Lockdown Prescriptions: Mental Health Truth and Trust
As Mental Health Awareness Week (MHAW) in the UK draws to a close as I write this, I think about how apt and how ironic that feels being in lockdown here in India, with our mental wellbeing in a constant state of flux. Whilst our attention is focused on our physical health and the spectre of Covid, our mental healthcare often gets neglected or overlooked. It is all too easy to feel subsumed, overwhelmed and out of control. As with physical health, remembering that mental health has different meanings and realities for each of us, is essential. Never more so than now.
During the first lockdown the spirit of bonding was omnipresent – we are all in this together, in the same boat, weathering the same storm. Social media ran riot, photographs of recipes to cook, grocery deliveries to contact, book lists to scour. The poems and affirmations flooded in. Jokes connected with the virus spawned a unique brand of Covid humour. Memes were everywhere. We learned about Zoom and tik tok and Teams.
As time has progressed the fatigue of lockdown has set in. No jokes, fewer memes. In Delhi we have lost our sense of humour at a time when we perhaps need it most. It is hard to see the funny side this year and subsequently that brand of bandied humour has faded. More serious pieces of information about beds, oxygen and doctors on call abound. Reassuring to have the information, but disquieting to think that we need it.
What is patently evident is the myth of commonality of experience. Yes, we are all aware of Covid, but not everyone experiences the disease or its repercussions in the same way. Just as we all know what it feels like to be hungry, but we have the ability to assuage that hunger. Starvation and permanent instability are on an entirely different plain. In short we are not in the same boat and we are not in the same storm. Those with private jets and private islands are able to ride high above the crashing waves. What about those who live cheek by jowl, one family, maybe two, in a single room for whom privacy, let alone social distancing, is never an option? What Covid has forced us to do is confront the reality of inequalities. One thing to read about it and another to live it everyday.
Mental health and wellbeing is something we live with daily. It is not static but ebbs and flows like physical health. We do not say we are sick if we have the odd headache, similarly we do not have a mental health condition with the odd bad day. However, the prolonged, sustained and unrelenting nature of our lives in lockdown is taking its toll on our body and mind.
The incidence of mental health has grown during this past year. That hardly comes as a headline statement. Long periods of isolation, regardless of whether we are ill or not, has profound effects. We are social animals and interact for many reasons (and sometimes none at all). Simply being around others can positively impact our wellbeing. We are trying to avoid being Covid positive yet told to remain mentally positive. Staying away from others is what we have to do and of course we know why that is the case, but it doesn’t necessarily mitigate the negative consequences of isolation.
We now have time and space to brood and worry as many of the things that give our life meaning, or variety or purpose may be unavailable or prohibited.Time is a healer, but too much time to worry can also damage our mental state. And the most affected? Well naturally those who are already vulnerable and deserve it least: the elderly and children. They are also less well-equipped to deal with safeguarding their mental health.
During the first lockdown In the UK there was talk of stoicism and the wartime spirit of community. I recall news reports of anonymous offerings: knitted rainbows painted shells, messages of hope and thanks. For despite restrictions there was the opportunity to go out into nature. Exercise was positively encouraged particularly in later UK lockdowns when the effect of inactivity loomed large; highlighted in public health warnings about obesity and heart failure, that the nation was hoarding up in comorbidities to come. Provision was made for people to have outdoor exercise once a day. I have no doubt it kept communities sane.
The theme of this year’s MHAW is nature. Again how pertinent and yet so sardonic – the balm that we crave turns caustic as it eludes us.Therefore, we must take Nature where we find her: house plants, the sky, trees if you can see them, birdlife, even geckos. The need for Nature is evermore pressing when we are urban dwellers, particularly in a Megalopolis like Delhi. If you don’t have any form of nature around you try tuning in to a nature channel, play Nature sounds, order a nature DVD or (DaViD Attenborough!), look at photos of Nature on your phone. In short, escape for a while. Escapism is very much part of my photographic offering this week by artist Marc Bauer from an exhibition I attended aptly entitled ‘Mal Être’ – which translates to ‘being in a bad way’.
Personal interaction, incidental informal everyday meetings and greetings are a point of great comfort. Chatting with shopkeepers and stakeholders in our community holds much meaning. In Brazil we lived in a beautiful city with lots of space and would walk to our local bakery and cafe honey pot. The owners knew my children and loved them to a point where they were invited to select a sweet treat of their choice on the house. They would sit high up on bar stools, slurping freshly made drinks through brightly coloured eco- friendly straws, striped and old fashioned like something from a 50s diner. We were part of the community and felt it.
Shopping local here in Delhi has enabled that too. The local grocery store owner and his family, flower vendor, vegetable stand wallah all know us. At one there is a man who is hearing and speech impaired, he signs to me that when I leave he will be sad. Four simple gestures involving a plane, and a teardrop more touching and eloquent to me than a sonnet. Most of the customers ignore him, brushing off his overtures to converse thinking that as he cannot speak or form words he has nothing to say. How mistaken.
Mental health and the inability to communicate can lead to feeling imprisoned within yourself. We may all feel that now as sanctuary becomes cell. To feel looked after is a fundamental need and we function best when we trust that those charged with responsibility or duty of care, are genuine custodians of our wellbeing. I have worked with organisations, mentors, colleagues, friends and family members who have raised each other’s mental health game. Similarly there have been those that have not. Truth and trust are key. When that breaks down we are on a slippery slope that is very difficult to reconcile.
At a recent conference with scientists, virologists, modelers and psychiatrists the panellists spoke of truth and trust. Wisdom, experience, craft and expertise rather than spin or empty promises. We need a return to that amid the panic, to listen and act upon the specialists on and in the field. Those who truly understand what is happening at ground level. I have written many times about the dumbing down of education, specialism and expertise. It feels like years of that has come home to roost.
Every day we see and hear the rising toll.Case count rises but there is still a lag if 2-3 weeks with the possible translation to death rates. Any health system whether overstretched, underfunded or in crisis needs the prevailing pressure released. Save lives protect the NHS was the motto in the UK that applies everywhere, even in countries with strong health care systems. Anything overburdened breaks. Strength does not mean invincible, especially in times of acute crisis. The same goes for mental health.
The juxtaposition of the slow pace indoors is in sharp contrast to the frenetic pace of what is taking place in the city: the search for medicine, beds, ICU and oxygen seems relentless.No one is immune from this trauma. Those in the frontline are at severe risk from the unending assault on their mental health. The recent suicide of Dr Vivek Rai, a Delhi physician survived by his pregnant wife, is one such tragic example. Who protects the mental wellbeing of those who are charged with protecting us all? What if the burden becomes too great to bear and heroes become victims.
Communicate however you choose with whomever you trust. Make or take a virtual conversation be it a phone call, zoom, text; whatever you can manage at a distance from the safety and sanctuary of your own home. Contact someone you haven’t in a while. That is this week’s prescription.