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Monday, September 28, 2020

Why the lockdown has heightened our anxieties

The walled-in life to prevent the spread of COVID-19 has led to a spike in mental-health issues. From patients regressing in their treatment to people with no prior history finding themselves unable to cope with the uncertainty, notes from a world at unease

Written by Surbhi Gupta | Updated: April 26, 2020 3:11:33 pm
mental health, coronavirus The lockdown to prevent the spread of COVID-19 has led to a spike in mental health issues. (Source: Getty Images)

“My weekend was quite bad”, says Nikhil Taneja, 33. “During the week, when I am clocking in office hours, I have something to focus on. But, during the weekend, when I don’t have much to do, I get very anxious,” says the Mumbai-based entrepreneur and producer. “And when you go online and see people doing pretty much everything that they have ever wanted to do – learn a new skill, go back to an old hobby or take an online course – you wonder about your own life. Just when you think everyone’s at home, so there isn’t going to be any FOMO (fear of missing out), there comes the quarantine FOMO,” he says.

Taneja had been struggling with Generalised Anxiety Disorder (GAD) for over three years but over the last one month, it has increased manifold. “Anxiety comes from a place when you don’t have control over situations, and, suddenly, we’re in the middle of a pandemic and there is an incredible amount of uncertainty all around,” he says. With his parents in Bahrain and brother in the United States, he’s been constantly consuming news about COVID-19. “I don’t know when we will be able to meet next, when international travel will be allowed,” he says.

mental health, coronavirus Source: Getty Images

Taneja is not alone. Ever since the world plunged into a crisis due to the novel coronavirus, COVID-19, and countries went into lockdown, there has been a rise in mental health issues across the globe. “Mental health issues are another pandemic running parallelly to COVID-19,” says Dr Naveen Kumar C, head, community psychiatry unit, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru. The Indian Psychiatry Society has noticed a steep rise in the number of patients suffering from mental health issues after the outbreak. A recent survey conducted by them has revealed that there has been a 20 per cent rise in cases, with at least one in five Indians suffering from some form of anxiety or depression. The Ministry of Health and Family Welfare has issued advisories in this regard, with assistance from NIMHANS, which includes advice on how to handle isolation and avoid fake news. The institute also set up a helpline about a month ago and has received over 11,000 calls since; over 250 mental-health professionals have been attending these calls from all over the country. “Initially, people who called expressed medical problems and logistical issues, but over time, the main issues are psychological – fear, panic and anxiety over an unforeseen situation. Since many outpatient departments are closed, patients are also reaching out to helplines to get fresh prescriptions,” says Dr Kumar C.

Apart from their usual helplines, Tata Institute of Social Science (TISS), Mumbai, has also launched a new one to provide psycho-social support during COVID-19. “This could be related to mental health, domestic violence, family conflicts, getting food or fresh prescriptions. Our volunteers speak in nine languages, including Tamil, Malayalam, Gujarati and Konkani,” says Tanuja Babre, project coordinator. The team answers around 100 calls daily.

This inability to face up to what is an unprecedented situation is taking its toll on people across the world. The death of Thomas Schaefer, the finance minister of Germany’s Hesse state – the financial capital of the country – who committed suicide last month as he was deeply worried over the economic fallout of the pandemic points at the far-reaching consequences of COVID-19. In India, a 50-year-old man in Andhra Pradesh’s Chittoor district took his life in early February – even before cases began to be reported in the country – after he was convinced that he had COVID-19. Delhi saw a 23-year-old man jump to his death from the seventh floor of Safdarjung Hospital in March. He was admitted to the isolation ward and was tested for the virus after he complained of a headache at the airport on returning from Sydney. His results came out negative eventually.

Mental health practitioners acknowledge the spike in anxiety and worry over the relapse of symptoms in patients. “It’s definitely gotten worse for people who have anxiety disorders, obsessive compulsive disorders (OCD) and depression. It is commonplace for people with severe anxiety to constantly live with the fear that the worst will happen to them. The outbreak has only amplified their symptoms. Patients now fear that either they will be infected or they will infect their close ones,” says Anupriya Sircar, clinical psychologist at Max Healthcare, Delhi. Some of her patients have been expressing feelings of guilt for talking about their problems at a time when the world is facing a crisis. “I tell them that just because there is a bigger problem, it doesn’t invalidate how they’re feeling,” she says.

What this has resulted in, says Dr Shwetank Bansal, consulting psychiatrist at Delhi’s BLK Super Specialty Hospital, is a possibility for patients to take a step back in terms of their progress. “Normally, as part of therapy, we tell patients to try and reject the catastrophic scenarios their negative thoughts paint for them and embrace a realistic view of the world. Due to the outbreak, the worst-case scenario is in front of them and this leads to increased anxiety. That’s where the therapy for anxiety falters, specifically with respect to GAD,” he says. For someone with cleaning compulsions, common treatment includes “exposure and response prevention” – patients are taught to expose themselves to repetitive intrusive thoughts but not to respond to them with action. “We ask them to not wash their hands, for instance, and to withstand the resultant anxiety. But now it has become difficult for them to draw the line between hygiene and cleaning compulsions,” says Dr Bansal.

When COVID-19 was declared a pandemic and guidelines issued for frequent washing of hands, Delhi-based pyschiatrist Dr Sanjay Chugh anticipated a spike in the number of OCD cases. He was proven right. “Someone who was washing her hands 20 times a day is doing it 50 to 100 times now. In a few extreme cases, patients are refusing to move away from the wash basin,” he says. According to him, the outbreak has validated the beliefs of OCD patients that their obsessions were justified. He cites the example of a patient with paranoid psychosis, whose symptoms have been aggravated by the pandemic. “He has delusions that people are trying to contaminate him with the coronavirus,” he says. For the past few years, washing hands over 30 times a day has been a routine affair for Abhishek Gupta (name changed). “Even before the outbreak, I had to do it if I touched something which I felt was dirty – an oily surface, or a piece of cloth. I even followed social distancing from people who I didn’t think were hygienic,” says the 32-year-old, who was diagnosed with OCD a few years ago. Recently, when the Delhi-based paralegal developed a cough, he was overcome by intense fear. “I kept going over what I had done in the last 24 hours which could have induced this and I remembered that I had had packaged lychee juice from a shop that I usually avoided but couldn’t this time because everything else in my neighbourhood was closed,” he says.

From there on, it was a downward spiral. “I got anxious wondering if it had been packaged in China, if, by a freak chance, I was infected because of that. When I couldn’t stand it any longer, I went and bought another one from the shop just so I could check the details. Finally, I found out that lychee juices in India are packed in Odisha and Uttar Pradesh. I felt foolish but at that time nothing else mattered,” he says.

For most people, work routine gives a structure to their days. But now, because of the lockdown, as they stay at home, the lack of structure makes people feel adrift. Sleep has been a casualty for many. The economic fallout of the lockdown, too, has impacted mental health, not just of those already afflicted but of people who have not had any such known medical history. The International Monetary Fund recently announced that the pandemic will effect a global recession worse than the one in 2008. Pay cuts and the possibility of layoffs have got everyone worried. Taneja, who runs an online content-creation platform Yuvaa, is also concerned about the future of his business. “All active conversations have stopped as no company has any idea on what they want to spend their money right now,” he says.

When the nationwide lockdown was announced on March 24, many mental practitioners moved their sessions online. Some began hosting group live sessions to help people learn coping mechanisms from each other. Delhi-based clinical psychologist Nupur D Paiva says, “You can gauge people’s anxieties on WhatsApp groups. By sending a series of forwarded messages, people are discharging their anxieties but that, in turn, is spreading more anxiety and feeding their own,” she says.

Babre says the nature of calls received on the TISS helpline has changed over the period of the lockdown. “The initial panic and anxiety have progressed to hyper-vigilance, related to the consumption of news,” she says. “Reading the newspaper was the first thing I did in the morning, but it is becoming difficult to keep up because things are changing so fast,” says Taneja. On his counsellor’s advice, he now devotes only 30 minutes a day to reading the news. It helps him cope better with the anxiety that arises from the news cycle. He has also reduced his screentime. “The fatigue of being online constantly is setting in, so I’ve started on activities that are not phone-related, like journaling and reading,” he says.

Relying on credible information sources and not on social media is important, says Dr Bansal. He has been advising his patients to give their days a structure – maintain an office routine, for instance, even if they clock in fewer hours. “This helps regulate our sleep and meal cycles,” he says.

For people living alone, the lack of an emotional support system has been particularly difficult. Bengaluru-based curator Riddhi Doshi (name changed), 29, speaks of losing a sense of time in lockdown. “Last weekend, I ended up watching Gilmore Girls for 21 hours straight. I got up only to drink water or feed my cat. There is hardly any physical activity and there is no sense of accountability. I have had a break-up recently and my company announced a pay cut. We weren’t even told the extent of it. The bosses haven’t checked on us even once, nor have they discussed any plan of action. Sometimes, I feel like my head is going to explode,” she says.

Those living with families have issues of their own. Conflicts have increased, notes Noida-based clinical psychologist Divya Parashar, as families are stuck at home. “Suddenly, everyone is in each other’s spaces. Fathers don’t have any idea about hands-on parenting; communications are breaking down,” she says. “Those who have been used to an active social life don’t know how to deal with the disruption. People are also worrying about the economic backlash,” she says.

Meanwhile, midway into the lockdown, people are noticing a dip in productivity. A task that takes a day to complete is taking three now; many say they don’t feel like working at all. At the end of the day, when you look at all that you did not do, a sense of guilt sets in. Taneja is calling the phenomenon productivity anxiety. “There is a sense among people that now that we have more time, we should do more work. One has to realise this is not summer vacation, this is a crisis,” he says.

However, there is a positive side to the lockdown, too. “Some people spoke of how they feel relieved. They have stressful jobs and were facing a burnout. But now, because they are working from home, they are coming to realise how anxious they were before,” says Mahananda Bohidar, a Chennai-based counsellor. Ishani Badyal, psychotherapist at the Bengaluru-based Hank Nunn Institute, a not-for-profit mental-health organisation, says many people who did not have the time or the headspace to seek therapy earlier are reaching out as they face fewer distractions.

Sircar says she tells her patients to keep aside a slot during the day for their “worry time”. Bohidar acknowledges this is a difficult time for all, even for those without mental health issues. She has been urging her patients to accommodate little indulgent changes to their routines – like wearing a perfume one uses on special occasions for a day of working from home or making a playlist of one’s favourite songs from school or college days. “I also tell my patients that it is okay if they are not doing anything and just managing to survive the lockdown. This is an unprecedented situation, one shouldn’t judge oneself for not making the most of it,” she says.

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