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A PARADIGM SHIFT: CHANGES, CHALLENGES AND WAY FORWARD
S. DIVYAPRABHA, N. GANESH, S. KALPANA, R. NANDINI, S. BHASKAR, R. SURYAKUMAR AND DR.T.R. UMA
Chennai Counselors’ Foundation (CCF), Tamil Nadu.
The Roman Emperor and philosopher Marcus Aurelius said, “Man’s life lies all within this present, as it were but a hair’s breadth of time; as for the rest, the past is gone; the future yet unseen!” How true! But alas, the human mind does not work in such a simple rational fashion. Ask Albert Ellis! Humans always ruminate about the past leading to a worthless sense of guilt in the present. They are unable to accept the uncertainty of the future and try to establish a homeostasis which becomes virtually impossible. This is the situation even in the best of times, isn’t it? Then what can we say about the current pandemic, the most feared COVID-19 which has shattered the myth of our perceived immortality. The virus has become the greatest threat to global public health in this century. The ephemeral nature of life and the certainty of death has been accentuated. We are reminded of our mortality on a constant basis now more than ever before, leading to increased levels of fear and anxiety. One of the primary causes for people experiencing such a threat is due to the uncertainty attached to it.
COVID-19 has spread across the globe threatening lives and altering life experiences. It is being considered an indicator of inequity and deficiency of social advancement (Chakraborty and Maity, 2020). Universally, societies are divided on socio-economic / educational / regional / cultural/ gender / racial and age lines, though collectively they make up the social fabric. This social fabric is going through a major upheaval impacting the physical and psychological health of the people, economies and environment all over the world.
Governments of countries globally have been tackling this crisis imposing measures like lockdown, developing herd immunity. Our Government has opted for a nationwide lockdown that continues till date. While the efficacy of this measure is a moot point, it has indisputably led to the stoppage of essential functions leading to financial crisis, job losses, shortage of essential commodities. People’s morale has taken a severe hit and they have sunk to levels of despair hitherto unseen. Other factors such as restrictions on socialising, travel, non-functioning of schools / colleges, sports activities have had a telling effect on the psychological health of people.
Current scenario
This pandemic has altered everyone’s lives in ways that we had not imagined. What we considered ‘normal’ now has ceased to be. A ‘New Normal’ seems to have emerged – as a forced and imposed response to the current crisis. Does such a paradigm shift in our daily lives overwhelm people? Of course, it does. Being at home unable to attend school or office for the best part of the day is a challenge. It is even more frustrating not to engage in your usual hobbies like taking a stroll along the beach or watching a movie at the theatre. And if you throw in the fact that you are stuck at home – which could be a small tenement for many – it can be a recipe for disaster. The absence of maids, cooks, drivers all add to the stress and sadly, if the family is dysfunctional, it leads to unpleasant consequences of domestic violence, sexual abuse etc.
During the initial days of the pandemic, as a few cases started trickling in, people were curious. However, with a constant increase in numbers without any let up despite the lockdown, people started fearing the worst. Being prisoners in their homes without the usual activities, only exacerbated the stress levels. Work from Home (WFH), while looked as an attractive option initially, had its merits and its own challenges for many industries. The lack of social contact has made this option a debatable substitute. All these led people to experience heightened anxiety, panic, insomnia, eating disorders, financial worries etc. Children were also impacted with schools and colleges being closed. Exam schedules were disrupted. Students who had overseas admissions were in a quandary as they could not travel. People who were visiting their home country got stuck. All these led to a manifold increase in anxiety levels. A fall out of all these perplexing issues was the surge in cases of watching pornography, addiction to internet, mobiles, alcohol dependence, substance abuse, and in some cases relapse of psychiatric illness or they developed comorbid disorders. With no definitive predictive models available, scientists are struggling to say for sure when this pandemic will be contained. The absence of a proven treatment or a vaccine, has only escalated people’s anxiety and fear.
It is always said that every dark cloud has a silver lining! The current situation is no exception. With reduced road travel, pollution levels have come down significantly. The ban on air travel has not only helped reduction in pollution, but also directly impacted the much-touted global warming positively. Rare birds and animals seem to have come out of their habitats. Hospitals are less crowded as people refrain from visiting them for minor ailments. The deaths due to road accidents has come down significantly. We can hear rare birds chirping. Nature, they say, has taken this time out to heal itself. That is the good news amongst all this pandemonium. However, in the overall analysis, do these gains justify the fear, anxiety, pains, lives, and livelihoods lost? We don’t think so.
Changes and challenges
This pandemic has certainly had a severe impact on the physiological, psychological and behavioural aspects of people. These need to be addressed on an urgent basis. The physiological symptoms of COVID-19 are not that pronounced except in some cases. However, the psychosomatic impact is quite striking. Fear and anxiety cause several negative effects in our body namely - increased heart rate, nervousness, sweating, fast or difficulty in breathing, increased blood pressure, headache, nausea, dizziness, changes in eating habits and insomnia. If there are pre-existing conditions like diabetes or asthma, these could get aggravated due to these symptoms. While immunity boosters are encouraged to protect us from this virus, it is important that psychological immunity is given attention to retain good health and wellbeing.
When psychological resilience is not practiced, the impact of the pandemic can be quite marked. Lack of concentration, lack of motivation, poor memory, paranoia, and confusion are seen quite often. People can also develop psychosomatic symptoms as listed earlier. The fear of getting infected, anxiety about losing one’s job, stress due to business loss, worries about outstanding loans and investments, and overall major concerns about the future may be fairly common issues, but they are capable of generating rumination of thoughts leading to cognitive distress and emotional turbulences. Uncertainty can cause immense anxiety, so much so, that people sometimes equate it to imminent danger. Facing uncertainty feels more distressing than even facing real pain!
The physiological and psychological impact of the pandemic does have a conspicuous influence on the behaviour of people. Procrastination due to low drive, getting verbally and/or physically abusive, uncontrollable anger, frustration leading to harming self or others, feeling helpless and hopeless can result in a noticeable deterioration in general wellbeing. Couples who live in abusive relationships have higher chances of experiencing domestic violence, including physical, emotional, and sexual abuse. Addictive behaviours such as smoking, using alcohol and substance use may escalate leading to violent behaviours. Working women as well as home makers, who have additional responsibilities of home care and/or paediatric and geriatric care require the highest level of psychological resilience, the absence of which may lead to a nervous breakdown.
A trauma like the COVID -19 pandemic may give rise to PTSD, especially survivors of COVID-19 (may remember the nearness to death while in the ICU), frontline workers (exposure to people dying before their eyes and the threat of contracting the disease). It is important for those to stay connected with family and friends, practise self-care (mindfulness, playing music, taking walks whenever possible). These are some strategies that can help people to cope in a more meaningful way. The help of the psychologist doesn’t end with the pandemic but even after the trauma, people may require the assistance of a psychologist in tackling the PTSD syndrome.
Way forward
With the media frenzy, it is imperative not to believe in everything everyone says, but only follow and limit it to news updates from official sources. It is advisable to restrict oneself from news channels and reading articles on social media and the internet. Instead one needs to focus on the positive aspects with which one can start a new lifestyle which can - balance and ease out the negative impact listed above. Some of the positive spin offs like spending quality time with family, utilizing the commute time for learning new skills, building meaningful relationships, innovative ways to stay connected, focusing on building a better immune system, reassessing priorities in life etc., should be focused upon. Being strong, positive, resilient, and learning to accept and adapt must be the mantra.
“Prevention is better than cure” goes the adage. The best way to tackle the physiological symptoms is to exercise precautions. This can be achieved to a large extent by following some of the good old practices of personal hygiene, hygiene in public places, wearing masks, gloves, using sanitizers wherever necessary and following certain basic etiquettes while coughing, sneezing, maintaining social distance etc. While this may sound novel to the current generation, these were age old practices that were being followed by our forefathers but that were given up in the name of ‘progress’ and dropping so called ‘conservative’ practices! The psychosomatic symptoms, however, need to be addressed and are covered in the next para.
By changing our perspectives and seeing what is positive in the situation can be the game-changer. Cultivating a growth mind set and developing resilience will help. With these interventions anyone can combat this crisis successfully. Psychologists, as mental health professionals, play a very crucial role in helping the public to improve a sense of well‐being and alleviate the feelings of distress during COVID-19. Whether it is restructuring cognitive distortions, or challenging irrational beliefs to recommending behaviour modifications, mental health professionals are required to rise to upgrading knowledge and competency to cater to the ever-changing needs of humans.
Like in every emergency, this virus has thrown up many challenges to almost everyone irrespective of class or creed, educated or illiterate, rich or poor, including front-line workers. Is the situation going to be like this forever? Absolutely not. The developments over the past two months followed the Kubler-Ross curve. Denial- initially assuming that it will not impact us; followed by anger at the lockdown; then bargain, perhaps, pleading for no quarantine or lockdown; then depression – feeling extremely stressed out about these developments and finally acceptance, inevitably learning to live with the pandemic. Those who are unable to move to stage 5 will be severely impacted by stress and the resultant anxiety. The resilient person, however, moves on confident that this too shall pass!
Necessity is the mother of invention
Steve Jobs once said, “Innovation is the ability to see change as an opportunity – not a threat.” So true. In the wake of this pandemic, one will be amazed and surprised that creativity and innovation has been the order of nature. It is heart-warming to note how human behaviour is transforming and redefining norms. The outstanding coping mechanisms of some, whether it be in their creativity of making masks, memes, posting videos or sharing beautiful pictures of nature, birds and animals is, quite frankly, incredible.
People are today more in touch with their friends and extended families via resources like zoom, WhatsApp video calls and Facetime. They make time to catch up with immediate and long-lost family members, colleagues, clients, associates, and friends. Be it online studying for schools to post videos and conduct classes, many engage in MOOC (Massive Open Online Courses) platforms and get certified in courses that they always wanted to complete. From doing fun courses, signing up to dance, Zumba, yoga, meditation, chanting, cooking, baking, mass prayers – it is all just a click away! This has been a huge boon!
Despite the boon, the challenges of mental health professionals are many and varied. They must equip themselves to be updated with skills due to the current needs. From the social context, there is still a stigma associated in approaching a therapist or counsellor. Some people fail to follow social distancing in public places, and it causes increased irritability and impatience among those who follow it. Keeping in mind this non-compliance, it is imperative for mental health professionals to educate and empower one and all about individual responsibility. For the professionals to do that with conviction, they must first adhere to those “New Normal” and be a role model. Today, the boundaries of the “professional me” and the “personal me” are blurred and this can cause additional trauma and stress to any professional and it includes mental health professionals too. They must also be mindful that they too are at a high-risk of experiencing secondary trauma and burn-out in their profession.
Teleconsulting is the order of the day – doctors, lawyers, business heads, training groups and organizations are conducting online courses with certifications, counselling and therapy, have for the first time moved to this platform too – private clients, patients, free helplines, conducting sessions online or over the phone. Need based webinars for clients across companies and corporates who want to keep their employees WFH engaged and mentally healthy are also on the rise. A lot more people are now willing to access help via online support groups for specific needs and reaching out to their peers for specific solutions, online – working has mostly moved today to a digital platform. Group work, for one, has been brilliant! Groups offer the advantage of normalizing the situation being discussed with the added advantage of group reflection and an interactive Q&A towards the end that sums up the intent of the session. It is not group therapy, but certainly a collective sharing that reduces apprehensions, and individual fears giving a sense of comfort that they are not alone in this battle.
CCF’s initiatives during the COVID – 19 crises
Chennai Counselors’ Foundation (CCF) is an association for mental health professionals registered under Tamil Nadu Societies Act. Since its inception in 2004 it is flourishing as an organization that can be globally recognized for its professional excellence and ethical practices. Their mission includes collaboration with the national and international associations for cross cultural learning. The Office bearers of CCF are the President, Secretary and Treasurer who are elected once in two years through Annual General Body elections. The four co-opted members are selected both on nomination and self-joining. These seven members form the Executive Committee (EC) who manages the functions of CCF. EC then selects coordinators for its Training, Career & Guidance, Research and Youth wings. Case study Circle is a monthly feature facilitated by an experienced senior counsellor supported by a coordinator. All these professionals volunteer their time, energy, and effort for the growth of CCF, mental health professionals and the mental health profession. To learn more about CCF, log on to www.chennaicounselorsglobal.org.
While individually, mental health professionals can be involved in the acclimatization of the paradigm shift, what can counsellors and psychologists’ associations do? Below you find some of CCF’s initiatives already implemented. We hope to continuously strive to work towards the best for our community and professionals.
1. Brochure on wellness tips: For a start, CCF prepared a brochure containing psychological wellness tips in English and Tamil to deal with COVID-19. It was circulated to over 160 members with a request for onward transmission to their friends, families and contacts. CCF also posted it on their website and FB page. Furthermore, the initiative was promoted widely through word of mouth, print, audio, visual and social media.
2. “Let’s talk”, a free telecounseling: CCF followed it up by offering “Let’s talk”, a free tele counseling pan India initiative, with the objective of reaching out to people facing psychological distress during the COVID-19 complete lockdown. We roped in a psychiatrist who is also our member for clinical intervention if required. People targeted were those in isolation, quarantined or suspected to be carriers and were home quarantined. About 20 counselors, a few of whom were polyglots, offered their time and expertise for the cause. During the first call, a mini Mental Status Examination was conducted to evaluate the depth of their wellness conditions. Depending upon the assessment, the tele callers were assigned to counselors based on the caller’s time and language preference. Counselors stated that they followed an eclectic approach based on the caller’s needs. Most applied Solution focused short term brief therapy. For any other future help, appropriate referrals were made. Following the termination of the sessions, feedback was collected from the tele-callers regarding the efficacy of the counselling services. Receiving positive feedback has given a sense of satisfaction too. Some of them mentioned that they were better equipped with positive mind set and healthy coping skills after the session.
3. Parenting Manual for COVID-19 free e book (CCF, 2020): Another initiative by CCF during the lockdown was the launch of a free e-book on – ‘A short Parenting Manual for COVID-19.’ The book was authored by four psychologists who had given tips on parenting at different ages and stages of child development. The framework was based on famous psychologists like Bowlby, Maslow and Erikson. To reach a larger audience, the e-book was then translated in Tamil.
To summarize, is there life after COVID-19? Well certainly there is, not after but with COVID-19! It is a fact of life and we need to embrace this paradigm shift and ease into the ‘New Normal’ way of living as it is! While the virus has shaken the very foundation of life, it has also made us aware and appreciative of what we have and be grateful for that. Many thanks to the Universe which keeps us afloat, the family time, bonding, sharing, trying out different treats and the housework, honing professional skills, learning new hobbies, developing new interests – are all in a day’s work! So yes, life certainly has changed and realigned itself for each of us. Staying safe and healthy as individuals, family and as a productive member of society is essential for survival and wellbeing. So, are we at the “acceptance” which is the 5th stage of the Kubler Ross model? Perhaps we are!
References:
CCF (2020). http://www.chennaicounselorsglobal.org/images/documentries/Talking_with_Children_pdf.pdf
Chakraborty, I., & Maity, P. (2020). COVID-19 outbreak: Migration, effects on society, global environment, and prevention. Science of The Total Environment, 138882.