Posted on 18th March 2020 at 23:32
Mental Health and the COVID-19 Pandemic
Corona Ville – it’s where we find ourselves these days on a global level, as a result of corona virus disease 2019 or COVID-19. Everywhere we turn there are instructions, recommendations, updates, statistics, restrictions, panic buying and scaremongering. It is overwhelming in an already scary and anxious time. We were just beginning to recover from relentless storms and enduring images of the vast bush land fires in Australia and prior to that, flames ravaging the Amazon Rainforest. It is a time of sustained threat to humanity which puts a strain on our collective mental health. Some of our anxiety is necessary and good – it keeps us on top of things and watchful. Social media has become a double edged word – adding to anxiety and fear on one hand while keeping us in touch like never before on the other. It is just one of the many contradictions and conflicts that abound at such a time. Contradicting information and differing national approaches create confusion and division. There is a suspicion that it is worse than we are being told. At its extreme, it becomes hysteria. Those of us with underlying health conditions may be particularly fearful at being classed as vulnerable to the virus.
Corona Ville is a ‘Fear Ville’ that links us to previous and transgenerational trauma. If we tend towards general anxiety or health specific anxiety, coronavirus fear can trigger and heighten it, perhaps leading to catastrophizing and panic. We feel powerless and out of control. Fear and the threat of the unknown, compels us to stock up on essentials such as toilet paper, hand sanitisers and tinned food, in a panic like response. Having a fortnight quarantine supply of toiletries is reasonable but accumulating months worth, may be excessive. The panic response is bolstered by the optics of empty shelves, triggering a fear of short supply. The only way to alleviate that fear is to buy lots of it, at the same time, oblivious to other's needs or how this appears to them. Official dogma compels us to look out for the other but the natural instinct is survival of the fittest. At the other end of the spectrum, the down players maintain the delusion that ‘it won’t happen to me’ or it won’t be that bad’ and thus may put others at risk by not adhering to public health instructions.
Corona Ville is a haven for anyone with obsessive compulsive disorder (OCD) or inclinations towards it. OCD is defined as the presence of recurring, exaggerated and irrational thoughts. The compulsive symptoms are usually a response to those intrusive thoughts of which contamination (in the form of germs, dirt, disease) is one of the most common. Such fears are heavily influenced by culture, society and public health scares like the present one. For some OCD patients, not washing their hands is part of the exposure and response prevention (ERP) approach to treatment. Thus the essential, authoritative public health advice of frequent handwashing, and concerns that we are not doing it properly, is rekindling their anxieties and compulsive actions while triggering them in others. Unless significant progress has already been made at uncovering the unconscious root cause of the OCD through psychoanalytic psychotherapy for example, there is a real risk of reinforced relapse - a real challenge for the patient and the therapist treating them. It is not surprising that mental health experts expect an OCD spike during and after this pandemic. How do we distinguish OCD from vigilant handwashing practice? For the OCD individual, there is a distinctive ritual and order to the activity which brings a brief, temporary relief, at an unconscious level. The obsessive thought (e.g.“I am dirty, contaminated”) causes anxiety which in turn triggers the compulsive behaviour (e.g. “I must scrub my hands clean”). After the intensive handwash, there is temporary relief from the anxiety until the thought creeps in again and sets the whole cycle off in an ongoing, repetitive pattern.
The conspiracy theories that suggested that this pandemic is a biological warfare launched on the world, could be classed as delusional, with the reality check that if this were true, the pattern and effects may be quite different to what we are witnessing. Indeed, such speculation was put to rest by the publication yesterday in Nature Medicine, that the genome sequence data from SARS-CoV-2 and related viruses, showed no evidence that the virus was engineered in a laboratory.  We have seen paranoia at play also in the xenophobia exhibited towards Asians (creating fear in them) and in the pandemic being classed as the political ploy of one leader. We see the scapegoating of potential carriers and perceived high risk individuals. Corona Ville is ugly.
A scientist colleague of mine reminded me that we are “mere visitors in a microbial world.” Indeed, when we look at our historical war with microbes; we endured leprosy in the 12th century; the Black Death of the 14th century; the Spanish Flu, polio, HIV and Ebola in the 20th century and H1N1, SARS, MERS in the 21st century. All of these register in our collective unconscious as a fear well founded. Growing up in epidemics or pandemics can leave scars and potentially traumatise a generation.
Social distancing and wariness toward others are hall marks of pandemics, which, in turn, promote isolation and loneliness. It is often hard to feel the “We’re all in this together” attitude which further heightens fear and paranoia. This is where the internet and social media has its strengths, if we can filter out hype and mania. Quarantine is a step further again. Most studies report negative psychological effects of quarantine including post-traumatic stress symptoms, confusion and anger. Quarantined health care workers tend to have more severe symptoms of post-traumatic stress, than their general public counterparts. There is an onus therefore to reduce, as much as possible, the negative effects associated with the use of quarantine as a public health measure. This explains why the less severe social distancing is a preferential public health approach, keeping quarantine for when absolutely necessary. 
Those of us now working from home may be missing the daily structure and routine that is going to and from work. The novelty of a lack of commuting and collecting children may wear off. We must be careful that insufficient stimulation, lack of exercise and social isolation coupled perhaps with financial worry, do not predispose us to loneliness, boredom, anxiety and depression. For some, the busyness of the routine work day can be a defence against thinking and introspection. We struggle with the quietness and just ‘being.’ Perhaps the time has come to do just that. Sometimes, nature is the great leveller of the field. Our world has got manic, careless, insensitive and greedy. Society puts pressure on the individual to be a certain type of 'successful' and accept whatever pressures it throws at them. The WHO last year recognised burnout as a workplace phenomenon. Such levels of stress have a negative impact on our immune system. Just as the body hauls in a mind that pushes it too far, so nature reminds us what can happen when we do that collectively.
What do we do? We need to do what healthily helps us feel in control and reduces fear. We need to understand this pathogen but also our physical and psychological reaction towards it. We need to face fear with facts, but reliable facts from reliable sources. We need to stay healthily connected within our households and to the outside world, albeit that this may need to be electronically for the most part. We can wonder how on earth our ancestors managed to stay connected but perhaps the scenes of singing and clapping from Italian and French balconies gives us some clues!
The World Health Organisation (WHO) has a nice summary of tips for dealing with stress due to COVID 19 and this can be found here.
Included is: a list of expected feelings like sadness, stress, confusion, fear and anger; talking about how you feel including with a professional if you feel overwhelmed; minimising anxiety in children and those with mental health disorders; avoiding using alcohol or drugs to deal with emotions; keeping the body and immune system nourished including with exercise sleep and fresh air if possible; keeping sources of information to trusted ones and avoiding over exposure to media; drawing on the survival skills that served you well before. Try and set up a daily routine that enables you to achieve a balance of activities rather than slipping into excesses of some (e.g watching movies all day, gaming etc). Use coping resources that work for you or seek help with learning such strategies from a counsellor or therapist. The aim is to reduce the emotional response, calming your mind and body, to enable a rise in rational thought and perspective. We have plenty of information about creating safe spaces in our living, working and social environment. Consider creating a safe space in your mind also. It might contain reassuring thoughts that this to will pass, as history has shown us time and again. Channel a reassuring voice to verbalise this and anything else you need to hear. Say it out loud to yourself if you find your own voice reassuring. Think of future options even if you never have to use them. Having options, even in thought, helps us not feel stuck and helpless. Evoke the calming effect of the parasympathetic nervous system by putting together a ‘kit’ that evokes the senses and grounds you, for example:
The sense of vision: a photo that makes you smile (person, group, pet, favourite place or view)
The sense of touch: something that comforts you when you touch or hold it
The sense of hearing: a sound that soothes you (music, a recording of the sea, a voice - use Apps as a source)
The sense of smell: a dab of e.g. peppermint oil or lavender oil on to a tissue or cloth. Citrus fragrances are also good but perfumes don’t tend to be strong enough
The sense of taste: a piece of citrus fruit, something sweet or savoury
We have an opportunity for a ‘potential space’ which paediatrician and psychoanalyst D. W. Winnicott describes as a place where we experience life creatively, such as: a landscape; a theatrical or musical performance; a poem; a story or another person. This play space enables us to connect with our inner and outer worlds. Becoming involved in creative experiences like art, writing, music and dance helps deal with trauma by showing us what the body can do. It has become a missing piece for many, in the frantic world we inhabit. Studies show that creating visual art reduces the experience of negative emotions and increases positive ones thus reducing depression, stress (by reducing cortisol) and anxiety. 
Get out in nature when you can. A forest, seaside or hill side walk; a bit of spring gardening. The German Renaissance artist, Albrecht Dürer, advised that we observe nature well and take her as our guide. Remember, there is always dawn after dusk and sunshine after rain.
At Time and Space Psychotherapy, we are here with you through this difficult time. We also provide on line sessions if you are staying home or if lock down is announced. If you are struggling with the psychological effects of this pandemic, get in touch now.
1. Andersen, K.G., Rambaut, A., Lipkin, W.I. et al. (2020) The proximal origin of SARS-CoV-2. Nat Med.
2.Brooks, S.K et al (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet 395 (10227): 912-920
3. Stuckey, H.L and Nobel, J. (2010). The Connection between Art, Healing and Public Health: A Review of Current Literature. Am. J. Pub. Health 100(2): 254–263
Share this post: