- Divya Ahire
Emily St. John Mandel’s novel Station Eleven starts with a seasonal flu, followed by a tsunami of death. People are reluctant to accept the epidemic at first, but soon, it proves to be so lethal, that most of the world’s population is wiped out within weeks. Law and order break down. As the plague aggressively ravages the town, funerals turn into rush jobs, emotions and ceremonies being buried with the deceased.
Mandel was trying to illustrate how humans respond and live with uncalled for ‘death sentences’. Perhaps, she was also trying to show us how little it takes for a society to fall apart. The arrival of COVID-19 certainly made it clear that pandemics are not mere imaginary products of a few artistic types.
The pandemic has highlighted existing political, economic and social shortcomings. We have also witnessed a crisis of leadership. In such situations, I believe most citizens tend to regress to a state of bigger dependency. It results in anticipating the kind of leadership that can soothe collective fear and anxiety. This explains the paradoxical phenomenon: Even highly inept leaders rise in popularity as the going gets tough. The pandemic becomes an excuse to take advantage of a growing sense of helplessness and turn it into an implicit autocracy in a democratic nation. It pushes us to make radical changes to economic systems, social decorum and the crucial role of government in our lives.
The simultaneous upsurge in virology and virality in this crisis called our attention to how not only the viruses are capable of spreading rapidly but so did the information and misinformation related to the outbreak of pandemic around the globe. People became vulnerable due to the surge of incorrect information, which led to an “infodemic” spread via social media. The nationwide lockdown has also produced acute panic, anxiety, obsessive behaviours, hoarding, paranoia, depression and post traumatic stress disorder (PTSD). Therefore, it is vital to determine the various possible ways in which this pandemic has impacted the world’s mental health.
We as a community are too stigmatized for “Corona Positive”
The outbreak has developed stigmatizing factors like fear of isolation, racism, discrimination and marginalisation with all its societal ramifications such as, the economic downturn largely affected people from the lower socio-economic stratum (SES). The unsettling visuals of migrant labourers going back to their native places on foot during the lockdown have been critically debated. More than 200 incidents were reported of people attacking healthcare workers during the pandemic, while they also faced social ostracism, lynching and harassment.
A stigmatized community tends to seek medical care late in the day, and hide medical history, particularly of travel, which leads to community transmission. It was also observed that health crimes which originated from fear of being COVID-19 positive were reported frequently in India. Health crimes include a wide range of illegal activities committed within the medical profession, such as fraudulent billing or performing unnecessary operations that can cause serious harm or even physical abuse of the medical professionals. Such health crimes rose dramatically during this pandemic.
The stigmatization can perpetuate negative stereotypes or assumptions, give rise to false associations between the disease and other factors, create pervasive fear or dehumanise those who have the disease. This drives people away from getting screened, tested and quarantined.
Healing the vicariously traumatized healers and frontline workers
The mental health of frontline workers is always overlooked during a pandemic. The unavoidable stress and increased responsibilities during a lesser known contagious disease, like COVID-19, can provoke acute anxiety, stress and depression. Knowing the lethality of this virus can negatively hinder the performance as well as mental well-being of health workers, bankers, policemen, armed forces, etc.
In India, where the healthcare system is already overworked, surges in cases are likely to cause irritation and stress among doctors and nurses. This develops due to inadequate supply of essential hand hygiene tools and shortage of personal protective equipment (PPE), among medical professionals, who are at the high risk of transmission. Their salaries are delayed by months, which in turn cause financial crisis leading to feelings of insecurity and loss of motivation.
They also find it difficult to deal with the appalled, uncooperative, panic-stricken and highly stigmatized patients of COVID-19, which generates apathy and withdrawal among clinicians. Many healthcare professionals were directly related to care of confirmed COVID-19 patients who were isolated, quarantined and separated from their families which took an enormous emotional toll on them.
Upsurge in suicides
Social isolation provokes the pathophysiology of psychiatric disorders and suicidal behaviour. It is also associated with major depression and generalized anxiety disorder. Social connectedness has always been emphasised as a critical factor in emotional health and social stability. From suicide prevention protocol, it is worrisome that the most important approach to reduce the transmission is physical distancing. This leads to feelings of loneliness which causes distress perceived from social deficiencies in relationships around them. Anxiety and fear of contagion during this crisis is related to uncertainty, fear of the unknown and panic-inducing social media, as repetitive broadcasting of reported cases can intensify anxiety.
In the midst of such an environment, sleep cycles get disturbed, and sleeplessness is a stand-alone factor for suicidal behaviour. Economic vulnerability increased across all sectors of the society, as millions of people lost their jobs. Historically, economic downturns were detrimental towards health disorders and suicides.
For suicide prevention, it is crucial to decrease stress, anxiety, fear, and loneliness in the general population. There should be social media campaigns to promote mental health and reduce distress. They should also be encouraged to stay connected and maintain relationships by telephone or video calls, get enough sleep, maintain good eating habits, and exercise.
Home quarantine for homeless people
India faces unique challenges in combating the pandemic as it has a large number of people without homes. Due to homelessness, these individuals are more geographically mobile than individuals having shelter facilities which makes it difficult for medical professionals to track and prevent transmission of this virus. The lack of preparedness to provide medical facilities to such a large section of society has increased their risk of contracting COVID-19. When it comes to mental illnesses, the majority of them suffer from severe schizophrenia, bipolar affective disorder, intellectual disability, and substance abuse, this also makes them unable to provide the information on personal identity, family history and illness. This lack of information makes it more complex to provide them with adequate healthcare facilities. They also live in constant fear of forceful hospitalizations and imprisonment.
A majority of the homeless population are daily wage workers, migrant workers or beggars. Since the first nationwide lockdown, most of them have been rendered penniless, without having a way of going back to their native towns or villages. They were stranded on roadsides across India. While initiatives are being taken to provide them with food and shelter, it is still far-fetched to maintain any form of physical isolation or better hygiene in such situations. The protection of the rights of this unprivileged section of the society, providing them with adequate healthcare, should be addressed by the state.
False media ecosystems by Netizens
Initial outbreak of the epidemic in China developed a “social media panic” which consisted of relentless overabundance of fake information. Twisted misinformation metastasized more rapidly than the virus itself. It instilled fright and panic by laying out unchecked rumours, lurid news propaganda and sensationalism. Even the spread of questionable information can largely affect how people comprehend and adhere to government provided countermeasures to curb the spread of virus. I believe the government should not only look after virological aspects of this pandemic but also on virality and it’s adverse effects on masses, they should be more prepared and be more involved in redirecting the false assumptions in this new information environment.
Individuals seeking medical help were perplexed and very anxious about COVID-19 as there was very little information during the initial days, which led to massive disinformation and disrupting the normal running of healthcare systems. Practicing therapies by lay people after being influenced by deceptive social media messages are increasingly reported.
There needs to be a protocol for psychosocial crisis prevention and intervention during a pandemic with application of the internet and appropriate technology. The urgency for the need of this system should be recognized by the government, health care personnel and other stakeholders. Development of an interactive platform including a dashboard to provide real-time alerts of concerns and misleading information about the pandemic would permit the public health officials to respond rapidly with a proactive narrative to mitigate such baseless rumours. In my opinion, only by joining forces of concerned authorities and public participation can we ensure the effectiveness of quarantine orders during such crises.
I believe, preparedness by establishing mental health organisations specific for future pandemics with branches in many nations and in individual healthcare institutions for research, mental healthcare delivery and arranging awareness campaigns across all sections of the society is desperately needed. For the current crisis, we call for the introduction of a real-time information sharing platform, developed from data and analysis from a range of social media platforms, in diverse languages and across nationwide diasporas. An inclusive “information diet” based approach should be implied through traditional/online media after receiving the apt training by health information professionals.
We all can agree on how a “virus” can completely halt and negatively impact our lives even in the 21st century and concurrently make us realize that vital assets of mankind are health, peace, harmony, ingenuity and knowledge.
Divya Ahire is a research assistant in the Department of Psychology with Nolmë Labs. Her interests include neuropsychology. She wishes to contribute and generate more awareness of this field in India.