Re: Pandemic Pschology
Re: Pandemic Pschology
Pandemic Psychology
By Grattan Woodson, MD
If the Pandemic is severe, we will find ourselves living in a challenging time. Simply put, the psychological response to a pandemic event falls into one of three phases: (1) The ante-pandemic phase of accepting the possibility that a pandemic is coming, (2) the pandemic phase of living through trauma from the event, and (3) the pandemic aftermath that will include the loss of loved ones and a changed world. Effective coping at each phase requires different skills. Having insight into how these major life events may affect people is the first step in coping.
Mental resilience
Psychological resilience is an attribute that will make dealing with the life-altering events of a pandemic more manageable. Resilience, the ability to bounce back, to come to terms with changed circumstances, and to carry on, is a trait that we can learn. Major distress, pain, sadness, and anxiety cannot be avoided, but they can be handled. We can adopt viewpoints, ask questions, and take actions, which will guide us in helping each other and ourselves.
The psychological stress of loss and trauma
The most serious potential loss a person can experience during the pandemic is the death of a spouse, child, or parent. Next comes loss of a job, wealth, or prestige. These losses are the fuel for a well-understood psychological process, leading most commonly to depression, anxiety, and posttraumatic stress disorder.
These losses are among the most significant that anyone can experience, and, unfortunately, all are likely to occur during a severe pandemic. Losses of this type play a major role in the development of depression, anxiety, and posttraumatic stress disorder. Physical injury or threat of violence as a result of civil disorder or lawlessness--especially in association with the crimes of assault, murder, and rape--also commonly induce these psychological states.
The grieving process
The predictable sequence during grieving is numbness, denial, anger, despondence, depression, and hopefully, resolution through acceptance. In a healthy response to loss, the final phase of the grief process is accompanied by the emergence of a new emotional structure that is deeper and more integrated than prior to the loss. Failure to make a healthy adjustment to loss often leads to the development of unhealthy mental states and even suicide in some cases.
No one will remain untouched by this emergency if it is severe. With no easy, psychological solutions to these problems, treatment could be complicated by the lack of access to professional psychiatric care and medications. Those suffering from unhealthy mental conditions will need the help of their family and friends.
Signs and symptoms caused by loss or trauma
As in other branches of medicine, a sign in psychiatry is something that you observe in another person. In the psychiatric context, symptoms are dysfunctional feelings or thoughts the person has about the self, others, or life in general.
Signs of depression
Withdrawal from other people, both emotionally and physically, is a common sign of depression. People suffering with this condition may appear less well groomed than usual, and their standards of personal hygiene can drop. They look sad and dispirited. Depression can cause people to be hypersensitive to comments made during routine conversation, appearing as inappropriate behavior such as an angry outburst, crying, or nervousness. Depression makes it hard for people to work or think, and if they are forced to work, they can exhibit physical symptoms that prevent them from that activity. Their sleeping patterns can be disrupted, or they may want to sleep more than usual. Their eating patterns may change, and they can gain or lose significant amounts of weight. They don?t seem to care about things they once deemed important. They appear to have given up and quit trying.
Symptoms of depression
Sadness and loss of an interest in things that a person used to enjoy are cardinal feelings with depression. The patient may feel remote from others, isolated, and alone. Guilt is a common theme as is feeling worthless and ?good for nothing?. The depressed often carry on an incessant conversation in their minds, criticizing faults and weaknesses. This unhealthy mind state is known as rumination. They feel worthless, unloved, and unlovable. They have lost hope for redemption or forgiveness for the things about which they feel guilty. They also may experience survivor?s guilt, questioning why they are alive while their loved ones died. Some people may contemplate suicide. They feel empty inside. Some are tortured by the feeling of a great emptiness within their chest. Its like their heart has been replaced with giant hole. They may think that others are talking about them and even planning to harm them. They feel unacceptable and unloved.
Signs of anxiety
Nervousness is the hallmark of simple anxiety. The nervous person seems unsettled and uncomfortable in most situations. They may seem restless, agitated, and fidgety, having trouble staying still.
A special type of anxiety is a panic attack. One minute everything is fine with a person, while the next brings on uncomfortable behavior. Although most panic attacks are unassociated with hyperventilation, some are. Hyperventilation means breathing too deeply or rapidly for the needs of the body, leading to fainting or other physical symptoms. A person undergoing a panic attack may have a rapid heart rate and excessive perspiration. These panic attacks are associated with hyperventilation syndrome.
Symptoms of anxiety
Symptoms of anxiety include feeling nervous and unsettled inside. The person feels that something is not right but is unable to say what is wrong. He may have difficulty sleeping, awaking in the morning more tired and sore than he went to bed. Back and shoulder pain are common as is tension in the neck. Eating can increase or decrease, with weight gain or loss, respectively. Some people suffer chest or abdominal pains that mimic serious medical disorders. A common presentation is the sensation of tightness around the neck, or in the throat, especially anteriorly near the larynx.
In addition to hyperventilation, other symptoms may accompany the panic attack, including nausea, air hunger, headache, chest pains, dizziness, an inability to concentrate or think clearly, and, in some cases, fainting. This disorder is more unpleasant than dangerous, although the person experiencing it often thinks she is dying. Placing a paper bag or plastic baggie over the mouth and nose and slowly rebreathing the exhaled air helps restore lost balance between blood acid and alkali, and it will help relieve the symptoms.
Signs of posttraumatic stress disorder
Posttraumatic stress disorder (PTSD) occurs more commonly in women than men. In women, sexual or physical abuse is its most common cause. In men, PTSD is often triggered by involvement in violent, life-threatening situations and experience of trauma during wartime. The deaths and civil disorder that could occur during a pandemic will certainly provide a fertile background for the emergence of this disorder. People with PTSD can become withdrawn but also argumentative. PTSD caused many of the cases of ?battle fatigue? observed during past wars. They often exhibit behavior similar to those with depression or anxiety. To relieve the stress, pain, and tension associated with this condition, they commonly self-medication with alcohol and drugs. Some people with PTSD have angry outbursts that can become violent. Irrational behavior and aggressive sexual acting are other features in patients with PTSD.
Symptoms of posttraumatic stress disorder
In addition to sharing similar elements with both depression and anxiety, the symptoms of PTSD include the distinguishing characteristic of flashback, or the reliving of the traumatic event with dream-like clarity. People with PTSD feel alienated and cut off from their family and friends. They feel sullen, have lost hope for a better future, and can become very cynical.
Emergency psychiatric care
If access to professional psychiatric help is available, the person suffering from these disorders should be encouraged to consult them. During a time of crisis when access to professional help and medications for treatment of these disorders is unavailable, the strategy recommended by organizations like the American Red Cross is to help the person cope with the direct consequences of the events without trying to delve deeply into their meaning or long-term consequences. The objective is to help the person remain functional rather than become another casualty during the emergency when resources are stretched to the limit. I have adapted and modified this approach for the Bird Flu Manual by suggesting we use the mind?s natural methods of dealing with the issues of depression, anxiety, and PTSD as an acceptable temporary approach. These naturally occurring states include suppression, denial, and regression.
Dealing with harmful thoughts and feelings during the emergency
It is important to recognize when a member of your family or a friend is displaying any of the signs and symptoms suggestive of these mental disorders. The sooner positive steps are taken to deal with the condition, the better. Because you may be stressed already in coping with your own survival, a mental breakdown of a loved one, friend, or neighbor can become advanced before you or others notice. Remember, the objective is to help the person return to a reasonable level of functioning and avoid complete emotional collapse.
Suppression of traumatic memories as an aid to a return to function
A natural way many people manage severe trauma is to suppress painful memories. This measure is very effective in helping people regain their footing and return to a functional level. Suppressing unpleasant memories is a form of active forgetting, as in changing the mental channel whenever painful thoughts arise. This active forgetting prevents people from becoming too absorbed in their misery. Thinking harmful thoughts repeatedly is a habit with bad consequences. While some traditional psychotherapeutic approaches encourage the patient to experience their pain, and even in some cases to relive the traumatic events that caused the damage, this approach is to be avoided during the emergency. Rather the person suffering this type of injury should put these thoughts and feeling aside and move on. In contrast to modern psychotherapy, first aid for these major psychological traumas during an emergency concentrates on helping the victim suppress the memory of traumatic events. The person is encouraged to devote themselves to one or more tasks that absorb their time and energy. The objective is to forget the events and refrain from dwelling on them.
Denial is the last defense of the ego
Another natural way the mind has to deal with traumatic loss is denial. This mind tool allows us to pretend that everything is fine. Like an actor playing a part, the more we can let ourselves adapt this attitude, the better we feel. Denial is a powerful psychological defense mechanism that has evolved in humans over the millennia. That it remains universally throughout humankind is a testament to its survival advantage. Denial is an important and useful technique for humans to weather tough times and keep going forward despite great loss and suffering. Denial enhanced by the active suppression of traumatic memories or thoughts is a powerful combined tool for combating mental collapse during an emergency.
To help someone maintain denial, avoid discussing the facts of the person?s loss unless he brings it up. In that case, listen to what the person has to say rather than trying to force him to ?face reality.? Completely avoid this tactic. Making a suffering person see the reality of her plight is not the objective here. Being supportive and encouraging is. Things usually have a way of working out in the end, and many times even for the best although that likelihood seems improbable prospectively. Painting as optimistic a view as possible is the best approach.
Regression is the refuge of the psychiatrically injured
A mental and behavioral change likely to be prevalent during a severe influenza pandemic is regression of those who have experienced major losses or trauma. This response is another common and natural method our minds have of dealing with these conditions. While people living with and around the person experiencing regression may be disconcerted by the change in the person?s behavior, their strategy should avoid trying to bring the person out of the state and instead tolerate and support the person. Given the circumstances, trying to force the person to return to a prior level of maturity could result in total emotional collapse. The regressed state may the highest attainable at the moment. As the person begins to recover, she will naturally regain her equilibrium and begin exhibiting more mature behavior. In the meantime, a good strategy is to accept and support the person. She will return to normal in her own time, when she is able.
The use of unconventional approaches during the emergency
Recommending the use of memory suppression, denial, and tolerance of regressed states will sound like heresy to many psychological professionals who have labored long to help patients uproot these behaviors sometimes perceived as barriers to recovery. Admittedly, these alternative methods have limited value and are far from ideal. They are poor alternatives to modern psychiatric treatments, and I suggest them here only for use in the event that access to professional psychiatric help and therapy is unavailable. Furthermore, I suggest them based on the mind?s natural way of dealing with crisis.
Supportive Group discussion
A regular gathering each evening to discuss the day?s events, problems, and rumors is a good idea for neighborhoods in the time of pandemic. Meetings such as this can serve several important purposes, among the foremost is a way to establish and increase cohesion of those undergoing the pandemic.
Serious psychiatric problems
Serious psychological problems require professional treatment. Therefore, if you have access to a therapist or psychiatric facility when confronted with one of the above problems, take advantage of this resource. The unconventional suggestions provided in this manual are designed to help prevent the person suffering these conditions from having a total breakdown. They may or may not help. At most, these methods are simply ?first aid? or a band-aid, not treatment. They are intended for temporary use only until a mental health professional can evaluate and treat the patient.
Remaining sane during the pandemic
Am I going nuts?
While stress and change will affect everyone during a pandemic, most people will manage to carry on without being at risk of mental collapse. In the population as a whole, during times of great stress, one in five people are at risk for suffering a breakdown with one in ten likely to have this reaction. Two people can be subjected to a severe tragedy of a similar nature with one suffering a breakdown and the other managing to cope. Nevertheless, stress is stress, and it can make life unpleasant. Feeling sad, anxious, and hopeless in response to severe loss and trauma is normal. It does not necessarily mean you are developing one of the psychiatric problems described above. These normal feelings become disorders only when they totally dominate a person and make it hard or impossible for that person to carry out regular activities. So don?t assume you have a problem if you share some of the feelings typically associated with depression, anxiety or PTSD. In fact, if you don?t experience some of these feelings after a loss or trauma, this state is abnormal. These symptoms become disorders only when they distort a person?s view of himself and his world in irrational ways.
Staying sane in an insane world
A severe pandemic could cause a large number of people to become suddenly and involuntarily unemployed. Schools may close, and it may become difficult, if not impossible, for most people to enjoy the freedoms and privileges they took for granted ante-pandemic. Worst of all, the TV might not work! Whatever will we do with ourselves?
Many people will find it difficult to adjust to the changed circumstances of an emergency. Life will be different than before, more physically and mentally demanding. Each day, people will spend more time just maintaining the basic needs of their family and friends. While this work is important, it will not be what people are used to, and it will be hard because new skills are needed to carry it out. Much of the work will be more physically strenuous than that to which people in the developed world are accustomed.
Plan to develop innovative ways to entertain your family. Policies like social distancing or quarantines may limit our activities, requiring us to remain at home most of the time. In the event we loose electric power, with no TV or radio as a diversion, you should draw on your creativity to discover productive and entertaining activities.
Reading is fundamental
Reading books will be an important pastime for many people, and particularly for all school-age children and adolescents. Throughout history, children have received their educations by reading books. Virtually all subjects except mathematics can be taught in this way. The classic Greeks as well as the Romans relied on an educational plan led by a tutor, who assigned students a reading lesson. After the reading, the tutor and the child then discussed the work.
The games children play
Children need to play, but depending on their ages, they also need supervision. In families that have experienced pandemic-related trauma, a child may express semi- and unconscious emotions and thoughts during play that they are unable to express consciously. An observant yet unobtrusive adult should be alert to the play of small children, monitoring their banter and behavior for themes. During play therapy, an adult may help a child express pent-up feelings at a time when the child feels safe to express feelings that seem like ?make-believe.?
Gardening for mental and physical health
Many adults already enjoy gardening. The pandemic period is likely to last between 12 and 18 months giving you plenty of time to grow fruits and vegetables. Even after the pandemic, stores will take time to reopen and restock with fresh fruits and vegetables. In most areas, gardeners can substitute store-bought produce with a large variety of fresh fruits and vegetables. Those with a green thumb will have an advantage, but even those with little or no experience can learn by beginning with a few basic books on gardening techniques.
Maintain as normal a life pattern as possible
An important way for families and individuals to ward off negative psychological effects of the pandemic will be to maintain as much normality in their lives as possible. Patterns should follow a normal routine, going to bed in the evening, waking early, eating at meal times, and maintaining standards of home and personal hygiene. Letting these things slip will send you and your family down a degenerative slope and reinforce negative mind states like depression, anxiety, and anger. Maintaining standards of behavior, dress, and conduct is reassuring at a deep level. These standards are familiar and expected, and in return, everyone knows how to behave and react. This removes uncertainly about the immediate situation, helping to reduce stress as well as other negative emotions.
Survival of the fittest
Adults will be responsible for many activities to keep their families fed, housed, clothed, and warm during a severe pandemic period. As discussed, the work will be different than what most people performed before the pandemic, and some of these tasks, while simple, will require greater effort because of unfamiliarity and the usual inactivity of most people living in advanced societies. Physically fit people will have of the advantage of surviving the challenge of pandemic.
The only constant is change
If we are destined to live through a severe influenza pandemic, this time will be unlike anything most people have ever experienced. The pandemic will end one day, and when it does, things will return to normal. However, during the pandemic, the return to normality may seem always a long way in the future. This is a delusion, not truth.
An experience as dramatic as a major influenza pandemic most certainly will affect everyone. In the end, we will adapt to the world anew. Some people may be traumatized so severely that they will require many years to come to terms with the change. Some may never do so. However, most will adapt, recovering fully. Bad memories will fade, to be replaced by new wounds. The old adage holds true, even in dealing with pandemic: time heals all wounds.
Good luck to you all and may your God comfort and protect you.
GW
