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)
Edited by: Dr. R. C. Koumar
