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Connecting, Communicating and Caring – the need of the hour
With news of COVID deaths and infection inundating our daily lives and the collective grieving of our customary funeral rites not possible, the mental health and well being of the nation is compromised. Speaking to the Sunday Island, Senior Consultant Psychiatrist and Senior Lecturer at the Kotelawala Defense University, Dr. Neil Fernando, discusses the need for emotionally supporting each other and fostering positive thinking to brave these hard times.
by Randima Attygalle
Q: Although social distancing, hand washing and mask-wearing have become the norm, there is hardly a public discourse on mental well being during this pandemic. How important is it to promote such dialogue?
A: Health is defined by the WHO as the ‘complete physical, mental and social well being of a person.’ Mental health is therefore very much an integral part of overall health, but unfortunately like in all other situations, mental health is neglected during this pandemic too. The mind comprises three important components: cognition (this includes your thinking, your memories, mental images- mainly how you think), emotion (how you feel) and your behaviour. These three components are interrelated and interdependent. For example, how you think will affect how you feel and how you feel will determine how you act. So this principle applies to the COVID pandemic – how people think, how they feel and how they behave. Wearing the mask, hand sanitization and physical distancing are all behaviours and behaviour is part of mental health.
Exposure to too much negative news affects your emotions and your behaviour. Initially when the pandemic broke here, the approach to it was more military than health-induced creating apprehension and fear in people. The initial impression given of the illness was more from a ‘criminal’ angle with media bulletins flooded with news of infected people and their first contacts being chased after. Later when people were exposed to COVID deaths, the scenes of coffins being put into crematoriums and personal protective gear-clad health workers everywhere traumatized many.
The world at large too made a blunder by using the term ‘social distancing’ when it ought to have been ‘physical distancing with social connectivity’. In a culture where social interaction is a norm, the term ‘social distancing’ became a double burden. When one house in a neighbourhood was quarantined, people feared a lockdown of an entire area and fault-finding came into forefront. Those who were responsible for the coining of terms such as ‘Peliyagoda cluster, Minuwangoda cluster etc.’ never thought of mental health implications they would trigger and accompanying discrimination and stigma. Apparel workers who were earning dollars for the country were shunned and were looked at as carriers of the virus.
While the importance of mental health and well being was not promoted, people were exposed to factors detrimental to their mental health. Media too has a responsibility of sending out messages of positive mental health instead of sending ‘news alerts’ with death tolls and the number of infected cases. More positive messages can be sent to the public.
Q: With reports on infected cases and deaths flooding in and anxiety levels of people rising, even among those not directly confronted by death, what coping mechanisms do you propose to foster ‘positive thinking’ in such a backdrop?
A: We need to apply the concept of ‘positive psychology’ promoted by Prof. Martin Seligman, a clinical psychologist from the University of Pennsylvania. Positive Psychology is relatively a new area in psychology where the focus is on well being. Rather than looking at the negative aspects of an illness and what is wrong, this concept looks at the stronger side. Up to the turn of this century, psychology was looking at means of filling deficits – when a person is ill, how he/she can be made well. In Seligman’s own words, “it was bringing a person at minus two to zero.”
‘E’ is for ‘Engagement’ or flow- to be actively involved in some useful activity. Children not being able to go to school is a drawback; however, they can learn household work or a craft during this time. Even in a lockdown situation, people should be engaged in something, even observing nature is a kind of engagement
‘R’ is for relationships. Social connection promotes well being. Social isolation is the reverse. Even in a quarantine situation, one must be socially connected with family, friends, work mates and neighbours despite physical distancing.
‘M’ is for ‘meaning’- to have a purpose in life. This pillar is connected to your spiritual life as well. Caring for others can give a lot of mental satisfaction and promotes your own well being as well. There are many who have lost their livelihoods, friends, neighbours struggling to survive and those who are more comfortable can help such people in need.
‘A’ is for accomplishment, to have goals and achievements in life; to be proud of what you have achieved.
Using this PERMA model, we can encourage people to think about the best scenario possible and not the extreme. One needs to take a middle path. Otherwise people will be overwhelmed by statistics, because statistics emphasize largely the negative side.
Q: With the rise of elderly deaths, there is apprehension among senior citizen.’ How best can they be supported?
A: It is essential that they keep negative news at bay. Watching and reading too much about COVID and deaths can be detrimental. People should also be encouraged to keep in touch with their loved ones and engage in positive conversation outside the pandemic. Engaging in an activity that interests them such as listening to music, gardening or reading can also help them to get distracted from negativity.
We should also support them psychologically with what we call the ‘Two-Es and I’s’: Emotional support of love and care, Esteem support (showing respect and giving value to a person), Informational support (providing correct information and knowledge to counter myths and misconceptions) and Institutional support (offering practical help).
Q: How vital it is to ensure the mental well being of our health workers?
A: It is of utmost importance to ensure their moral well being as it could affect their productivity. Unlike in the first and the second wave, in this third wave of the pandemic, health workers are facing what is known as ‘moral injury’. That is, with limited resources, they are unable to cater to each and every patient. For example, while there may be two patients who need ventilators, only one machine may be available. So it is the health worker who has to decide who gets it. Of course there could be protocols and guidelines but it is another human being who has to implement these guidelines. Therefore health workers can experience ‘moral injury’ or a kind of guilt that could haunt them later that a decision had to be taken at the cost of another patient’s life. The trauma of the pandemic and its mental health impact will be enormous and could last for years to come.
However, on the brighter side, there is a new concept associated with Positive Psychology called ‘post-traumatic growth’ where people can actually make use of traumatic events as a learning opportunity and be empowered.
Q: Sri Lankan funeral rites enable shared grief with community involvement. The pandemic has deprived our people even of religious rites. How does this impact their mental health?
A: When a death occurs in normal circumstances in our culture, it is referred to as a mala gama or an avamagula, the very terms connoting that it is a community affair where ‘grief reaction’ is a shared one. Almost all our funeral rituals are psychologically very sound. The social and religious customs which follow a funeral support the sharing of grief, so that the bereaved family can come to terms with it.
Sadly this communal exercise is now replaced by solitary grief. You cannot even see the body, there is no funeral ceremony, no rituals performed. The psychological buffer provided by our culture is now being taken away. Some people have lost several family members. There is a lot of silent mental suffering going on right now as survivors also have a ‘guilt feeling’ that they couldn’t even give their loved one a dignified funeral. Hence talking and listening to those who are mourning, sharing of grief should be done using other means while keeping the necessary distance.
Q: We are a nation which went through a civil war. Pandemic is a ‘war’ of a different kind. As a senior professional who dealt with combat-related mental issues/depression etc. do you see a difference in human response to the war and the pandemic from a clinical standpoint?
A: Yes, there is a difference. Compared to war where the majority of Lankans were not directly affected, in this pandemic situation everyone is affected. Right now you don’t see the enemy but only destruction. While war and its impact were ‘structured’ pandemic is a different phenomenon.
In times of war, even when a sealed coffin was sent home, there were funeral rites performed and military funerals accorded with the respect of a nation demonstrated by draping the national flag over the coffin. All these interventions helped families to overcome grief. Today with solitary suffering, people are finding it hard to come to terms with death.
Q: Organizations have lost employees and some employees have lost their loved ones. In such challenging times, what can be done at organizational level to keep people motivated?
A: Organizations can make use of available resources and promote the well being of people. They can make use of virtual platforms to share ideas and grievances and be supported by professionals. At the same time it is important for organizations to maintain proper communication channels with their staffers and support them through difficult times.
Q: With children being home-bound, what tips would you give parents to keep their children optimistic?
A: If parents have a negative attitude, children invariably will be negative and even when schools reopen, some children may fear associating with some of their friends. Parents should encourage children to remain connected with their friends, grandparents and family through other means while maintaining physical distance. Association is very important at this point. They can also be encouraged to make use of this time to learn a new craft, household chores etc.
Online education itself has created problems. Children who are unable to connect due to different reasons can feel sidelined. This could be psychologically traumatic because at the end of the day, all children will have to face the same examination paper. Policy makers should be conscious of this factor.
Q: Do you see a rise in depression in your clinical practice since the onset of the pandemic?
A: Yes I do. There is what is called post-viral depression. Any viral infection can precipitate depression. COVID too began as a viral disease and it is natural to expect people who recover from it to develop symptoms of depression. Loss of a loved can also precipitate depression in certain people.
Q: How can family and friends support someone who is at risk of depression?
A: Grief is a natural reaction to loss, but it could turn into abnormal grief especially when death is sudden and unexpected. When grieving is prolonged (beyond six to eight months), a person can develop depressive illnesses and in order to help we should be conscious of the three Cs: Connect, Communicate and Care.
It is important that you listen to a person grieving because listening itself is therapeutic. For this, one need not necessarily be a mental health expert nor does one need to have solutions to all problems. What is important is to encourage a person to talk taking his/her own time and listening in an understanding, non-judgmental manner. Empathetic listening is vital and this entails communication – showing your understanding and most importantly, acknowledging and validating a person’s emotions.
Q: With lifestyles turned upside down, working from home arrangements interfering with domestic chores, socializing in office and outside being a thing of the past, and visiting loved ones being restricted, the ‘new normal’ has become stressful to many. How best can we navigate these challenges?
A: The pre-frontal lobe/cortex or the front most part of the human brain is well developed enabling humans to adjust to new situations. This is the reason why man is ahead in terms of evolution. It is true that the new normalcy has created its own set of problems but it is imperative that we make changes and adjust accordingly rather than trying to persist with what we were once used to. A good example is working from home – this concept was not heard of before COVID but people are getting adjusted to it. This shows that on the whole humans are capable of adjustment, although some may be quite comfortable and others may be less comfortable with adapting to new situations.