There’s no escaping that noise, it’s always there, in or around your head, like low radio chatter, or a mosquito. It’s the background sound of a pandemic...it’s not unlike a silence, or a headache on the horizon that you try to forget but can’t. It presses in between the work con-calls in the mornings and the Zoom meetings with friends.
It’s on the mind all through a bare-essentials shopping expedition. Take a break to do the dishes and your social media chat-log has meanwhile piled up. People are seeking conversation like never before...madly, insistently. Often the content doesn’t seem to matter—information, misinformation, all of it wears the same grey cloak, striking the same nervous barter with the future. Everything we do suddenly seethes with a slow manic heat.... You don’t want to ask the question, but it pings you again and again. Are we alright?
But then, what is alright in the world? Death, pestilence and sudden onsets of distress are what people prayed to gods to save them from. And just look at the world and the unseen hand of...fate? No, the sheer law of averages. Mocking our insurance policies, our diet plans, our gated communities, our medicines, all the instruments we use to secure our lives. And so this ghostly corona of fear already rings us: not the virus itself but the cloud of mental dem—ons it flies in with. It infects all of us to varying degrees—this species of anxiety, this nervousness of the age. It’s like a crash test on the psychological health of a world that has not seen a moment of collective trauma like this in generations. “Everybody has some sort of anxiety,” says P.K. Dalal, president of the Indian Psychiatric Society. “It’s a pandemic none of us have seen before. The last one happened in 1918.”
And yet we have to fight this—an avalanche of bad news—with each of us alone. We have isolation for breakfast and dinner; normal society is in the freezer. The stuff of dystopian fiction? No, mordant reality. No wonder, signs of trauma and depression abound, and that there have been suicides, and a spike in cases of domestic violence, besides those related to addiction and withdrawal symptoms. The darkest bit of news from inside India’s homes? There were almost one lakh distress calls for help related to child abuse in just 10 days of the lockdown. Let’s get this clear. This is not just about science and the virus, or being able to buy vegetables. India is not normal. Maybe it never fully was, but each point of stress is creating new victims as we speak.
Call it the Psy-Ops part of the COVID-19 war, and it’s no less of a pandemic. It’s like one gigantic challenge to our collective sanity....
Or rather, an additional one on the already fragile faultlines of our mind. For, all of us come to this with pre-existing sources of stress, now exacerbated. No one was socio-economically (or psychologically) perfect anyway: the farmer and the middle-class retiree on either side of a disrupted food chain, the delivery boy on the street and the sharp-suits in glass buildings, the politician in his bubble, the teenager in her cyworld, even those virologists in their cutting-edge labs. We may ask: can’t godmen, gurus and cult leaders be psychologically disturbed too? No vaccine will immunise us except our own equanimity and resilience.
But how do we map this pandemic, how do we trace its footfalls, and how do we cope? Helplines, newly set up across the country, are buzzing. “A majority of districts in most states are being covered,” says Dalal. All across this new frontline, counsellors are tackling numerous COVID-19-related queries everyday: those are the “normal”, surface manifestations of anxiety. And deep manifestation? Take a handful of suicides? An elderly couple in Amritsar had left behind a note, leading police to suspect they feared infection. A patient in Delhi awaiting a test result leaped out of the hospital’s third floor, but luckily only broke a leg. Or take the almost-lakh figure of children who actually got to the point of calling a helpline. Imagine them trapped with known predators. So it’s there, and it’s real.
Health workers, paradoxically, can’t escape that fog of fear. Rather, they bear the brunt of it—a recent survey of 1,257 health workers across hospitals in China found any number of them had symptoms of depression, anxiety, insomnia and distress. The Indian Psychiatric Society too has started an online survey for health workers this week. At the King George’s Medical University in Lucknow, where Dalal works, staff teams are given training sessions before they head to the COVID-19 ward. “We give a 30-minute capsule to the team on how to deal with this because they will be on duty at the ward for seven days, followed by a 14-day quarantine.” The Indian Medical Association too is launching a tele-counselling service for doctors and health professionals this week.
And how exactly do we cope? Dalal sticks to matter-of-fact, doable targets. “For corona-related problems, basically people need counselling. We are also telling them not to get bogged down by an information overload.” Samir Parikh, director of the department of mental health at Fortis Healthcare, Delhi, also breaks it down to concrete aspects. The first anxiety that typically assails most people is “what if something happens to me or my family?” he says. “Post that, the second scenario, which is adjusting to this whole new way of living. The third is anxiety of the aftermath...will my job be there, my finances, when will life come to normal? All of these questions are as normal as it gets.”
Yes, perhaps normal questions, but with an abnormal, millenarian aura. Those who live in disaster-prone areas—where earthquakes abound, or tsunamis—they at least expect that nasty twist of fortune, and hedge against it. But what’s washing over our world, one that we built on optimism, is a tidal wave of shock and pessimism as the stability and predictability we seek lies shattered all around. That’s why we are, collectively, in a blue psychosomatic funk—responding to everything with a psychic edginess, actually realising our fears. Look at those congregations the priests called, or the son et lumiere shows on the balcony conjured by the king, or the webs of digital words we weave madly around our sudden islandhood.... Yes, we are all home: safe, but adrift. Robinson Crusoe was alone on an island, here we are all rafts floating in the sea, while being in cities full of people.
But we emit our digital signals to each other. This is where a lot of coping...and also a lot of unravelling is happening. Imagine all those thumbs whizzing on touchscreens. Many bring forth monsoons of emoticons. Many just can’t resist the forward button—as if it’s the ritual of a new religion, as if by plastering a banner of hope all over our virtual streets, we can forestall gloom or bring forth the good. Many fall back on that old ally: jokes. April Fool’s day came and went with the world in no mood to suffer pranks—even if the joker was a K-pop star. But we weren’t entirely washing our hands of jokes. There’s an overdose of them on WhatsApp and Twitter: a safety valve in these stressed times, or sheer boredom? Either way, it’s a tell.
The golden rule, says Dr Nimesh G. Desai, director of the Institute of Human Behaviour and Allied Sciences, Delhi, is that one has to accept the uncertainty. “The second rule is to treat the lockdown as a social responsibility,” he says—that actually helps us break out of our silos, and restores community. Of course, the demands of coping in the present moment will be as varied as there are people—some anyway live alone, some are stuck far from home, all situations differ. “So the coping will differ,” says Desai. “And we have to take class differences into account.” The barometers of depression are one thing for a divorcee alone in a new apartment, another for the migrant labourer who was among those who built it.
But on its ubiquity, there’s no doubt. Desai is seeing a spurt in cases of alcohol dependency and depression. “Depression cases are always the highest in numbers, but we are seeing more now,” he tells Outlook. Frustration could bring on behavioural changes, even spur domestic violence, he says. There’s another side to being shut-in: some reports, citing anecdotal evidence, say condom sales have risen. So are people having more sex? This is not facetious speculation. It’s a well-attested human response to moments of disaster: our genetic survival trigger. But can sex even be thought of in pristine ways at a time when the body itself becomes the site of dread?
There’s probably a class divide to this anyway, reckons sexologist Prakash Kothari. “The frequency of sex may increase among the affluent,” he says. “The poor who have problems of space, their sex lives can only deteriorate because, forget anxiety, they don’t have the privacy.” So the speculation about whether the world will see a baby boom post-corona is one thing. Kothari has more prosaic answers. “In India, where people can’t afford to spend a few hundreds for a movie ticket, this is the only stress-reliever people have even in normal times.”
If normalcy is abolished from this zone, things can get psychotic. Childline 1098—a toll-free helpline for children in distress that an NGO runs for the government—saw a 50 per cent spike in the number of calls from across India between March 20-31, the latter part of which included the first week of lockdown. That was a total of 3.07 lakh calls, says Harleen Walia, deputy director of Childline India. And of the 4,857 times the SOS calls warranted a direct intervention from Childline, 1,457 related to situations of direct threat and abuse—including sexual abuse. Remember, most child abuse in India happens within cloistered domestic spaces, and what we have now is an abundance in the supply of the latter.
Alcohol-related issues seem tamer by comparison. Yet, alcohol withdrawal has been a visible facet of the lockdown—and it can kill. Last month itself, the National Drug Dependence Treatment Centre put out a note advising health services across India to be prepared for this. Kerala even decided to allow those with withdrawal symptoms access to liquor on a doctor’s prescription—till the high court stayed the move last week. The state government cited the suicides (as many as six in the first week), even if many experts argued that liquor-by-prescription was no answer. Meghalaya too has approved home delivery of liquor on health grounds—again, on a medical prescription.
Johnson J. Edayaranmula of Alcohol & Drug Information Centre-India, an NGO that opposed the Kerala liquor prescriptions, admits he was apprehensive about the sudden closure—it was, after all, the first time since 1967 that Kerala saw total prohibition, albeit indirectly, he points out. But consumption levels had been coming down (even if revenue is up) since the state’s 2014 liquor policy, he says. “That gave me confidence. Also, the health machinery was prepped up much earlier through training protocols.” Over 400 people with severe withdrawal symptoms were admitted to various hospitals in Kerala in the past two weeks, says Johnson.
Kerala’s District Mental Health Programme has counselled over one lakh people over the last month, including those in quarantine. Most helpline calls in the first 3-4 days following the closure of Kerala’s beverage outlets were related to alcohol withdrawal symptoms, says Thiruvananthapuram-based psychiatrist Arun B. Nair. The uncomplicated cases are referred to nearby primary health centres or, if needed, to the excise department’s Vimukti deaddiction centres in every district. Beyond that, if people go into seizures or delirium, they are referred to medical colleges for expert care. “The acute withdrawal phase is usually three-five days and that period is now covered. Now the alcohol-related calls are coming down,” says Nair, who also handles at least 30 messages for advice on WhatsApp every day. Some infected people are troubled by guilt for having passed on the disease to others. Other recurring phrases: domestic stress and sleep disturbances, the latter partly owing to a digital addiction, another phenomenon that straddles disease and cure.
A Bangalore psychiatrist explains how deep the fear has struck with an example of a patient recently referred to her for a consultation: a well-adjusted family person, with no pre-existing anxiety condition, but who couldn’t shake off the obsessive urge to wash her hands. She had come to the hospital with a sore throat, worried that she had a COVID-19 infection. “She felt much better after the brief counselling session,” says the psychiatrist. “The bottomline is: it’s important to tell people it’s OK to feel anxious. It doesn’t mean you’re mentally ill. It’s OK not to sleep an occasional night. But it should not be overwhelming,” she advises.
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Patients with existing disorders are a bigger concern, as their treatment/consultation routines stand disrupted. “One major problem we are facing is access to medicines for existing patients,” says Dr Nand Kumar, professor of psychiatry at AIIMS, Delhi. Some drugs fall under Schedule X, which require doctor’s prescriptions. “Our OPDs are closed and patients are unable to visit doctors, so they’re unable to get a prescription. I’m hearing of cases relapsing...it’s dangerous for patients and the people taking care of them.” If the lockdown continues, adds Nand Kumar, governments must learn to put mental health front and centre of its policies and priorities. “It’s a major casualty of any pandemic.”
Other casualties? Even core concepts like ‘trust’ and ‘reliability’ could take on shakier meanings, reckons writer Vivek Shanbhag—among the things this will impact will be the written word, he says. “The whole premises of literature, things it takes for granted, are getting affected. Everything, the way we live, travel and work, is going to change,” he tells Outlook. Things that seemed important until now may seem inconsequential. “Even the way we appreciate art or a book is going to change.” Essentially, one thing we have to cope with is that the change could be here to stay. “Even to come back to the normalcy of the pre-corona days is going to take a long time,” he says.
Again, the sweeping impact of the 1918 Spanish flu hoves into view. Look only at what Mahatma Gandhi had to say when he was stricken by the flu that killed millions. Gandhi, writer Laura Spinney recounts in Pale Rider: The Spanish Flu of 1918 and How it Changed the World, had finally yielded to the doctor’s plea to change his notions about food, particularly milk, which he had avoided until then. “This protracted and first long illness in my life thus afforded me a unique opportunity to examine my principles and to test them.” Many, many millions are offered a similar chance to adapt and ruminate.