The impact of social isolation
As I have previously argued, I do not believe that we are sufficiently discussing the mental health and wellbeing risks of the current crisis. I expect that there may well be a mental health crisis post-covid-19 as the impact of the pandemic and responses to the same, take hold. When our survival responses lessen and we can better contemplate the devastation. This distress is foreseeable and understandable. And while medicalising it may do more harm than good, it needs consideration and preparation at individual and collective level.
Human beings are social animals. Isolation is for most of us, not something we are designed to tolerate for extended periods of times. It is of course for that reason that it is used as an ‘effective’ form of torture and violence. Isolation has high costs. So much so that some researchers have proposed the adverse health impact of isolation are similar in magnitude to the health risks associated with obesity, smoking, lack of access to care and physical inactivity.
The risks are indeed serious. Social isolation has been consistently associated with poor physical, mental and cognitive health. It is correlated with depression, reduced sleep quality, impaired executive functioning, cognitive decline, poor cardiovascular health and impaired immunity at every stage of our life. It is therefore a risk factor for increased morbidity and mortality including death by suicide. Vulnerable groups are particularly at risk. As a nation, let us remind ourselves, we are not particularly well psychologically, to start with. We may even argue there was already a mental health crisis. Psychological distress is prevalent with increased concerns regarding many groups, children and older people, for example.
Trauma and loss
It is not only social isolation which threatens our wellbeing. The isolation we are dealing with is naturally associated with fear including the fear of death and of illness on a mass scale. As human beings we use powerful defences to deny our vulnerability and mortality. Repeated exposure to death and unexpected dying deeply disrupt our psychic equilibrium and, our sense of safety and stability. It affects how we view ourselves, make meaning and sense of the world as well as our sense of normality as our relational, financial and social resources are stretched or shift. Further, group exposure to suffering is likely to lead to massive stress responses at individual as well as at collective level.
Most of us worry or will worry about the welfare of relatives, family and/or friends. Many have lost and will lose loved ones. Bereavement is therefore likely to feature heavily as a response to this context of death and dying. How we experience this loss will depend on various factors including our background, personal history, worldview and the circumstances surrounding the loss. Sustained sadness, hopelessness, anger, guilt, and regret are nonetheless common responses to bereavement. In addition, grief can be activated when we are faced with any loss including loss of health, of independence, of financial security, of safety and even of worldview a such as the loss of a sense of justice or moral anchor. Again, understandable feelings likely to be widely experienced.
We speak of collective trauma to refer to the psychological responses to traumatic events that go beyond the individual and affect entire groups of people. Traumatic events, crises or catastrophes that are witnessed or experienced by many can have effects on an entire society, its culture, functioning as well as its psychic structures, leaving wounds and/or memories with the potential to shape future generations to come. Indeed, catastrophes and crises have been found to have profound and long lasting effects, often these are intergenerational, shifting behaviours, belief systems, attachment and safety seeking mechanisms in both helpful and less helpful ways.
Inequality and marginalisation
The current crisis will be trying for most of us. Regardless of our mental health pre-COVID-19. Nonetheless, the impact of social isolation and associated losses and trauma will not be similar on all of us. Existing mental health inequalities in the prevalence of psychological distress for example will naturally have a direct influence on how the crisis is experienced and on its effects, once over. Those who struggle with anxiety for example or low mood may find the current circumstances particularly difficult and will remain at higher risk of psychological distress once the crisis is over.
How this risk is mediated will vary from person to person. However, feelings of entrapment and powerlessness are common in people who struggle with low mood, depression and suicidality. The lack of control and uncertainty associated with the pandemic together with the requirement to stay home can be expected to trigger helpless or claustrophobic feelings which may create or exacerbate low mood, depression and anxiety. Similarly, recurrently worrying about contamination and health coupled with a reduced availability of quality social support, may trigger or worsen anxiety related problems and, in particular, health anxiety and obsessive compulsive difficulties.
Racism is likely to be an additional compounding variable. As previously written the politics of the pandemic are racialised. Not only are groups of people of colour more likely to experience racism and hostility (e.g. people of East Asian ancestry) as we’re all watching, structural racism has reared its ugly head. Black and brown bodies are dying disproportionately. Exposure to racism and to these race inequalities in mortality rates is a form of vicarious and collective trauma. Further, groups with higher levels of trauma including racial trauma (people of African descent) are now being exposed to loaded cultural scripts such as the prospect of black bodies being experimented on. This is likely to activate distress including intergenerational and historical trauma.
Social economic status is another variable which will create further inequity. The evidence suggests that people from lower socioeconomic backgrounds are much more likely to develop and experience mental health difficulties. Added to this existing baseline, will be new or additional worries about money, precarity or debt. Moreover, there are real concerns over the stress which will be generated for those stuck in unsanitary (if not unsafe) housing and/or in overcrowded or unfit accommodation. Conditions which as we are started to see, will invariably lead to increase domestic and/or child abuse both of which will further fuel the cycles of psychological distress and mental health inequality.
There are clearly various groups who are at an increased risk of experiencing mental health ‘problems’ in addition to people of colour and poor people. They include women, those who identify as LGBTQI, those without a stable home, asylum seekers and refugees, those with physical disabilities and chronic health issues, and those who care for others. Those groups are not mutually exclusive and an intersectional approach is required to remember that health and mental health penalties and risks of harm, including risks of structural violence are cumulative and more severe in those with various vulnerable or marginalised identities. As a result, those with experiences of multiple traumas and/or who have faced more adverse life events, particularly experiences involving loss, separation, confinement or exclusion such as bereavement or bullying are likely to be even more vulnerable.
Resisting and looking after ourselves
It would be impossible to give a comprehensive personalised list of self-care or wellbeing activities which may help all of us look after ourselves, as individuals. Nonetheless there are general principles we can all try to follow to maximise our resilience and to limit the negative effect of the crisis on us. This is particularly important if you belong to a marginalised or vulnerable group.
The below is based on a short twitter thread, I wrote last week;
1) Stay connected. As much as you can. Use phone. Skype. FaceTime. Zoom. Make sure to hear and ideally see people everyday.
2) Limit the time you spend watching the news. There is little point in tracking terror inducing news every minute of the day or getting incessant alerts. This is likely to increase your anxiety. Once a day is plenty. Enough for most of us.
3) Plan pleasurable activities. Everyday. Schedule and diarise them. What brings a smile to your face? What brings you joy which you can still do at home? Music? (I recommend drum based and African music) Dancing? Reading? Make sure you do a little bit of that everyday.
4) Build stronger relationships with those in your household, if you don’t live alone. And if it is safe to do. Spend quality time with them. Talk (I know revolutionary, right?).
5) Related to that it is usually best not to bottle things up. Express fear, worry, anger, despair…, if you struggle to express yourself verbally consider writing or art. Painting and poetry can be very soothing and can help us process difficult emotions.
6) Keep active. Move. The government allows us to get out the house for exercise. Do it. Go for a long walk or a run. Also armchair exercises are good if you cannot leave the house. Plenty of videos on YouTube.
7) Laugh! Some of us have become expert at dark humour. It may not be your cup of tea. But again whatever makes you giggle wether watching a funny movie or cracking up jokes. Do this regularly. Actively seek to laugh. Be deliberate.
8) Structure your day. This is particularly important for those without work or other formal commitments. And even for those employed but unaccustomed to working from home. Consider planning in advance what you will do each day, stick to a routine. And again include things to be looking forward to.
9) Clean up your lifestyle. This is really about lifestyle hygiene. Try to eat ‘clean’ as often as you can. Tighten sleep hygiene as much as you can. Avoid overdoing it when it comes to alcohol or whatever else. Remember to be kind to yourself, this I would say is basic self-care.
10) Practice gratitude. I know this may sound counter-intuitive but the evidence base is solid. Try everyday to remember at least one or two things you’re grateful for. Little things & big things. This will help you to ‘catch the good’ to pay attention to beauty in the world too.
If you’re struggling please contact your GP, your therapist (if you have one).
The Samaritans 116-123 are available 24h a day.
Remember you are not alone and you will make it through.
If you’re in immediate danger call 999 (UK)
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