Authors: Haider A. Naqvi  ( Department of Psyhciatry, Dow University of Health Sciences, Karachi. )

The COVID-19 pandemic with its subsequent mental health consequences has challenged the word view of most people. A genome typically of 26,000-32,000 bases long RNA has shut down the wheel of man made progress. The social isolation after the lock-down has not only led to economic difficulties but also adverse psychological reactions. The most common reaction is stress, anxiety and depression when faced with life-threatening circumstances. People have to deal with the imminent issue of death which is anxiety provoking in itself. This calls for dealing with the immediate mental health consequences with the aide of technological advancements as discussed in this write-up. A new inter-personal ethics need to emerge which is scientifically correct and in-line with age old values.

Keywords: COVID-19, Mental Health, Stress, Anxiety, Synchronicity.   

DOI: https://doi.org/10.5455/JPMA.30

 

 

The situation seen amidst the COVOD-19 pandemic is unprecedented. The mental health consequences, as an aftershock, will also be unparalleled. People derive meaning out of their daily routine. When life goals are thwarted due to lock-down of movement, in order to avoid transmission of COVID-19, there is a likely chance that life will fall-back into chaos without any active intervention. This situation is also a chance to examine what really matters at the core of our value system in work and relationships. Human mind with all its complexities is not without deeper insights. These insights direct the person to restore his peace of mind. Just as body tries to contain the infection through an immune response the mind makes an effort to restore the balance of thoughts, emotions and perceptions. The deeper structures of mind, unconscious processes, find meaning in events so that person can go on with the daily business of living.

The initial response can very well be fear and foreboding — anxiety reaction — when faced with a challenge which people find difficult to cope. The stress response is geared towards helping the individual to deal with the life situation. The activation of neuroendocrine system leads to better adaptability. When this is done over longer period of time then it can lead to exhaustion. The clinical syndrome of depression, anxiety and some forms of substance use, are a manifestation of inability cope with life circumstances. The symptoms of stress can manifest in the domain of physical symptoms, affective or emotional reaction, cognitive processes and behavioral manifestations. The concerns related to each domain are sighted in Table-1.

Anxiety disorders are group of disorders in which central features are worrying thoughts, negative anticipation of events, accompanying physical symptoms of distress and sense of foreboding described as "Ghabrahat" in a local idiom of distress. The physical symptoms can range from shortness of breath, hyperventilation, suffocation, muscle tightness, fatigue, tremors, palpitations, chest pain, excessive sweating with cold extremities, and frequent micturition which may or may not accompany bowel irregularities. The anxiety can be episodic, paraoxysm of intense fear accompanying catastrophic thinking, that life is going to end or one would have acute cardiac or neurological event. The focus, for most part, is on physical symptoms which are the reason for help seeking. In other circumstances then anxiety can be free floating which is focused towards work or relationship difficulties.¹ The symptoms of stress typically last for days to a week after the initial stressful event, to settle down to normal state of mental wellbeing, according to International Classification of Disorder (ICD-10), World Health Organization.² When the symptoms last for more than a month one or other form of anxiety disorders can be diagnosed.

Depressive disorder is a clinical conditions characterized by a disturbance of mood, a loss of sense of control and a subjective experience of distress. Symptoms include persistent low mood, lack of interest in activities (anhedonia) for duration of at least two weeks. Minor symptoms could be low energy, impaired concentration, psycho-motor retardation, sleep disturbance, worthlessness, guilt and hopelessness related to future. In sever circumstances people could commit suicide or engage in acts of self-harm.³

The treatment of mental health concerns are in the domain of building resilience to ward off stress. There are various forms of psychological therapies. They are focused towards counseling to develop problem solving, and cultivating mindfulness, which can be given by a trained person in a face-to-face setting or via on-line sessions (Table-2).

There are other general measures which include life style modifications to deal with the stress in the lock-down settings. They can be divided in to a) regulating sleep-wake cycle. b) balanced and healthy diet which build immune system and c) regular exercise. Those individuals who develop full blown mental health problem can contact an expert either through tele-consultation or visit to a health care facility. The guidelines for telepsychiatry are already formulated and it's time to redefine them to come up with better solutions.

It is important to highlight the role of media which can act as an instigating factor or a mitigating factor of stress. Thoughtful news leads to empowerment where people can take precautions to protect themselves while thoughtless repetition of facts reinforces fear and panic reaction. Cultivation theory by George Gerbner (1919-2005) states that those who invest most of their time living in the virtual world of media start reflecting what they are repeatedly exposed to.⁴ This influences the way they perceive the social reality especially in times like these. It is not surprising that World Health Organization is advocating limited viewing of media outlets. Some mental health authorities are proposing a social distancing with media.

We have to reconcile to the fact that normal we are so used to is the thing of past. The priorities, preoccupations and past times, we employed are no longer present in the COVID-19 Pandemic. A period of isolation is to force us — individually and collectively — to grow. This needs to be endured or celebrated to embrace life more fully. The compulsion needs to be lifted, the habitual way we deploy to ward of anxiety, so we review our world view. A genome typically of 26,000-32,000 bases long RNA has shut down the wheel of man made progress and threatened everyone with the imminent reality of death. The human fascination with death is as old as life itself. When man attained the conscious awareness of life then annihilation became a concern. All major religions give a description of life after death. In fact it's emphasized and ingrained to enable man to live responsibly with a purpose. Science with its technological advancement has not only extended the life but made the process of annihilation (almost) obsolete. It's, as if, driven by single obsession, to achieve an everlasting life — immortality — the research has driven mankind into the twenty-first century. The current physical form of life, with myriads of elements, does not support immortality as we are discovering in the COVID-19 crisis. Consciousness might outlive the physical disintegrated of elements defining life. People have to deal with the imminent issue of death. Consciousness may outlast the death as we understand it now.

The advancements in the technology are expected to free us to serve the purpose of our life. The vision individuals bring to experience life is central to their life purpose. The emotion of fear is the real disease. When anxious and afraid, people scurry to control things to particular outcomes, playing havoc to natural order of things. Finding a rational, why this has happened, is central to any form of counseling. Restoring the morale comes next in the process of psychotherapy. The current event has shaken the world view to core; why do we do, what we do and it's underlying economic cost. Everything is under question. We are however not without the "insights" — internal working of mind — on where to look. The force of evolution which has established mankind on the face of globe is a positive one. It also guides them to solutions; things we need to do to prepare us for the long haul in education, industry, services and interpersonal harmony. A new inter-personal ethics need to emerge which is scientifically correct and is in-line with age old values which has guided humanity in its pursuit of happiness and meaning in life.

Science moves forward in a systematic way. A theory is designed in initial instance which sets the stage for generating a hypothesis. Under this new hypothesis, experiments are designed to generate data. The data either refutes or confirms the hypothesis. In either case, the scientific argument moves in small steps to new construct which is considered a fact, a reality or a way of life. The facts can be verified through sound research-methods by anyone who wishes to examine them. New theories are devised every so often given the academic appeal and human passion to do things in better way or understand the assumptions defining everyday life. While the theories are advanced, the methods take time to evolve given the technological advancements.

Carl G. Jung (1875-1961), Swiss psychiatrist and psychoanalyst was credited for discovering the phenomenon called synchronicity. He described it as "events which are not casually related, i.e. one do not lead to other, but they co-occur to be called as coincidence as such".⁵ There is a sense of excitement and meaning related to such magical moments. The synchronicity is preceded by an intuitive thought which compels a person to do something, or talk to someone, and focus otherwise on some event in the environment. Carl Jung himself, and many others after him, explained this phenomenon in the domain of quantum physics.⁶ Albert Einstein defined his theory of space-time relativity in theoretical physics at the same time when Jung was formulating his ideas of synchronicity.^7,8 He postulated that Universe is not an empty space rather it's filled with sub-atomic particles which follow specific laws, bending light and matter in ways not thought off previously. Jung, impressed by the developments of his time, delved deeper looking for possible answers on mystery and mysticism. Synchronicity works in a way that fabric of time, in two parallel reality of individuals, come together magically to attract the attention. It is to guide people consciously on their destined path in life. The force which warps time and space is also working in individual lives. The coming together of external and internal guidance brings the harmony to life (and direction). A pattern emerges through which life design and creates positive reality. Once individuals align their lives to the process of creation they feel more fulfilled.

In conclusion the COVID-19 pandemic with its subsequent mental health consequences has challenged the word view of most people. The social isolation after the lock-down has not only led to economic difficulties but also adverse psychological reactions. The most common reaction is stress, anxiety and depression when faced with life-threatening circumstances.  This calls for dealing with the immediate consequences with the aide of technological advancements. Professional counseling through online systems and social media Apps serve a useful advancement in the area of mental health care. The guidelines for tele-psychiatry are already well established. There is a need to systematically build on those guidelines so it can serve maximum number of people in current times. The human interaction is guided through synchronistic interaction with others which is well defined in the psychiatry literature. The focus on research in the last century has been the rational-emotive aspect of brain; there is a need to do more focused research on intuitive aspect of the human psychology. Synchronicity, when understood properly, spurs people on the evolutionary path of life which best serve them and all those who are around.

 

References

 

1.      Sims A. Fundamental Concepts of Descriptive Psychopathology. In: Symptoms in the Mind. Bailliére Tindall, W.B. Saunders, London, 1992.

2.      World Health Organization. The world health report. Mental health: new understanding, new hope [online] 2001 [cited 2003 November 1]. Available from:URL: www.who.int/whr2001/ 2001/main/en/

3.      Mumford DM, Bavington JT, Bhatnagar KS. The Bradford Somatic Inventory. A multi-ethnic inventory of somatic symptoms reported by anxious and depressed patients in Britain and the Indo-Pakistan subcontinent.  Br J Psychiatry. 1991 Mar; 158: 379-8.

4.      Gerber G. Cultivation Analysis: An Overview. Mass Communication and Society 1998; 1 (3): 175-194.

5.      Jung, C.G. (1985). Synchronicity: An Acausal Connecting Principle, London: Routledge. ISBN 978-0-415-13649-5

6.      C. G. Jung, Collected World, Vol 14 p.464. Quoted in Aniela Jaffe, "C. G. Jung and Parapsychology", in Science and ESP, ed. J. R. Smithies (New York: Humanities Press, 1967), p. 280.

7.      Alan Vaughan. Incredible Coincidences, The Baffling World of Synchronicity (New York: J. B. Lippincott Co., 1979), p. 162.

8.      James Redfield, The Celestine Prophecy (Hoorer, Ala.; Satori Press, 1993), p. 142.