Corona virus and mental health

Sunday 5 April 2020

“There are decades where nothing happens; and there are weeks where decades happen.”

“There are decades where nothing happens; and there are weeks where decades happen.”

‘So said Vladimir Ilyich Lenin of the ferment of revolution, but he could just as easily have been talking about the 100 days that have passed since the moment corona virus officially became a global phenomenon, the day China reported the new contagion to the World Health Organization. The world has been transformed in that time, perhaps nowhere more so than Britain’. And so wrote journalist and broadcaster Jonathan Freedland in the Guardian recently.

It’s now two weeks since the start of lockdown and most of us have had to accommodate the massive overnight lifestyle changes which come along with that. At one fell swoop, travel was severely restricted and numerous venues we may otherwise visit regularly, such as bars, cafes, restaurants, gyms, churches, cinemas, theatres, libraries and galleries closed, forcing us perhaps more than ever before to access or develop our inner resources and resilience.

During just one weekend came the announcement of Keir Starmer’s victory in the Labour leadership contest (finally allowing some proper opposition), numerous floutings of the lockdown due to the unseasonably warm weather, the Queen speaking to the nation and the Prime Minister being taken to hospital and subsequently moved into intensive care. We’re now getting used to things changing quickly, yet more for us to absorb and needing ministers and policymakers to demonstrate agility and think on their feet.

Sudden changes make significant demands on our mental wellbeing and sense of equilibrium, which could already be fragile. The overnight deletion of much habitual external stimulus will expose vulnerabilities and fears which everyday ‘busyness’ tends to mask. It can also mask longstanding fragility, stemming from insecure attachment and lack of ‘containment’ in early life. (‘Containment’ is the important term coined by psychoanalyst Wilfred Bion to describe the kind of psychological holding, which, if all goes well, the mother or caregiver performs for their infant, which detoxifies their fears and makes them manageable. This function ideally is then ingested by the child and sustains them in the years to come). During adulthood, authority figures such as employers and governments become proxies for these parental ones. We consciously or unconsciously look to them for this same kind of ‘holding’, whereby our anxieties during an unprecedented crisis are ideally met with understanding and made manageable via a considered and effective response we cannot implement as individuals. Therefore, anxiety can be magnified when, instead of sensing and benefiting from genuine authority and capability in our government and policymakers, we witness incompetence and lack of preparedness.

It’s understandable that we chafe against unprecedented restrictions on our freedom, feel frustrated at not being able to get to our normal activities and sad, perhaps even distraught, at not seeing loved ones except via a screen. There are also the ‘first world problem’ irritations of not being able to get to the hairdresser or beautician, and the cancellation of holiday plans, with the attendant hassle of trying to obtain refunds. But these are minor compared with the very real difficulties some are facing, their livelihoods having disappeared overnight and it becoming increasingly clear that the Chancellor’s apparently generous offer will still not be enough.

Added to this there’s the expectation for people to work from home, (unfamiliar for many), the isolation of those living alone, the challenges posed by sharing small spaces, often with no access to garden or balcony, the rise of domestic violence, cancellation of routine but necessary treatment and surgery due to reallocation of NHS resources, and concern about obtaining food, supplies and medication. The government’s initial strategy of ‘herd immunity’, besides stockpiling and panic buying in shops, raised the Darwinesque spectre of ‘survival of the fittest’, exacerbating anxiety across the population. If we’re not worried about becoming ill ourselves, we could be worried about family and friends, about infecting others, about losing work and income with dire consequences like losing our homes, and generally what all this is doing to the social fabric. Added to this anxiety is the stigma and burden many still feel of having to hide their feelings, to appear capable, able to ‘just get on with it’. Stress also exacerbates numerous physical conditions, such as dermatological and gastrointestinal disorders. Then there’s the bereavement experienced by those who have lost those close to them, in circumstances bordering on disenfranchised grief (Doka,1989), where the loss and/or the bereaved cannot be properly recognised or processed and therefore mourned, in this case because of the enforced distance, people dying alone with loved ones unable to say their farewells.

It’s likely everyone’s mental wellbeing will be impacted to some degree, yet the government has been silent about this important aspect of the pandemic, the questions actually coming from one or two journalists at the PM’s daily press briefing. Mental health has long been the Cinderella service of the NHS and evidence of longstanding underinvestment is very clear at times like this. The primary care service (IAPT – Increasing Access to Psychological Therapies) has long attracted criticism for its privileging of Cognitive Behavioural Therapy over relational therapies, limited success rates and its long waiting lists. So anyone expecting help from this quarter is likely to be disappointed, at least in the short term.

A huge mental health burden is likely to emerge post Corona virus, not to mention the position of those in secondary mental health services, including those detained in hospital under the Mental Health Act, many of whom are feeling additionally neglected.

Meanwhile, many counsellors in private practice, who had to switch very quickly to online and telephone working (and they should be undertaking training for this very different way of working), have seen their incomes under severe pressure because of clients not wishing to work in this way or because they can no longer afford it due to their own financial difficulties. Therapists have an additional ethical dilemma to navigate- that of again (much counselling goes unpaid because of an arguably outdated training model of unpaid placements and its widespread exploitation by employers and others) being asked to support NHS workers for low fees or no payment. Because we’re a nurturing profession and because of the longstanding tradition of so much counselling work being unpaid, not to mention empathy for NHS staff, we could feel drawn towards donating our time and many have done just that. On the other hand, self-care is another important principle in our ethical framework and which other caring professions are compelled to work for free? Therapists under financial pressure themselves will have to carefully consider these issues.