to make the right decisions and decrease distress. Use all the available resources (printed matter, doctors, support group etc) to acquire the needed information. However it is important to avoid overexposure.
- Exercise and physical activity: Physical activity /exercise has been recognized as the “miracle cure without a pill’. Being active, even when you have feelings of tiredness and fatigue is important. Develop regular habit of exercising for whatever period of time you can, ideally at least 30 minutes per day. This will help to fight fatigue, improve your appetite, lead to a better sleep. Make exercise a joint activity and where possible do it in green places.
- Sleep: Sleep and its benefits are known for over 2000 years. Go to bed at a particular time and wake up at a particular time. Minimise use of the phones before sleep.
- Diet: Healthy diet with fruits and vegetables is important. Avoid all intoxicants.
- Relaxation/ Meditation: Make rest/relaxation/meditation daily part of your life and gaining mastery over your emotional life.
- Connectedness/Social support: In all situations of stress, the more social support there are lesser the negative effects on emotional health. Look into your life and reconnect and utilise all the supports available. Do not hesitate to seek out support from family, friends and community.
- Spiritual support: The pain of illness, uncertainties of the future demands that you find meaning to the changes and challenges to your life. Most people find solace and support from spiritual resources. This could be reading of religious texts, regular prayers, visiting place of worship, meeting a religious teacher etc. Please use whatever spiritual resources you are comfortable.
To conclude this section, it is important to make as many of the above lifestyle activities as part of your everyday life.
DISTRESS:
The second group of people who need help are those with ‘distress’ symptoms like fear, anxiety, irritability, fatigue, feeling of uncertainty, fear of death etc. The interventions to address, ‘distress’ should be of higher level than the first, to maximise the coping capacity.
The next section addresses, the steps that can be taken by everyone, to master emotional DISTRESS during the Pandemic.(BOX 5) As the Photo(3) shows it can improve immunity.
BOX 5: Measures to counter ‘distress’
1.Acceptance
2.Seek assistance
3.Share your feelings
4.Journaling
5.Art/ Music
6.Make pleasure time part of daily life
7.Finding the meaning
Photo: 3
- Acceptance: Acceptance means to recognise that life is no more the same as the past and look towards living in the ‘new normal’.
- Seek assistance: Pandemic has brought many changes in your and your family life. You and the family require all the support you can get. Understand your needs and reach out to those who can help you. More help you receive, you will feel less burden and less burden means less tension.
- Sharing your feelings: Pandemic has brought about multiple changes and challenges to life of everyone. Many of these are distressing. Keeping these feelings to your own self is not good. Sharing it with others, decreases distress. Do not consider it a weakness to express helplessness. It is normal to be distressed.
- Journaling/ Writing down your feelings: In situations, when you cannot share your feelings with others, writing down your feelings and thoughts for about 20 minute daily and on a regular basis, is another way of decreasing distress and gaining mastery over your emotional life.
- Art/Music: These are veery valuable way of decreasing stress. Go back to those pleasurable activities that make you relaxed.
- Daily “Happy moments”: It is important that you find ways of being happy. This could be in the form of finding time for hobbies, playing games, being with people who give you positive feelings, etc. As far as it is feasible, maintain your interests and routines. It is best to avoid thinking too far into future as it is not predictable. Alternatively focus on the present. This you can do it by prioritizing areas for action, doing things according to plan and pacing of the activities. Remember, every time you complete a task you will increase your confidence and that will further increase your confidence.
- Finding Meaning: Spirituality help in understanding, making sense, and finding a meaning in the changed situations. Studies with people living with chronic illnesses, HIV, cancer have shown that those who use spiritual resources recover better.
When to seek professional help:
The above measures will help you to master most of the changes and challenges of of living with the pandemic.
However, do not hesitate to seek specialist help in the following situations:
- You want more guidance to incorporate the above psychological measures to your emotional health;
- Your emotional distress is associated with many life challenges that you cannot handle;
- Your emotional distress is interfering with daily routines (self care, eating, sleeping, work) or your treatment;
- You have continuous feelings of tension, worry, irritability sadness, crying, anger, suicidal thoughts, that is causing distress to you;
Conclusion
Pandemic is a challenge to all of us. It is for this reason everyone of us should do every thing to limit the negative impact. The same way we use handwashing, wearing mask, keeping physical distance, it is possible by the measures described in this article, to maintain emotional health as well as take care of the distress that will be experienced during this challenging period. It is within in each of us to prevent negative things, master the distress and find a meaning for life from the situation.
(Prof.R.Srinivasa Murthy, Email: smurthy030@gmail.com can provide more information/help and the complete list of resources. Please feel free to write to him).
Living with cancer 
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