Covid and Mental Health: A perspective 💛

Covid and Mental Health: A perspective 💛

It’s easy to judge someone with a mental health condition; they’re different, right? Nope. It’s even easier to avoid them because engagement requires patience and the willingness to really listen to what is and what isn’t being said. And above all else it requires you to have empathy for the journey, one that you may not fully understand.

Stephen Fry. MIND’s President Ambassador since 2011.

Mental health has been the focus of increasing attention over the past few decades within education, television; adverts, news, soaps and films, music, theatre and society in general. The primary intention has been to shine a light on what it’s like to live with a mental illness; positives and negatives, in order to de-stigmatise sufferers away from the many misconceptions; some of them absurd and others negativity generalised to a whole population of people.

We’ve still a long way to go in my opinion; the message that “it’s ok to not be ok” hasn’t quite caught on in certain corners of society, especially in communities where there’s strong patriarchal influence. In these areas, there’s a dominant perception that it’s dishonourable and/or unmanly to admit that mentally, you’re not ok. It would be accurate to state that this is prevalent right across the world, and within particular cultures and religions it’s even more difficult or indeed impossible for men to admit that they are suffering mentally and emotionally. Add socioeconomics into the mix, the lower we go, the more challenging it becomes for men to admit that they don’t feel ok lest they appear weak or are mischaracterised as “nuts”, “mad” or some other disparaging term.

The final taboo…

Defined by the World Health Organisation (WHO) as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”

WHO’s definition accurately defines how important mental well-being is to live and function normally. The opposite being that mental illness can impair our capacity to function normally and can affect our ability to cope with life’s stressors. There are a number of mental illnesses listed in the DSM—5 with varying degrees of severity and treatments and each of which impair a person differently.

The parameters of mental health and mental ill-health are regularly blurred because a person can have a diagnosis but live well and someone can have lesser diagnosis yet be severely impaired. This indicates that mental ill-health is a subjective experience and our response to it stems from the resilience blocks that we built in our formative years. Attachment Theory can provide one argument for this – but that’s for a whole other blog 😊

Mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.

https://www.psychiatry.org/patients-families/what-is-mental-illness

I’ve enough experience with mental illness to know that burying it and avoiding addressing it will only last so long before you erupt and it seeps toxically into your daily world irredeemably or for a period of time that could last forever – yes, I meant the paradox. Furthermore, when the eruption happens, you won’t only be dealing with the effects of that but potentially the rollback of whatever coping mechanism(s) you used to get you through the day; be it an addiction to alcohol and/or drugs, or some other damaging behaviours.

1 in every 3 people will face a mental health problem in their lifetime, which seems like a staggering figure – it is. It’s a serious amount of people struggling to face the day. Struggling to function normally. Struggling to sleep. Struggling to connect with others. Surely this means that as a population we can be more empathic and compassionate towards others because we too have had, or will have a mental health concern at one point in our lives? Or maybe we just need to reflect on what we think we would want or have needed on days when everything was just too much?

Mental illness is primarily an individualistic journey, a hidden myriad of despair, confusion, pain, lethargy and ‘all about me’. It can appear hugely selfish to others especially children, family and friends, because the dynamics can be exhausting and subsequently very isolating. For example daily chores can require the energy of 4 people or you’ve used all your energy overthinking plans that you’ve made with a friend and by the time to meet arrives you’re too exhausted and wound up to leave the house.

There is no health without mental health.

World Health Organisation

It’s no secret that there’s a strong correlation between Fibromyalgia and Mental Illness. It’s like a game of cat and mouse; have a poor night’s sleep and feel your body engulfed in pain the next day and tick tock here comes the depression, the anxiety, the why me? And with the ‘why me’ comes a throbbing burning pain in your shin bone, your knees, your big thumb;so painful that it keeps you awake another night…. You get the picture?

It’s also common knowledge that there’s a strong association between childhood trauma and adult mental ill health. I recall sitting in a lecture on Child Abuse many years ago and feeling short of breath and my heart rate began to increase with a Thump! Thump!, that I swore it could be heard around the lecture hall.

Numerous statistics denoting the links to PTSD, Depression, Bipolar and Personality Disorder kept sliding across the screen. There were also relationships with addictions, criminality and repeated attempts at recidivism, homelessness alongside risk-taking behaviours. Please note that I have stated ‘association with’, meaning that it’s not factually definitive that any of this will happen should you have experienced a childhood trauma, but the data suggests that it is one of numerous factors that can lead to these life outcomes.

As the lecturer proceeded, oblivious to my internal disarray, all I could think of was that my distress was being witnessed by the rest of my student colleagues and that all eyes were on me. This led to me sweating profusely and as my breathing became shallower, I started to feel lightheaded. I have personal experience of some of the traumas being discussed and had not been prepared for the onslaught of flashbacks that were assaulting me with every rolling slide and with every sentence spoken by the lecturer. All I could think about was climbing over students heads as I needed out of that room and fast.

Thankfully, there are a whole host of factors that can offset many of the adverse outcomes experienced in Adulthood, beginning with parental or caregiver love and nurturing. I read a journal almost a decade ago on schizophrenia and the impact of Nature v Nurture. The author considered the likelihood that schizophrenia could be genetically passed from parent to child and whether nurture could reduce this likelihood.

The study focussed on a set of twins who were separated at birth with one child remaining at home with the birth family and the other being adopted. The outcome determined that the child who had remained with their birth family developed schizophrenia as a young adult and the adopted child did not. Obviously this isn’t as clear cut as it appears and geneticists and biologists have progressed hugely in this field of work to be able to determine which part of the brain can trigger specific schizophrenia. However, the outcome of this study had demonstrated the power of nurturing and love with a child predisposed to schizophrenia.

The Corona Virus

A Timeline:

  • WHO was informed of a cluster of pneumonia cases of unknown cause on 31 December 2019, in Wuhan City, Hubei Province, China.
  • SARS-CoV-2 and the associated disease Covid19 were identified from the case samples as being the cause of the outbreak on January 12th, 2020.
  • By October 2020, global cases totalled over 45 million with over 1.1million fatalities.
  • March 2021, Schools in the North of Ireland plan to fully return by April 12th as the number of those vaccinated rapidly increase in-spite of concerns relating to Oxford AstraZeneca.

Aside from the very obvious direct impacts of Covid19, the Dept. Of Public Health outlined a range of indirect impacts of the Pandemic resulting from the measures introduced to control and mitigate the death grip of the virus. Published in the British Medical Journal (BMJ), they include:


• Changes to employment and income, known to affect life expectancy.
• Access to education for children and adults.
• Social isolation, family violence and abuse.
• Changes in the accessibility and use of food, alcohol, drugs and gambling.
• Changes in physical activity and transport patterns.
• Changes in the availability and use of healthcare services. https://www.publichealth.hscni.net/sites/default/files/2020-12/DPH_Report_Final%2031%20Dec%202020.pdf

Each of those categories denotes a group of people, some potentially vulnerable before the pandemic, but most certainly vulnerable since the pandemic, with the effects forecasted to last at least a generation. This has significant ramifications for individuals, families and communities here due to already hugely underfunded health services, particularly Mental Health. How then will people survive without vital supports? An example though slightly off topic; I received a letter yesterday from the Rheumatology Clinic advising me that my next appointment could take up to 6 years – that’s the new waiting time! In 2017, the waiting time for rheumatology was 12 months.

Similarly, whilst the whole world attempted to adjust to lockdowns, coming together under the British Government PR catchphrase “we’re All in this together” and the U.K. wide #ClapforourCarers, it wasn’t long before it became obvious that we weren’t actually in this together, we weren’t even in the same *boat*; some boats were drowning under the weight of the waves whilst others, built like the QE2, had champagne and canopies with the best views of the rowing boats going under. Let’s think of our nurses, embarrassedly underpaid, risking their lives and their families daily, to keep us safe. Similarly, other essential workers like grocery store workers, postal workers, teachers and social work and social care workers, each of them sinking in overcrowded, unsafe boats. I could go on forever…

ILLUSTRATION: BARBARA KELLEY

So basically what this indicates is that the lower your socioeconomic status and the higher your demographic variables, the greater risk you are for contracting the virus AND being high risk of experiencing adverse effects from the social distancing measures. Here are a number of examples:

  • Older people—highest direct risk of severe COVID-19, more likely to live alone, less likely to use online communications, at risk of social isolation.
  • Women—more likely to be carers, likely to lose income if needed to provide childcare during school closures, potential for increase in family violence for some.
  • Individuals with Mental Health conditions such as depression and anxiety may be at greater risk from social isolation.
  • Increased chances of job losses and increased poverty stemming from furlough
  • Loss of income from cessation of zero hour contracts. Workers on precarious contracts or self-employed—high risk of adverse effects from loss of work and no income.
  • People on low income—effects will be particularly severe as they already have poorer health and are more likely to be in insecure work without financial reserves.
  • Increased dependency on alcohol and/or drugs to cope with the worry and stress
  • People who use substances or are in recovery—risk of relapse or withdrawal.
  • Social isolation, loneliness and loss of routine
  • People with a disability—affected by disrupted support services.
  • Homeless people—may be unable to self-isolate or affected by disrupted support services.
  • Cessation of social norms particularly in relation to Wakes, Funerals and Burials
  • Loss of education hours due to reduced access to technology and availability of reliable broadband, reduced teaching hours,
  • Child and young person social isolation, increased time at home supporting parents with MH, Addiction and Domestic Violence
  • Young people—affected by disrupted education at critical time; in longer term most at risk of poor employment and associated health outcomes in economic downturn.
  • People in criminal justice system—difficulty of isolation in prison setting, loss of contact with family.
  • https://www.publichealth.hscni.net/sites/default/files/2020-12/DPH_Report_Final%2031%20Dec%202020.pdf

What does this mean in real terms for someone like me for instance; single parent of one young adult, and one teenager, both in full time education, no practical or financial support from children’s father. living with a debilitating health condition which is a trigger for mental illness including anxiety and physically unwell enough to work?

Insomnia

I’ve had issues with sleep for most of my adult life. Covid-19 brought that to a whole new level; I was now going 4-5 nights in a row without any sleep. Lockdown 1 was the caveat for what faced me throughout the next year in relation to sleepless nights and increased mania as a consequence.

My mind was so overactive withs fears for my children’s and Mother’s lives. My son has chronic asthma and my Mother has a variety of health concerns that placed them both in the high risk category. My sister had just had a new baby and in the absence of any stats relating to Covid19 and child mortaliity, I expected the worse, waiting on ‘that’ call that would tell me what I expected to hear.

My new focus became disinfecting and sterilising walls, doors, handles and everything else in the house. Letters weren’t opened for 72hrs after being disinfected because the data suggested that it could remain that long on packages. Everything that entered our home went through the same process:- cleaning with sanitiser and left in the hall for the appropriate timeframe. And whether it was the fumes of the sanitisers or the over-activity, sleep still didn’t come.

Isolation

My separation had already redefined my friendships into true friends and fake ones, seemingly atypical in marriage breakdowns. It’s a shock at first, because you kinda expected the pain associated with the loss of life as 2 {+ 2 kiddos, in our case} made redundant to one person making all of the decisions, dealing with all the consequences and being singularly responsible for the lives of two young humans. You also sort of expect to come face to face with the trauma experienced; the reason that you left it all behind, and whilst you foresaw that there would be hurt and pain, realistically never in your wildest dreams did you expect the depths that that pain would reach when people you trusted exited your life.

What you don’t factor in is the cessation of calls or texts from “our” friends, the excuses, the distance or the blatant support for your ex; which is rather like Alice going down the Rabbit hole – you just can’t quite believe all of what’s going on around you. What remained was my true friends, unshakable in their faith in me, their love for me and their indomitable support for me.

You all know who you are 😊

The pandemic forced us all to reflect on the fragility of humanity. Watching the death tolls every hour, every day reach disproportionate figures, the pain and loss being experienced by citizens all around Europe, all around the world, impacts you in a way that you’ve never experienced before; you don’t know these people but without expectation you’d already crossed the boundaries of empathy and sympathy to feeling that loss yourself. Short city breaks in Krakow and Barcelona prior to the Covid19 outbreak become the focus of my thoughts as I witnessed them being ravaged by this virus and you wonder if they’ll ever be as magnificent as they were when you roamed their cobbled streets.

Krakow

Barcelona

The journey to self-awareness and healing isn’t clear cut and follows no order nor sequence. I’d already naturally begun to withdraw from family and friends in order to understand the depths and complexities of my pain and anguish, but I was safe in the knowledge that I only had to make a call and one or all of them would be there for me.

Enforced isolation however, is a different category altogether; being told that you could not visit your loved ones creates a type of vulnerability that frightens you. Covid19 lockdowns led an already troubled mind down a turbulently dark path. No visitors calling to the door to check on how you’re keeping, to share all the going’s on over a cuppa, or to go to a friend’s house for a drink and a cathartic bare all, reduced my existence in my mind, to a nothingness, empty of purpose apart cook and cleaner. Conversations with yourself become darker, riddled with hopelessness as the isolation period grows longer. I struggled to concentrate, to read, to think of anything else beyond Covid19 until one day the sun began to shine and with that came hope. Don’t get me wrong, I was still too anxious to leave the house or to have visitors call but I began to plant flowers and herbs which gave me a renewed sense of being and a renewed faith in life.

Loneliness

It’s pretty obvious that loneliness can be a stepping stone from isolation – bereft of true human connection. Loneliness however, is a state of mind underpinned by feelings of sadness, emptiness, lack of purpose and low self-esteem and self-worth. It can be a symptom of psychological issues such as anxiety and depression.

Therefore, it is a subjective experience, with causation and responses differing from individual to individual. Loneliness is non-discriminatory meaning that no age, race, creed or sexuality is exempt from it, yet some are more at risk that others, older people for example. Did you know that you can feel lonely in a room full of people? On the other end of the scale, loneliness can kill. This is why we have so many advertised programmes asking that we check in with our elderly neighbours to ensure that they have all what they need, ask how they’re keeping and maybe encourage a conversation with them.

Apart from death, which is an extreme but likely outcome of loneliness, it can also lead to;

  • Depression and Suicide
  • Alcoholism and Drug Misuse
  • Progression of Alzheimer’s Disease
  • Cardiovascular disease and Stroke
  • Increased Stress Levels
  • Antisocial Behaviour
  • Decreased memory and Cognitive Function
  • Poor Decision Making
  • Altered Brain Function

My own experience with loneliness began long before covid19 and even before my separation.. It was a very strange diametric; being 1 of 2, yet feeling like the loneliest person alive. Covid19 progressed this to dangerous levels, devastating an already damaged self-esteem and confidence.

You see, when the mania dissipated and the fear ebbed, there was nothing to replace it with. As lockdowns reduced and the morbidity and mortality rates dropped, so too did my overzealous needs to sanitise every single item coming into our home and I became redundant once more, roaming about the home, overthinking the facets of leaving the house for groceries and medications to the point that anxiety prevailed, preventing me from going out of the house. I overthought catching covid19 from others and passing it to my vulnerable son. I overthought seeing someone that I knew who would judge my appearance. I overthought someone attempting to verbally engage with me and not having anything interesting to say. The list goes on but each leaving me disappointed in myself to the point of despair.

I was also acutely aware of the impact of loneliness on my children. They had both been thrust from their routines that involved spending most of the day out of the home, learning with their peers, having fun with their friends, engaging with educators, seniors and a wide range of societal actors.

Now their worlds consisted of rotating around zoom classes on their laptops during the day and submitting homework’s and essays in the evenings. Friendships continued via social media, which brought with it more than a range of its own problems. More time spent in their rooms – I missed them dearly, even though they were only two floors above me. They were feeling the loss of their social networks and being kept out of nature.

There is hope now, for us all. The vaccination process has given my son his confidence back, and my daughter has used her time proactively to progress her interest in the acting field through persistent research of relevant and educational webinars. Both are very ready to return to ‘normality’ after Easter via school and university and the engagement with their peers and the sanity that they derive from both.

For me, the journey back to normalcy is not so clear cut. Loneliness is soul destroying, rendering you exhausted, empty and without purpose. Your self-worth is so diminished by multiple contributors that it’s ridiculously hard to rebuild. Exhaustion from doing so physically little on top of a health condition, is almost impossible to shrug off and the self-depreciating voice at the forefront of your mind berating your lack of value to society can be so challenging that it’s easier to continue ignoring calls from family and friends thus isolating yourself further, implanting loneliness deeper into your soul.

Mental Health

Family members noted my neurotic and fraught demands that they remain at home, spewing out morbidity and mortality rates, intentionally frightening them half to death. In my mind this was better than them succumbing to covid19, being ventilated and dying. I kept envisioning being unable to properly say goodbye, to hold the wake; a key element of the Irish grieving process, and to have my family member buried in a plot far from those already in family graves.

I was completely and irrationally obsessed with Covid19; it’s claws had slithered into my bloodstream dominating my every thought and action. I had alienated loved ones because of my approach in trying to “protect them”. I was a ball of restless energy, fighting the great unknown and failing miserably. I know now that this was me mid-breakdown, feeling that everything was out of my control, helpless and hopeless. I was very unwell and needed a break from my own thoughts. Thankfully, a renewed interest in Aromatherapy and Bach Flowers returned some of my natural curiosity and from then onwards I have used my time productively to focus on building a small business. Some days are easier than others to get motivated. Some days it feels like the walls are closing in on me and all I can think of is escaping.

Anxiety

That’s where self awareness and stress management comes in

Anxiety became a full time lodger in my mind around 5-6yrs ago. I always had a streak of anxiety in me but I managed it so well, no one would ever have known. Friends and associates never knew, even my family didn’t know. As a child I’d mastered the art of containment, controlling my emotions until I was on my own and as my little mind developed, so too did my ego; I grew to think that it was weak to cry in front of others, even my parents.

With my job, there was a certain amount of stress and anxiety. I thrived on this. There was a healthy buzz that came from addressing difficult issues for families; every difficult challenge overcome meant that the family were feeling more secure in their environments. My personal life was a different matter. I lived constantly on a high state of anxiety with no output.

Covid19 fed that anxiety and God, it was ravenous. I changed from an individual who assessed facts, used logic, rationale and data before forming a conclusion, to one who read from every news outlet, blogs, social media sites including conspiracy theorist pages. I became fixated with Global numbers; the ratio of those diagnosed to those who lost their lives. I talked about nothing else and drove my kids nuts, particularly my son for failing to use my brain when regurgitating nonsensical information that I had found on the Web.

I was living on a nervous energy, it kept me awake, I couldn’t sit still, I couldn’t focus my brain. I was irritable. I was agitated and no amount of home cleaning and decoration reduced that. Physically, I was exhausted. Listening to my fear drone on and on in my mind that my family were at risk, was draining. My heart was palpitating constantly, I wasn’t sleeping and I began to going into panics over the slightest thing. I’d wake at night drenched in sweat. At one point I thought that I was menopausal. Thankfully, being able draw from my knowledge of Aromatherapy and Bach Flower remedies and take some time out to reevaluate and refocus on what was going right, not what could go wrong, helped me to heal.

Nutshell

I couldn’t describe what I was feeling to anyone. I assumed that everyone around me felt the same way, that they were all experiencing the tilting of our world like I was.

I remember going for groceries and disinfecting my hands every 2 seconds, struggling to breathe with a mask on my face. My glasses kept steaming up because of the mask and I began panicking because I wasn’t meant to touch my face, but I had to because of the mask. I recall cracking up watching an older lady who wasn’t wearing a mask and who also ignored every social distancing measure, touching most items on the shelves and walking down the ‘up’ aisle. She then persisted in standing so close to me that her arm touched mines whilst I was waiting to pay. I don’t know how I held it together. This should never have provoked the internal reaction that I experienced; that’s not the type of person that I am, but it’s telling of the levels of stress I was dealing with and my fears about the wellbeing of my family.

Self Esteem

Self-esteem was never something I had in abundance. Every so often it popped in and I felt wonderful until my gregarious self doubt banished it. It’s a wonderful feeling that bolsters your confidence to face the world. You feel attractive, loveable and valuable.

There’s no surprise then that there’s a strong correlation between poor mental health and poor self-esteem. Loving oneself is a mitigating factor to increasing our self-esteem and self worth and in turn it can also positively affect mental health.

Often what we need is time out to reflect on just who we are, our strengths and resilience factors and appreciate how far we’ve come and the enormity of what we have already survived. Gratitude is essential because it provides a perspective. So many people lost their lives to Covid19; young, old, healthy, sick, Mother’s, Father’s, Grandparents and Children. I’m inextricably thankful that none of my immediate family caught or died from it. But I lost my aunt to It. Helen was her name. Corona Virus had found its way into her Care Home and Helen sadly caught the virus. I choose to remember her as the glamorous, vivacious, strong woman that she was and I think about her everyday.

Allowing yourself time-out to ‘just be’ can be hugely beneficial in mental health recovery. Learning to still our minds from the constant chatter can aid better sleep thus improving you outlook on life and contribute to a better, next day. The key is to stop pressurising yourself to do more than you physically can and to stop berating yourself for not meeting unattainable goals. Compliment yourself on a regular basis; there’s a lot to compliment yourself for, if only you allowed yourself to believe.

“I hope you understand you need your love more than they do”, Dhiman

I’m thankful to have come out the other end, of course there are still tough days but no longer trying to control everything around me (as much) definitely helps. My sleep patterns are still appalling, I think that’s just part of who I am, but I use a lot of my time with purpose now, I read a lot about business development and growth which is objective and fulfilling. I avoid most, if not all of Covid news, opting instead to count and focus on my blessings. The manic sanitation has stopped also. We have much more quality time at home now; we’re not trying to survive this independently, we laugh a lot and whilst it’s not ideal, what we watch on television, we mostly watch together. Both my kiddos go for walks daily – I haven’t just reached that point yet. And that’s ok.

Acceptance can be challenging for me. I’m always pushing boundaries, testing my limits particularly in relation to fibromyalgia and body image. I’m always trying to be better, to do more, to eat less, to push myself further. Calling Time-Out on my overactive, judgemental self was a must for any healing to occur. Maybe practice really does make perfect, and in that case I haven’t practiced enough or maybe there’s another trick to ‘be still, my sweet mind’.

It costs nothing to Be kind to others, and it should cost even less to be kind to ourselves. Check in with yourself regularly, where are your emotions at? Where have they stemmed from? Journal regularly, even if it’s only to remember something that happened that day or to vent. Finish each journal entry with something that you’re thankful for; it’ll help minimise the same thoughts to flow into your sleep.

Ask for and accept help, from you Dr., your pharmacist, family and friends. Set yourself a goal to make contact with one person at least once a day. Set other goals, no matter how small – ticking off those boxes feels good.

Burn your favourite candle and practice breathing. Close your eyes and let yourself drift. Use a room mist with your favourite Aromatherapy blend, inhale and exhale. This pandemic can’t last forever and we can learn, together, what our new normal will be.

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