Nepal | September 29, 2020

Opinion: Covid-19 and Mental Health

Nikesh Rajbhandari
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What has changed in our lives because of this pandemic? What will our future be like? For about five months, we have had to change our lives dramatically, we have had to stop ourselves from meeting friends and family. We cannot go out to buy toys for our kids, get new clothes, and buying groceries has become stressful.

What this pandemic has done is create a state of universal uncertainty. We are uncertain today about our health, we are uncertain about our neighbours, we have doubts about the wellbeing of our families and friends, we are apprehensive about our tomorrow. We just don’t know when and where we might meet this virus.

Should I go and have a drink? Is it ok to work? If I don’t go to work where will I get money from — for rent, for food? How can I ensure a better future for myself, my kids?

These are the common questions that are probably doing rounds in lot of our minds. Fear, worry and stress are normal responses to perceived or real threats, especially at times like these, when we are faced with an uncertain future.  Add to this a health system that has always been below-average, and a non-existent public health system, the fear of contracting the virus seems like a jail sentence to many of us.

There have been many good things our government has done but expecting a straw hut to last a storm is just wishful thinking. Faced with the new realities of working from home, no schools for children, and lack of physical/social contact with loved ones, it has become more important for us to know how to care for our health — physical and mental.

What problems can Covid-19 cause on mental health?

It is absolutely possible but for most people to develop common psychological disorders like anxiety and depression. In the United States, it has been seen that there was a 370 percent increase in anxiety screening and 394 percent rise in depression screening in May as compared to January. What this means is, there were that many more people seeking help for symptoms of anxiety and depression. More than two-third of them complained of loneliness and isolation and more than 60 percent of them were under the age of 25 years and females. Other problems cited were relationship problems, fear of the virus, current global events, grief or loss, financial problems, among others. Almost 80 percent of those who were screened were found to have been diagnosed with depression.

“But how do I know whether I am suffering from anxiety and depression?” Feeling anxious or stressed and suffering from an anxiety disorder is different. If you feel restless, have disturbed sleep, constantly have the same thoughts over and over again, or get angry and irritated very easily, then these could be signs of you being stressed or anxious. If along with these symptoms, you also have on and off feelings of fear or thoughts that you might die at that very moment, and if such feelings are accompanied by a racing heart, shaky legs, a sudden draining of all energy from your body and difficulty in breathing, this could be symptoms of a panic attack. If you experience a panic attack at least once a day, then you are likely to have an anxiety disorder.

With or without the feeling of anxiousness, your mind might also be filled with worry, worry about yourself or your loved ones contracting the virus, worry about finances and future. But if along with that worry, you also experience a constant feeling of sadness even though you know it is unnecessary, you have no interest or energy to do anything around the house, your thoughts are consumed with negativity and fear, you start to blame yourself for most things, and experience feelings of guilt when you shouldn’t, you seem to lose all your confidence and self-esteem, you start feeling alone and worthless, and have thoughts that there is no future at all, if you feel you are without hope, then there is a high probability that you are suffering from depression.

Even though these are the most common mental health problems — feeling stressed, worried or suffering from anxiety or depression — there is still a small possibility that a person could experience even more serious mental disorder like psychosis.

We have to also remember that it will be different for people who are already suffering from mental illnesses. For them the concerns will not be limited to recurrence of symptoms or relapse of illness, but also unavailability of drugs and mental health professionals.

How do I keep my mind healthy?

It is not rocket science; it is something you have to remember. It is easy if you do it, and if you still don’t feel good after this, then you should seek help. One of the primary secrets of stress management is to try and fix the things that is in your control and to not bother about those worries that you have no individual control over. But in the case of this pandemic, even though we have no control over how it started and when it is going to end, we do have a choice of taking as much precautions as possible. So we stay home, physically isolate, wear a WHO recommended mask, keep a distance of at least two metres when in public, and take a bath when home.

The WHO recommends these simple things to keep ourselves mentally healthy — stay connected, maintain a balanced lifestyle, eat timely and nutritious food, exercise, spend time together as a family, do not use alcohol and smoking as means to manage your emotional problems, use methods that have helped you in the past to manage stress and worry, get facts from the right sources.

Staying informed is necessary but don’t obsessively check the news, select a time of the day when you would like to do it and also a trusted source like WHO or the Ministry of Health. You could even check the website of the Centre for Disease Control (CDC) of America. Constantly checking can fuel your anxiety. Stay away from news that may cause anxiety, for instance death of a celebrity — no it has nothing to do with you, it should not be emotionally relevant to you.

A passing feeling of sadness is enough, if it is constantly on your social media, take steps to unfollow those types of news. It is important to remember that the artificial intelligence of social media will show you things related to posts, videos you constantly follow. Hence, if you watch something that disturbs you emotionally, then tomorrow it will show you a very similar disturbing kind of a post. You have the power to change that; if you don’t know how, ask someone in your family. If you think avoiding media a hundred percent is the way to go but still want to stay updated, then ask someone to update you.

Keep a daily routine to stop boredom from creeping into your life. Having a sleep routine and sleeping for a minimum of seven hours is one of the best ways to manage your daily stress. Sleep will refresh you and give you the energy to work the next day, as will exercise. Exercising at least once a day keeps you physically healthy but will at the same time be of immense help for your mental well-being. Any simple rhythmic movement is good to the mind, walking, jogging, dancing, or skipping. Due to space constraints walking may not be possible. But that should not matter as you can go online and search for exercise routine suited best suited for you.

Other ways to relax, especially when you are stressed or anxious, could be to listen to music that helps you calm down, calling a loved one or a friend and have a laugh, watch a funny TV show or movie. If these don’t work, then try relaxation exercises — on YouTube search for ‘Jacobson’s progressive muscle relaxation technique’ and follow the instructions. Or you could try the simple breathing technique where you take deep breaths in and out. Take about a second to deep inhale slowly and then stop and say ‘200’ inside your head then exhale even more slowly for just over a second, then stop and repeat but now say ‘199’. With every breath inhale, go down the numbers from 200 to 1. You can use these techniques to help you fall asleep as well. If these techniques cannot reduce your stress, then seek professional help.

Likewise, diet is important, keeping a regularity in meals is very necessary. Without fuel your mind won’t work right. Eat a balanced diet with a good amount of fruits and vegetables, don’t forget proteins in your food, and eat together as a family. Drinking about four litres of water a day is also important especially during hot days. If you smoke, you should quit. You could start with decreasing the number of cigarettes a day, then when that reaches a minimum, stop smoking the whole cigarette, and eventually stop completely. Your lungs need to be healthy, and if you stop now, you give it a chance at fighting the disease. Do not substitute your cigarette with other forms of tobacco. Drinking alcohol should be to a minimum, about a maximum of 200ml of spirits a week and not more. Wine or beer is not a better alternative than whiskey or vodka.

We are asked to stay indoors, so prepare activities for yourself, read a book, learn to play an instrument. It is also important as a social animal to remain socially connected despite not being together. If you have family or friends that are far away, set a time to speak with them. This can be especially helpful if you have a family member alone in another country locked inside their home. For parents with kids, find creative ways to keep them engaged, search the internet. Encourage them to discuss their fears, try and answer their queries, it is important to keep them close to their primary care taker. But mothers should take breaks everyday from caring as well; looking after children is tiresome and it can overburden you especially if you have to work from home.

Last but not the least, be aware of your emotions and thoughts, and if they overwhelm you, then seek professional help.

(Nikesh Rajbhandari is Biratnagar-based MD Psychiatrist ; all views expressed here are his own)

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