Interaction with Dr. Karishma Kulkarni on taking care of mental health during and post-pandemic lockdown rejoice

Covid19 pandemic has distanced us from nature and has forced us to embrace the virtual world leading to mental stress and health disorders. Even though medically advanced as compared to last century, we are still ill-prepared for the pandemic of this scale that has done little in saving lives. The world has moved to a new normal as it sees the end of the lockdown in many countries, including ours. Many of us are excited by the end of the lockdown in various regions of the country to rejoice with friends and families in person (within the social distancing norms). However, the fear of getting infected is confining us under extended periods of lockdown, as suggested by the scientific community. The lockdown or self-isolation and social distancing is a crucial measure in combating this deadly pandemic.

Further, this not only offers protection to us but our elder generations in particular who are more prone to this illness. All of us are battling inside and trying to do our best to accept the pandemic and its future disasters, by making sure to stay physically and mentally sound in these tough situations. We may notice changes in physical health among ourselves and our loved ones and seek comforting attention when necessary. While we all experience overgrowing stress due to lockdown and the new life adaptations, post lockdown, which is shadowed during the everyday struggle.

Hence this interaction with Dr. Karishma Kulkarni might help in finding answers on how to tackle the tectonic shifts in our mental and physical health. She says that keeping ourselves busy and being organized and not bringing negative thoughts could help us to manage this adverse situation. She stresses to be vigilant and help the frontline workers for their selfless contribution laying their lives at risk. Maintaining social distancing and other safety precautions could help tide this difficult situation.

Sayali: As most of us are filling the gaps of being practically social by spending time on social media and turning the social behavior norms to virtual behavior adaptations, will this cause any effect on individual patience level and stress management ability? How should one cope up with such situation?

Dr. Kulkarni: Humans have not evolved naturally to interact through screens. Our brains are designed to pick up on social cues, including nonverbal behavior and body language in the real world through face to face interactions. The pandemic necessitates social distancing, and as a result, people have now begun interacting using technology. The use of screens, though vital for people to stay in touch – does not satisfy the need for physical presence that most of us have. Interactions that are devoid of ordinary social cues might, therefore, be more anxiety-provoking as they do not provide the same level of comfort or support. The best way to cope with this scenario is to accept the limitations of social media and video calls as compared to face to face interaction in settings as varied as personal and professional ones. Often explicitly stating that there is awkwardness and discomfort in ‘virtual behavior’ helps lighten the moment and acknowledges that any social faux pas are to be expected with the virtual medium. This also helps others be more patient with us and for us to be more patient with them. Of course, at a future time point, there will definitely be opportunities to interact in person again so the social skills we have evolved with will still be important. Man is a social animal for sure.

Sayali: “Starting a new day with new hopes” was one of the best positive attitude people carried. Since the lockdown all days seems to be same, and most of us have changed the daily routine. Unknowingly it has caused a change in cycle of circadian rhythm, causing a change in behavior leading to be more stressed and disturbed/offensive behavior, How can one control these negative emotions and not let this behavior dominate?

Dr. Kulkarni: The best solution to this to have a structure to one’s day. Circadian rhythms have once again evolved from the time when humans were dependent on nature for their biological cues – sleeping at night and being active during the day. This becomes a lot harder to do when there’s nothing to wake up and do in the morning. Incorporating physical activity such as a home exercise program, along with a fixed time table for meals, for work (if working from home), for recreation (streaming music or movies online) will be vital to maintaining these social rhythms. If in lockdown at home with other family members – sharing meals at set times would allow for a shared space to interact with others. Of course, creating a routine is something which requires some discipline and cannot be done strictly. But even a loose time table is better than no time table. The best way to control negative emotions is through some relaxation exercises – yoga, mindfulness meditation, deep breathing, progressive muscle relaxation, Tai chi are all practices that help with relaxation. Various apps and YouTube videos can provide basic techniques of these practices. Of course, this also requires the personal motivation to practice. If negative emotions and negative behavior become too challenging to control – contacting professionals through a mental health helpline may be another option. 

This website provides a list of Indian mental health helpline numbers. 

https://www.unitedgmh.org/mental-health-support/india

Sayali: All the age groups are affected due to lockdown, while the lockdown might create unnoticed effects on juvenile group as they are being deprived from being social since schools and play times have now turned into virtual time zone. How should the family work towards motivating this age group towards social behavior and help them to overcome physiological issues leading to anxiety, poor attention and frequent changes in mood and emotions.

Dr. Kulkarni: The best way for children and adolescents to cope with the absence of the social and educational environment that school provides is to create a home school environment where the parents or grandparents can provide one on one support as the child engages in online teaching. Providing a gentle, supportive stance to this rather than a strict one would be most useful for the child. Making time to play with the child or adolescent – board games or even with toys or cards and including the whole family in play will help to distract from the temptation of screens and online video games. Screen time contributes to inattentiveness and listlessness in children. It’s one on one attention with reading books or doing arts and crafts projects that help children build concentration as well as to develop good sitting tolerance. Children depending on age level can be engaged in projects such as home gardening or painting – these are excellent interventions to deal with children’s anxiety. Please remember to be patient with your young person. It’s possible that with positive attention, young people might remember this lockdown as a time when they had maximum quality time with their families. 

Sayali: What are the effects of lockdown on youth, and how should one support him/herself while feeling stressed or anxious during COVID-19?

Dr. Kulkarni: The effects of the lockdown on the mental health of young people can vary depending on each individual. More introverted persons might be able to engage themselves in hobbies such as reading or art and enjoy this time while more extroverted young person’s might miss the company of their friends – feeling lonely and isolated. Overall, all young people might react with some degrees of stress and anxiety along with worry about the health of their parents and grandparents. The best way to support one is to find a useful coping strategy. This can range from reaching out and connecting with peers and friends through technology, taking up and pursuing a new hobby, engaging in exercising, using relaxation techniques such as yoga and meditation and if struggling with depression or uncontrollable panic and anxiety – consulting a mental health professional will be helpful. 

Sayali: How should one help him/herself towards crisis management and holding intact emotional balance?

Dr. Kulkarni: Identifying the triggers for a crisis are the best ways to prevent a crisis. Making a crisis management plan is another useful process. This plan might include – what are the situations that trigger a crisis, what are the symptoms of being in a crisis, what are the coping strategies that help with a crisis, who are the people that act as supports in case of a crisis – friends, family, neighbors, doctor, mental health professionals etc.

Acknowledging that all of us can feel emotionally imbalanced from time to time is essential. The best way to maintain a balance is self – care. Looking after oneself – sleeping on time, eating balanced meals, regular exercise, routines, making connections with family and friends and doing what you enjoy – eg. Eating a piece of chocolate, playing a song on a guitar, watching a comedy film, watching the sunset from the window. All these are important and help one stay balanced. 

Sayali: Mental health, stress and anxiety for essential workers (health care/scientist/ teachers) and how should family and friends support them?

Dr. Kulkarni: At this time, those who are on the frontline will be exposed to high levels of stress. This may be due to heavier workloads, longer hours, anxiety about becoming sick, anxiety about infecting family members, lack of self-care and recreation as well as the vicarious trauma of seeing patients suffering from COVID. 

It is essential to recognize that while work is important to prevent burn out – self-care for essential workers is also crucial. This includes all the elements described in response to the earlier questions. Adequate sleep, regular meals, rest, recreation are all important and should be taken care of, guilt-free for essential workers. The best way for families and friends to support their essential workers would be to provide a listening ear, checking in on them, understanding the need to stay apart from families due to their professional role as well as to check if they need help with supplies or meals. Even just a kind appreciative word goes a long way. 

Sayali: How important it is to provide a mental health awareness post lockdown? What is your suggestion on seeking mental health support for the one in need?

Dr. Kulkarni: Experts all over the world agree that the mental health fallout and after-effects of lockdown will be part of the second wave of the coronavirus pandemic. This makes preventative public mental health strategies, such as raising awareness crucially. 

Most mental health professionals continue to practice through the lockdown. Major hospitals continue to provide emergency mental health services for those in need. Trained counsellors and mental health professionals are available on telephone helplines, as mentioned in response to an earlier question. It is likely that telemental health will be the next most important method in providing support for persons in need. 

Sayali: A word from you on the significance of mental health in general, and note for people to support friends or colleague seeking help.

Dr. Kulkarni: The World Health Organization has defined health as a combination of physical, mental, social and spiritual well-being. Mental health is thus a vital component of good health; however, it is unfortunately often neglected or stigmatized. If you have a friend or colleague seeking help, please do not treat them with stigma or discrimination. Be patient with them and provide a listening ear to them. If you find that they are beyond your help, please recommend them to seek advice from a professional in a non-judgmental, respectful and caring manner. Though all of us have to stay apart at present, it is still possible to be able to keep those you care for, close. 

Closing remarks: We thank Dr. Karishma Kulkarni for accepting our request and becoming part of this interaction. Her views are an eye-opener that anyone could be an invisible warrior if philanthropic activities are taken up to serve the nation at difficult times. Surely her thoughts will help many thinking minds to stay strong and stable, as we all at some point are going through storms of thoughts stressing us.

Dr. Karishma Kulkarni, MBBS, MD (Psychiatry), MRCPsych (UK).

Principal Psychiatry Senior Registrar,

Northwestern Mental Health Services and Melbourne Health, 

Melbourne, Victoria, Australia. 

(Educational background: Post Doctoral Fellowship in Psychiatry from National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.

Post Graduate Diploma in Medical Law and Ethics from National Law School of India University)

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