With news reports on COVID deaths and infected cases pervading our daily lives and the collective grieving process enabled by our customary funeral rites being replaced with solitary grieving, the mental health and wellbeing of a nation is compromised.  Senior Consultant Psychiatrist and Senior Lecturer from the Kotelawala Defense University,  Dr. Neil Fernando elucidates on the need for emotionally supporting each other and fostering positive thinking to brave the hard times.

By Randima Attygalle

Q: Although social distancing, hand washing, mask-wearing have become the norm, there is hardly a public discourse on mental wellbeing during this pandemic. How imperative is it to promote such dialogue?

A: Health is defined by the WHO as the ‘complete physical, mental and social wellbeing of a person.’ Mental health is therefore very much as integral part of overall health, but unfortunately like in all other situations, mental health is being neglected during this pandemic as well. The mind comprises three important components: cognitions (this includes your thinking, your memories, mental images- mainly how you think), emotions (how you feel) and your behaviour. These three components are interrelated and interdependent. For example, how you think will affect how you feel and how you feel will determine how you act. So this principle applies to the COVID pandemic- how they think, how they feel and how they behave. Wearing the mask, hand sanitization and physical distancing are all behaviours and behaviour is part of mental health.

Exposure to too much of negative news affects your emotions and your behaviour. Initially when the pandemic broke out here, the approach to the pandemic was not a health approach but more of a military approach inducing apprehension and fear in people. The initial impression given to the illness was more from a ‘criminal’ angle with media bulletins flooding with scenes of infected people and their first contacts being chased after. Later when people were exposed to COVID-induced deaths with the scenes of coffins being put into the crematorium along with the personal protective gear of health workers, they traumatized many.

The world at large too made a blunder of using the term ‘social distancing’ when it ought to have been ‘physical distancing with social connectivity’. In a culture where social interaction is a norm, term ‘social distancing’ became a double burden. When one house in a neighbourhood was quarantined, people feared a lockdown of an entire area, hence finding fault with places and came into forefront. Those who were responsible for the coining of derogatory terms such as ‘Peliyagoda cluster, Minuwangoda cluster’ never thought of mental health implications they would have amounting to discrimination and stigma. Apparel workers who were earning dollars for the country were shunned and were looked at as carriers of the viral.

Therefore, while the importance of mental health and wellbeing was not promoted, people were exposed to certain things detrimental to their mental health. Media too has a responsibility in sending out messages of positive mental health, instead of sending ‘news alerts’ with death toll and the number of infected cases, more positive messages can be sent to the public.

Q: With reports on infected cases and deaths flooding in, anxiety levels of people are on the rise, even if they have not dealt with death directly. What coping mechanisms do you propose to foster ‘positive thinking’ among people in such a backdrop?

A: We need to apply the concept of ‘positive psychology’ promoted by Prof. Martin Seligman, a clinical psychologist from the University of Pennsylvania. Positive Psychology is relatively a new area in psychology where the focus is on wellbeing. Rather than looking at the negative aspects of the illness and what is wrong, this concept looks at what is strong. Up to the turn of this century, psychology was looking at means of filling deficits- when a person is ill, how he/she can be made well. In Seligman’s own words, “it was bringing a person with minus 2 to zero.”

Positive Psychology on the other hand, looks at a way of taking a person from zero to plus 2. It looks at features a person has rather than looking at features a person has lost. It looks at character strengths and promotes those strengths to make a person better. Promotion of wellbeing as Seligman says, rests on five pillars called PERMA. ‘P’ stands for positive emotions, looking at your past, present and future in a positive way and to find something positive even in your setbacks.

‘E’ is for ‘Engagement’ or flow- to be actively involved in some useful activity. Children not being able to go to school is a drawback, however, they can learn household work or a craft during this time. Even in a lockdown situation, people should be engaged in something, even observing nature is a kind of engagement

‘R’ is for relationships.  Social connectedness promotes wellbeing. Social isolation is actually against wellbeing. Even in a quarantine situation, one must be socially connected with family, friends, work mates and neighbours despite physical distancing.

‘M’ means ‘meaning’- to have a purpose in life. This pillar is connected to your spiritual life as well. Caring for others can give a lot of mental satisfaction and promotes your wellbeing as well. There are many who have lost their livelihoods, friends, neighbours struggling to survive and those who are more comfortable can help such people in need.

‘A’ is for accomplishment, to have goals and achievements in life. To be proud of what you have achieved.

Using this PERMA model, we can encourage people to think about the best scenario possible and not the extreme. One needs to take a middle path. Otherwise people will be overwhelmed by statistics, because statistics emphasize largely the negative side.

Q: With the rise of elderly deaths, there is apprehension among senior citizens and how best can they be supported?

A: It is essential that they keep negative news at bay. Watching and reading too much about COVID and deaths can be detrimental. They should also be encouraged to keep in touch with their loved ones and engage in positive conversation outside the pandemic. Engaging in an activity that interests them such as listening to music, gardening or reading can also help them get distracted from negativity.

We should also support them psychologically with what we call the ‘Two-Es and I’s’: Emotional support of love and care, Esteem support (showing respect and giving value to a person), Informational support (providing correct information and knowledge to counter myths and misconceptions) and Institutional support (offering practical help).

Q: How vital it is to ensure the mental wellbeing of our health workers?

A: It is of utmost importance to ensure their moral wellbeing as it could affect their productivity. Unlike in the first and the second wave, in this third wave of the pandemic, the health workers are facing what is known as ‘moral injury’. That is, with limited resources, they are unable to cater to each and every patient. For example, while there may be two patients who need ventilators, only one machine may be available. So it is the health worker who has to decide. Of course there could be protocols and guidelines but it is another human being who has to implement these guidelines. Therefore health workers can experience ‘moral injury’ or a kind of guilt that could haunt them later that a decision has to be taken at the cost of another patient’s life. The trauma of the pandemic and its mental health impact will be enormous and could last for years to come.

However on the brighter side, there is a new concept associated with Positive Psychology called ‘post-traumatic growth’ where people can actually make use of traumatic events as a learning opportunity and be empowered.

Q: Sri Lankan funeral rites enable shared grief with the community involvement. The pandemic has deprived our people even of religious rites. How does this impact their mental health?

A: When a death occurs in normal circumstances in our culture, it is referred to as a mala gama or an avamagula, the very terms connoting that it is a community affair where ‘grief reaction’ is a shared one. Almost all our funeral rituals are psychologically very sound. The social and religious customs which follow a funeral support the sharing of grief, so that the bereaving family can come to terms with it.

Sadly this communal exercise is replaced with solitary grief. You cannot even see the body, there is no funeral ceremony, no rituals performed. The psychological buffer provided by our culture is now being taken away. Some people have lost several family members. There is a lot of silent mental suffering going on right now as survivors also have a ‘guilt feeling’ that couldn’t even give their loved one a dignified funeral.  Hence talking and listening to those who are mourning, sharing of grief should be done using other means while keeping distance.

Q: We are a nation which went through a civil war. Pandemic is a ‘war’ of a different kind. As a senior professional who dealt with combat-related mental issues/ depression etc. do you see a difference in human response to the war and the pandemic from a clinical standpoint?

A: Yes, there is a difference. Compared to war where the majority of Sri Lankans were not directly affected, in this pandemic situation everyone is affected. Right now you don’t see the enemy but only destruction. While war and its impact were ‘structured’ pandemic is a different phenomenon.

In times of war, even if a sealed coffin was sent home, there were funeral rites performed and a military funeral was given with the respect of a nation, draping the national flag over the coffin. All these interventions helped family overcome grief. Today with solitary suffering, people are finding it hard to come to terms with death.

Q: Organizations have lost their employees and some employees have lost their loved ones. In such challenging times, what can be done at organizational level to keep the staff motivated?

A: Organizations can make use of their available resources and promote the wellbeing of people. They can make use of virtual platforms to share ideas, their grievances and be supported by professionals. At the same time it is important for organizations to maintain proper communication channels with their staffers and support them through difficult times.

Q: With children being home-bound, what tips would you give parents to keep their children optimistic?

A: If parents have a negative attitude, children invariably will be negative and even when schools reopen, some children may even fear associating some of their friends. Parents should encourage children to be connected with their friends, grandparents and family through other means while maintaining physical distance. Association is very important at this point. They can also be encouraged to make use of this time to learn a new craft, household chores etc.

Online education itself has created problems. Children who are unable to connect due to different reasons can feel sidelined. This could be psychologically traumatic because at the end of the day, all children will have to face the same examination paper. Policy makers should be conscious of this factor.

Q: Do you see a rise in depression in your clinical practice since the onset of the pandemic?

A: Yes I do. There is what is called post-viral depression. After any viral infection, it can precipitate a person into depression. COVID too began as a viral and it is natural to expect people who recover from it to develop symptoms of depression. Loss of a loved can also precipitate depression in certain people.

Q: How can family and friends support someone who is at risk of depression?

A: Grief is a natural reaction to loss, but it could turn into abnormal grief especially when death is sudden and unexpected. When grieving is prolonged (beyond 6 to 8 months), a person can develop depressive illnesses and in order to help we should be conscious of the three Cs: Connect, Communicate and Care.

It is important that you listen to a person grieving because listening itself is therapeutic. For this, one need not necessarily be a mental health expert nor does one need to have solutions to all problems. What is important is to encourage a person to talk taking his/her own time and listening in an understanding, non-judgmental manner. Empathetic listening is vital and this entails communication- showing your understanding and most importantly, acknowledging and validating a person’s emotions.

Q: With lifestyles having taken a complete reversal, people being home-bound, work from home arrangements interfering with domestic chores, socializing in office and outside being a thing of the past, visiting loved ones being restricted, the ‘new normalcy’ has become stressful to many. How best can we navigate these challenging times?

A: The pre-frontal lobe/cortex or the front most part of the human brain is well developed enabling humans to adjust to new situations. This is the reason why man is ahead evolutionarily as well. It is true that the new normalcy has created its own set of problems but it is imperative that we make changes and adjust accordingly than trying to persist with what we were once used to. A good example is working from home- this concept was not heard of before COVID but people are getting adjusted to it as well. This shows that on the whole humans are capable of adjustment, although some may be quite comfortable and others may be less comfortable with adapting to it.

The writer is the Co Editor of  Lankan Isle. She is also an award winning senior journalist and a lawyer