A lowdown on pandemic-induced stressors, coping with loss and grief, and novel therapy approaches—here is what the experts have to say about mental health in the midst of the pandemic. By Rashima Nagpal & Sumeet Keswani
The COVID-19 pandemic has taken and continues to take, an enormous toll on people’s health. Even those who haven’t contracted the disease have been affected by it mentally. The fear of catching the virus, social isolation, coping with loss, dealing with the socio-economic impact of lockdowns, vaccine anxiety—there are many factors weighing on people’s minds. The second wave in India only made things worse and brought death close to home, points out Varkha Chulani, clinical psychologist and psychotherapist, Lilavati Hospital, Mumbai. “Financial losses, job losses, [and] spiralling medical costs were practical problems, which then led to mental health issues.” As people attempt to get back to somewhat normal lives and predictions of a third wave loom, experts weigh in on the mental health crises of the pandemic and its possible remedies.
As a grief and trauma therapist, Dr Hiba Siddiqui, senior psycho-oncologist at Max Healthcare (DelhiNCR), has helped many clients with familial losses during the pandemic. “The two primary emotions I dealt with are guilt and anger. It’s different from usual losses in the sense that the pandemic has pushed people to look into dark spaces. People have been stuck in abusive homes, in financially disturbing situations, in spaces where they don’t have control and feel helpless—this has added another dimension to the mourning process.”
There is also a cultural and communal aspect to grief that social isolation has snatched from people. “In India, we live in a collectivist society. Cultural assimilation is such that we’re constantly communicating. Our rituals and rites allow us a shared space, where we don’t feel alone. In the past, in certain communities, people were hired to cry at funerals—to ensure that the family who had suffered the loss grieved,” says Siddiqui. But the pandemic has made sure that we grieve alone, and often without the sense of closure that comes with final rites.
Losing parents and grandparents at a young age has had a huge impact on children, says Aditi Kaul, psychologist and programme lead – expressive arts-based therapy, Fortis Healthcare. Although it is normal for kids to experience loss, the scale has been unprecedented. “This pandemic is a tsunami that doesn’t end. It is going to drag us down, and we are going to take time to swim up to the surface. We will eventually find our life rafts, but we have to recognise that we need them, and use them. Already I find people diminishing loss, saying things like, ‘It’s not just you; everybody’s losing jobs and people’. That attitude is detrimental,” shares Kaul, who’s currently treating three kids—aged six, seven, and 11—all of whom have lost their fathers.
The Guardian recently reported that “the subtle, but frustrating, mental deterioration” that a lot of us have incurred over the course of the pandemic is indeed a mass phenomenon. It’s come to be called the ‘pandemic brain’. The jury is still out on whether this will have any long-term effects. “The pandemic has caused substantial stress. The nature of stress and the magnitude of perceived stress vary. There are many variables that influence the extent of this perception, including the individual’s personality, their past experiences, and their bank of resilience,” says Dr B N Gangadhar, former director of the National Institute of Mental Health and Neurosciences (NIMHANS). However, one simply cannot overlook the surge in mental health concerns since last year. “We’ve more than doubled our team since the start of the pandemic,” shares Paras Sharma, director, The Alternative Story. Kaul, too, has seen a doubling of cases, but she’s quick to point out that this may just be a minute fraction of the real number since a lot of people don’t have access to mental health services.
In a recent New York Times article, psychologist Adam Grant described the “blah that you’re feeling” during the pandemic as ‘languishing’. “Those who weren’t showing symptoms of anxiety or depression were still talking about lower motivation, blunted feelings of joy or enthusiasm, being stuck in a loop,” confirms Sharma. In a society where most people feel like they’re in a rut, mental health, productivity, job satisfaction, etc. are likely to dwindle, he adds. “This is alarming for things like civil participation. When people are driven, they do great things, like activism or altruism. When people are languishing and disenchanted with everything, they move towards conservatism.”
Numerous people have reported irregular sleep patterns since the pandemic struck. While many found it hard to fall asleep despite being exhausted, some said they’d take naps every chance they got, reveals Sharma. “Both excessive sleeping and the inability to fall asleep are signs that mental health is not in the best state.” An interesting fallout has been the proliferation of melatonin products. “From melatonin gummies to drops, pills, and strips that were not popular in India are suddenly being discussed on Instagram.” Also, CBD oil products, typically used by people with ailments like chronic pain, endometriosis, and fibromyalgia, are now being marketed as relaxants and sleep aids, Sharma points out. “Therapy, on the other hand, uses what we call ‘sleep hygiene’ to help clients back on track.”
CABIN FEVER & ANXIETY
Prolonged isolation and a lack of dissociation between personal and professional lives have led people to feel something akin to cabin fever, multiple therapists have observed. Anxiety is one of the by-products of this feeling. “I see students graduating from schools and colleges with no direction of what to do next. Unemployment and job changes have resulted in increased anxiety. Hidden anxieties have surfaced within relationships,” says Siddiqui. In some cases, though, anxiety didn’t have a big life milestone as its root cause. “When existence is the reason for feeling anxious or depressed, we call it normative anxiety or depression. Which means, it was normal and common to see people showing a degree of anxiety and depression,” Sharma explains.
For those who find themselves stranded at the surface of a mental health crisis, Sharma highlights the role of a therapist. “It’s not the job of the client to determine the kind of therapy they might need. They should definitely be a part of the process, but it’s the therapist’s job to explain why a certain treatment should be used.” The counsellor also emphasises the role of allies. For instance, he says, it might be hard for an individual to identify a panic attack the first time it happens.
Kaul practises a more client-centred approach. As an expressive arts-based therapist, she works collaboratively with her clients using an evidence-based approach. Her work includes dance movement, music, visual arts, and writing/-telling.
But the pandemic threw her a curveball with physical distancing. While talk therapy could adapt to virtual sessions, Kaul’s methods were harder to improvise—at least initially. “Arts therapy is about being present in the space with the therapist and being in contact with a piece of paper or the clay you’re using,” she says. Kaul had a breakthrough of sorts with the Zoom Whiteboard, which allowed her to create art together with her patients. Digital tools also reduced the cost of therapy, both to the client and the environment. “When people were stuck at home, without easy access to resources, I started doing eco-art therapy. We utilised old sanitiser bottles and other disposable things, flowers and leaves picked up on walks, etc.,” says Kaul. Apart from the individual sessions, her team conducted over 700 Instagram Live sessions, which became very popular.
As the second wave recedes and restrictions ease in every sphere of life, some people have pounced on the opportunity to travel to their favourite hill stations while others are struggling to return to shared office spaces. Pulkit Sharma, clinical psychologist and spiritual counsellor, advises against both extremes. “Sometimes, it’s essential to step out for the sake of our mental health, but for physical safety from the virus, you should get vaccinated, wear a mask, avoid going to crowded places, and travel in a bubble of select friends and family who have been vaccinated and are as cautious as you.” He also recommends being shameless and assertive in asking for COVID-appropriate behaviour from others, including coworkers—to reduce anxiety.
Whether there is a third wave in India or not, the mental health crisis arising out of the pandemic is undeniable. But as the experts say, the first step to remedying it is recognising it.
HELP IS AT HAND
If you or someone you know needs help, please reach out to any of these helplines:
KIRAN 1800-599-0019, toll-free; available 24×7
SAMARITANS MUMBAI 8422984530; available every day from 5 pm to 8 pm
NIMHANS 080-46110007, toll-free; available 24×7
CONNECTING 9922001122; available every day from 12 pm to 8 pm