How Covid-19 isolation affects our mental health

  • Mind
  • Wednesday, 08 Apr 2020

A Covid-19 patient in isolation only has physical contact with a doctor or nurse fully suited up in protective gear, which does not provide the comfort of a human touch. — AP

Few humans can live in isolation for a prolonged period of time, as it is associated with negative feelings, especially fear, and can lead to illness, and eventually early death.

As social creatures, we need to connect, communicate, interact, and above all, be touched.

The power of physical touch, no matter how fleeting, from someone we trust, leaves a lasting impact on our wellbeing.

It is comforting, therapeutic and has a painkilling effect.

Unfortunately, to fight the challenging war against Covid-19, we’ve all been asked to maintain social distances or quarantine ourselves if we are suspected to have come into contact with someone who is infected.

We are only able to freely physically interact with those living with us, as long as we are not under self-quarantine.

Even if we are working in an essential service or can go out to buy groceries, we are supposed to maintain our distance from others and avoid physical contact to minimise the chances of infection.

Focus on recovering

If you think that is bad enough, consider the Covid-19 patients who must be treated in isolation rooms or wards.

It is not uncommon to find them battling with mental health issues as they’re in an unfamiliar environment away from their loved ones.

The only people they see are clad in sterile protective gear, and are often too exhausted to go through social pleasantries.

“Many studies have documented that plenty of emotional and physical health benefits come from touch.

“Lack of human touch can lead to an increase in blood pressure, and even heart problems.

“With patients in isolation, perhaps the medical team needs to express more empathy, communicate more with them and encourage them to communicate with family and friends using technology, ” suggests psychologist and clinical hypnotherapist Dr Lennie Soo.

Although there are many strategies to cope, she says that the perception patients have about their situation plays a large role in how they thrive (or not) during isolation.

“If they perceive the situation as an opportunity to rest or to focus on their wellbeing, the chances that they will thrive after the isolation increases.

“Otherwise, it could be quite traumatising for people to be isolated and not have any human contact for an extended period of time, ” she says.

According to clinical psychologist Low Mi Yen, there are two universal triggers of compassion: soothing touch and gentle vocalisation.

“These patients will feel even more isolated as they cannot be touched by healthcare workers when in the hospital or by family members when quarantined at home.

“However, we can still express our compassion to these patients by using gentle vocalisation techniques to soothe, comfort and console – to show that we care for them, ” she says.

Practising self-compassion

The perception that patients have about their situation plays a large role in how they cope during isolation, says Dr Soo. — FilepicThe perception that patients have about their situation plays a large role in how they cope during isolation, says Dr Soo. — FilepicLow advises everyone to learn how to “make friends with ourselves”, which is the basic principle of practising self-compassion.

She cites pioneering self-compassion researcher Dr Kristin Neff’s three components that we can practise: self-kindness, common humanity and mindfulness.

“Learn to treat ourselves with kindness, care and understanding as we would treat a loved one, family or friend.

“Research reveals that most people treat themselves more harshly, saying cruel words to themselves, but they would never say those same words to others, ” she says.

Low further explains: “During a challenging period like this Covid-19 pandemic, it is very important not to self-blame or blame others for causing this distressing situation, as it will make it worse with negative feelings ‘fuelling’ our mind, heart and body.

“Often when we struggle, we feel that this shouldn’t happen and this creates a feeling of isolation, fear, blame, etc.

“By understanding common humanity, where everyone suffers, we recognise that we are not alone in fighting this pandemic.

“By knowing this, we will gain hope, energy to survive, skills to cope and overcome the battle.”

The third component – mindful-ness – is defined as a balanced state of awareness where we neither suppress nor avoid what we are thinking or feeling, nor become carried away with the overwhelming thoughts or feelings about what is happening at present.

According to Dr Neff, mindfulness is the foundation of self-compassion practice, where we need to first notice and turn towards our suffering, before we can respond with kindness.

Low adds, “Mindfulness practice is very crucial for all of us at all times.

“Learning to be aware or to notice when negativity pervades our minds – especially when we are so vulnerable to ‘overload’ with new information or fake news via many different channels of social media – can be extremely overwhelming.

“It will eventually affect our body.”

All kinds of stressors

For patients with pre-existing paranoia, psychosis, anxiety or depression, the isolation could also trigger a psychological crisis within them.

Dr Soo says, “If someone feels traumatised, the best thing for them to do post-isolation is to seek professional psychological help.”

When people, like those kept in solitary confinement in prison, know their sentence is nearly up, their mood lifts again in anticipation.

Likewise, once patients are discharged, they might feel a sense of temporary relief when they leave the hospital and are reunited with their loved ones.

Low says, “But they are not totally free from stress and worries, as there are some initial findings from Wuhan, China, that several of those recovered tested positive again (for the coronavirus).

“There is still a risk of being re-infected as infection in the community has spread up to five generations or more.

“As there are still a lot of unknown facts about Covid-19, the uncertainty can affect their mental health.”

For those who are cooped up at home alone, social isolation, together with loneliness, has been linked to a higher risk of physical and mental health issues.Low advises everyone to learn how to ‘make friends with ourselves’, which is the basic principle of practising self-compassion — FilepicLow advises everyone to learn how to ‘make friends with ourselves’, which is the basic principle of practising self-compassion — Filepic

It can lead to obesity (due to emotional eating), heart disease, high blood pressure, anxiety, depression, a weak immune system, cognitive decline, Alzheimer’s disease, and in some cases, even death.

On the other hand, if homes are crowded with dwellers, the environment can be stressful.

“Many families have pre-existing issues and being at work helps them avoid these issues.

“Clustering together at home for weeks can be a challenge for relationships that are already toxic, tense and weak.

“In essence, the relationships that are weak may crack and those that are strong will get stronger.

“Maintaining a routine for the family and using this period to actively spend time with each other by doing things together is important, ” says Dr Soo.

Issues that can crop up include higher divorce rates after the outbreak (as seen in Wuhan, China), higher domestic violence rates and higher child/elder abuse rates.

Singles working from home may also experience boredom, lethargy, anxiety and fear.

As for residents of nursing homes who are barred from receiving visitors and are not tech-savvy, Dr Soo points out that age is not the main factor in how they cope with isolation.

“We need to consider the mental state of the aged.

“In cases of Alzheimer’s and dementia patients, there will be little impact on whether they are isolated or otherwise.

“For those who are of sound mind, as long as they can read, watch TV and interact with the care staff, most of the mental and psychological impact will be minimal.”

Low differs in her opinion. She says, “Any age group needs belonging and love.

“Older adults at nursing homes are already at high risk of isolation, especially those with cognitive decline/dementia.

“They may become more stressed, anxious, agitated, withdrawn or depressed with the current move-ment control order.

“They don’t know how to stay connected with their loved ones, so there is a higher risk of mental health challenges.”

Lack of support

Both psychologists voiced concerns about the mental health infrastructure in the country, as Malaysians in general are confused over where to seek help for their mental issues.

Dr Soo says, “It does not help that mental health covers so many areas of specialisations and methodologies.

“Also, wide systemic support for mental healthcare that encompasses government support, insurance buy-in and so forth are not available.

“As mental health specialists, we need to be careful not to label someone as, for example, depress-ed or anxious, without going through the long process of testing, then observing them.

“Only afterwards should they be labelled and medicated.”

Low says that similar to medical/healthcare professionals, there is a lack of manpower among mental health professionals.

“It is more serious because not all mental health professionals are trained in crisis/disaster/pandemic management, but need to be mobilised to provide psychosocial support to the frontliners and the community.

“Thus, issues of burnout and mental health breakdown among medical/frontliners will also happen to mental health professionals as they support this pandemic.

“So, right now, the 3Rs are very important for the world.

“If each of us starts with self-Responsibility, followed by family-aligned Responses, it will definitely lead to a countrywide Recovery.

“Let’s stand united and do this.”

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