While You Are Social Distancing: The Role of Psychiatrists During Pandemics
Vol 7 #4
Caroline Giroux1, Ana Hategan2, Sonja Lynm3, Alan Eppel4
1 Associate Clinical Professor, Psychiatrist, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]
2 Associate Clinical Professor, Geriatric Psychiatrist, McMaster University, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Ontario, Canada
3 Consultation-Liaison Psychiatrist, Anchorage, Alaska, USA
4 Professor, Psychiatrist, McMaster University, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, Hamilton, Ontario, Canada
A quarter of a century ago, when one of these authors (CG) was in medical school, the teacher of infectious diseases warned the students of the likelihood of a flu pandemic during their lifetime. She still remembers vividly the gravity of the scenario during an interview of this specialist, broadcast on TV. She got her flu shot yearly ever since to build herself some immunity. But we are not prepared for what is happening now. As psychiatrists, we also realize the importance of a form of psychological or emotional immunity to survive a public health crisis. Do psychiatrists have a role during a pandemic? The authors think so and will explain their perspective as they reflect on the current pandemonium that will likely affect the human condition and the infrastructure of societies.
Over the last few weeks, many of us have seen our lives turned upside down. There is no question that the current pandemic from the COVID-19 coronavirus is a real threat to our physical health and wellbeing. How to weed-whack the overflow of contradictory information, or the lack of clarity regarding a response, in order to get an accurate picture of what is really going and make important decisions in an informed manner? Most importantly, how to stay calm and not completely panic?
In medical school and residency, we are presented with large volumes of information, and we train our brains to absorb and critically evaluate data and research. The COVID-19 pandemic among the current state of world affairs has taken our training to new levels. We have a new challenge to rise to. Given that this is a novel virus, there is both a paucity of information to reference, and at the same time a constant, almost hourly stream of new data that can seem conflicting and confusing. How will we know what to do? How do we know what will work? How will we stave off suffering and increasing mortality rates?
At this time, there is a lot of uncertainty. Usually, psychiatrists feel at ease with that experience since they are used to managing “mental chaos.” But when it is happening on a larger scale or societal level, it is difficult not to feel overwhelmed, stunned, or scared. We are faced with managing patients’ reactivated fears of death, but also possibly our own.
Colleagues disclose that they are scared, uncertain, and anxious. The authors acknowledge that they share their concern. These are normal and common thoughts for us as providers. Current events occurring in our society are unprecedented. Friends and fellow medical colleagues around the world have tested positive for COVID-19 virus.
Questions on how to handle this stress are being presented to us daily, by colleagues and patients alike. “How do I continue to prepare my family and myself, and have enough energy to care for my patients?” As physicians, nurses, and providers of all kinds, working on the front lines, we need to recognize that we are all still human, experiencing change and loss with each new day of this health crisis. With change and loss comes the full range of emotional reactions, including an existential angst that is easier to handle when verbalized and shared.
In stressful times, as humans we need to join together, and increase our connectivity. Now is a time when we must be creative and utilize technology to our advantage to decrease social isolation: Facetime, Skype, text, and phone calls, to name a few. Social distancing, quarantining, CDC, Canadian and International recommendations must be adhered to. At the same time, we need to be fully aware of the difference between physical and emotional distance.
In the midst of collective panic, it is especially important to pause to make sure we respond appropriately and rationally rather that overreacting, which could be damaging. Self-care is non-negotiable and even more so in such trying times of crisis and need for physical social distancing. Here are some reminders the authors would like to share with the readers in regards to coping with the psychological impact of physical social distancing:
- Manage stress. How do you cope with stress from existential dread and catastrophe? First and foremost, breathe: taking even six to ten deep breaths (counting to three as you inhale, brief pause, and then counting to three as you exhale) can actually help counteract the stress response systems that are likely in overdrive in times of crisis. Many people might experience this pandemic as a shock or even a trigger, which then throws their autonomic nervous system into sympathetic, or “fight or flight” mode. Hence the need to recalibrate by practicing diaphragmatic breathing, to bring yourself back into a more restorative mode (parasympathetic mode) to be able to think more clearly about a situation. Singing or humming can also facilitate this. Stress management apps such as Calm or Headspace can help.
- Give thanks. Be thankful for the fact that you can breathe and for other aspects of your life we tend to take for granted.
- Stay healthy. It is important to consider your own health. You will not be helpful if you are ill. Make sure you generally maintain a healthy lifestyle by ensuring adequate sleep, nutrition, and exercise and engaging in any activity (even if virtually created) or experience (even if virtually bonding) with full presence and attention (e.g., mindfulness).
- Maintain positivity. Take some time to recognize how your common “thinking traps” (i.e., patterns of thinking that correspond to deeper beliefs, assumptions, or expectations about self, others, and how certain situations should unfold) are being activated. You may be able to identify your own common thinking traps (or unhelpful, “hot thoughts”) and challenge “catastrophizing” and other cognitive distortions that are hijacking your brain. Repeat positive thinking to yourself everyday (“I can do this,” or “I can think creatively about solutions,” or “I am grateful that my loved ones and I are safe”). A gratitude journal can be helpful to create a tangible reminder to reference during particularly trying moments. Foster compassion for yourself.
- Set aside time for laughter and hope. Inject enjoyable activities and pleasurable moments (anything that helps you feel good or recharges your batteries, whether it is going on a walk in nature, petting your beloved animal, calling a friend, reading a book, baking cookies, gardening, playing an instrument, or dancing). Cultivate those micro-meditation practices. The quality of presence in your pause for joy (rather than the duration) counts even though we are required to avoid traveling, attending public places and large gatherings such as cafés, movie theaters, or concerts.
- Keep connections. Because physical social distancing is currently the required norm to abate the spread of the virus, we must continue to nurture the social aspects of our psychological being by channeling venues to do emotional processing and connect with loved ones and beyond (e.g., make use of technology such as phone, e-mail, social media platforms to stay psychologically connected).
- Maintain engagement and purpose. Work from home as much as possible and consider providing virtual services. Discuss stress with trusted colleagues to combat professional burnout.
- Support community. If you can, continue to support local businesses and newspapers that keep you informed with up to date and reliable information; search out various sources of information before you make important decisions and look for expert, non-biased views.
- Establish a healthy routine. Create a new routine in your home that takes into accounts everyone’s needs. Talk with your family. Children can be especially sensitive to the threat to their sense of normalcy due to school closure and social distancing from friends. Having family movies (comedies better than dramas, as laughter is therapeutic), board game evenings, ball games in the backyard, or family art projects can help with bonding and mindfulness.
- Prioritize needs. Use healthcare resources only when urgent. It might be better to postpone non-urgent visits such as annual check-ups or dental cleanings to minimize exposure, not only to ourselves, in those potentially contaminated environments, but also to avoid exposing precious healthcare professionals who are currently risking their lives to assist the population. This is a time to refocus on judicious use of health resources for the greater good of our communities and public.
All of the above could help us stay healthy (gratitude and other mindfulness practices help boost the immune system) and make us feel in control of our emotions while being socially responsible and accountable for the greater good.
Despite doing our very best to nurture ourselves, we could be dealing with difficult emotions, and people sharing a household might even see an increase in tensions because they cope differently. There will be some universal emotional experiences (such as fear) but each person will also go through this experience in his/her own way. Just as there is not a one-size-fits-all sequence of stages for grief, as people go through various micro-grief reactions on a daily basis (school closure, cancellation of trips, concerts and sports events, financial loss, loss of employment, illness and potential death of self and others, increased work demands, etc), they might go through various emotional responses as well, which will depend on past life events that shaped them, temperament, personality, coping, etc. Regardless of your feelings (frustration, numbness, sadness, fear, etc), it is important to make room for your own emotional experiences and seek validation from someone who might understand you. Consider seeking psychotherapy for yourself or family members.
This situation and other similar ones to come in the future of mankind are also a great opportunity to put things into perspective, learn from the recent events in order to increase preparedness and resilience for next time, and also to find meaning. Human beings are “meaning-making” creatures and trying to find how this fits into the greater scheme of life or why our world has arrived at this point might help deal with helplessness. Creating meaning will be enhanced by the four overlapping S: sense of belonging, storytelling, sense of purpose, and spirituality or transcendence. For instance, have a mindfulness meditation exercise (spirituality) for five minutes through video-conferencing with friends (sense of belonging), followed by sharing a success story or something to be thankful for today (storytelling) and develop a resolution to contribute to this world (sense of purpose).
We see this situation as a unique moment to reflect on broad picture topics and learn to make room for our emotions especially as solitude kicks in. Whereas we believe that social distancing is an efficient antiseptic in this situation, we also realize that some may fear, and rightly so, an “isolation pandemic” as people stay away from each other and no longer gather for some unforeseeable time. As we know, social interactions are essential for wellbeing and human touch is crucial for psychological attachment, the development of children and, ultimately, the wellbeing of all humans. Psychiatrists have a role in educating the public about the potential impact of the changes that are forced upon us, but they can also be part of the solution and help buffer stress by providing guidance for self-care. It is also urgent to enlist experts from various fields (e.g., science, technology, medicine, psychology, social sciences) to think co-creatively about the possible repercussions of the radical measures we need to put in place to limit the spread of this contagious disease. We must continue to do what we can still do, such as connecting with others. As such we are grateful to be able to continue to co-write this piece with authors from different parts of the world as professional collaborations can feed the social aspects of our disrupted lives. Doing what we can and adapting our skill set to current needs will enhance self-efficacy and adaptability to the unknown.
While the COVID-19 influenza pandemic is already taking a toll on the world, we would like to dedicate this article to all the physicians and other healthcare professionals who are risking their own lives in endeavouring to care for those in need. To all healthcare workers, please accept our profoundest gratitude for all the work you are doing, today and every day, on the frontlines of healthcare. Please take care of yourselves.
Conflict of Interest and Source of Funding: