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| Photo by Macau Photo Agency on Unsplash |
You’re here, so
take a deep breath. I just wanted to start things of by wishing you a good
weekend ahead and I hope things are in some ways alright with you wherever you
are – at home or at work. Let’s not sugar-coat it, it is a difficult time for
everyone around the world. For some, ‘difficult’ would be an understatement. So
many lives are lost every day. The old especially – even the young are not
spared.
I
try not to look at the news every day, mostly to shield myself from feeling too
much and causing myself not to function normally because I still have to go to
work, although I don’t consider myself as a ‘front-liner’. But the times when I
do watch the news or some documentary about nurses, doctors, volunteers,
researchers and medical professionals in the front-lines doing something,
sacrificing the time with their loved ones to directly or indirectly help those
affected, I feel that it really is inspiring and moving.
It is during these times, we are able to see the
selflessness of man-kind. It is sad to say that during these times, we are also
able to see the selfishness of some. Some are ignoring advice, some are taking
more than what they need, some are stealing from the poor, some are spreading
rumors and false information just to gain popularity and the list goes on.
The global economy is plunging as cities are put into
lock down and the people out of work. In current news, some hotels in Malaysia
are forced to close as there is no volume of guests. People can’t even travel
from country to country, let alone, state to state. The travel industry is at
its knees. Most businesses are suffering terrible losses. The food industry is
merely surviving by providing delivery and take-away options for hungry
patrons.
When is this going to end? The numbers are increasing as
more people are being tested. More people are dying. More families are
grieving. More people are starving. More resources are being poured into fighting
this pandemic, therefore hunger and poverty are forced into 2nd and
3rd place. In some countries, if you’re not sick, you’re either
starving or extremely poor. Well, at least sanitation is put into the
spotlight.
The weird thing is, The United States of America is at
the top when we’re looking at the total number of reported cases. Either
America is being super transparent (as usual) about their big cock-up or other
countries are taking bigger steps in ensuring that reported cases are dealt
with more red tape. I do not know. Maybe I’m being too biased by using the word
‘cock-up’, because I do not know the exact factors but we all know statistics
can be manipulated or how the numbers are being presented. Sure, there can be
less positive cases and more negative cases even if more people are being
tested which probably shows that the curve is gradually flattening, but how and
why is that so? Are we being extra careful when handling positive cases when
compared to negative cases? These are all the questions we should be asking
ourselves when we think about our country lifting restrictions.
Disaster
The COVID-19
pandemic is causing a surge in the capacity of hospitals around the world.
Healthcare professionals are working around the clock, putting in more working
hours than what their bodies can take. They come into work every day, wearing
PPE (Personal Protection Equipment), and leaving their loved ones at home. It
is causing great anxiety for them and for the public. People are forced into
isolation as we are encouraged to socially distance ourselves causing high
levels of fear, anger, stress, boredom and especially loneliness. It is really
scary when facing with fear of contagion and infecting loved ones as we are not
able to see the enemy.
Thus,
we seem to naturally channel our anger, frustration and confusion at certain
groups of people and individuals. There are so many cases of Chinese immigrants
living abroad suffering from verbal and worst of all, physical abuse. Chinese
who have been born in that country are also suffering from the same abuse.
Their neighbors are boycotting their businesses and children are verbally
abusing their children; stigmatizing and traumatizing them for many years to
come. Malaysians are less explicit about their opinions, but I’m sure the fear
is still there. Luckily, as Asians we are more understanding and respectful of
others.
Although
we might channel our anger and frustration at other people, we ultimately feel
that in some ways, we are being betrayed by nature. Most of us have come to
acknowledge that our own bodies will deteriorate and we will die one day, but
this thought can be put aside. However for a pandemic, it is different as we
know that we are not truly safe when we walk out of our houses. It is
invisible.
DMH
A pandemic is characterized as a natural disaster.
Natural disasters come with psychological effects on survivors. Disaster mental
health is a field in crisis intervention. It is a new and developing field and
with every new disaster, natural or man-made it becomes even more important
that it is refined, developed and advocated.
As a friend or loved one or even a fellow human being, we
are exposed to people around us who are feeling lost and worried during these
times. In some cases, the psychological response is too much for any of us to
handle. Wives, husbands and children could come back feeling devastated to
their families at the end of a 12 hour shift at the hospital. Friends and
family members are feeling helpless as they have been left jobless and unable
to pay their rent. We must in some way understand and within our own capacity
help to care for those around us who are unable to cope psychologically.
A major trend contributing to the development of DMH is
the link to the general concept of ‘trauma’. The impact of trauma on a disaster
survivor’s mental health has only been acknowledged by mental health
practitioners as a clinical diagnostic entity for the past 25 years since the
addition of posttraumatic stress disorder or PTSD to the DSM (Diagnostic and
Statistical Manual of Mental Disorders). Before that, no one thought that
external events such as disasters could produce lasting effects on a person’s mental health as
ideas on childhood maladaptive behavior or family dysfunction were more
dominant in the field of psychology.
Let’s
look into three topics under DMH. You can get more information online or on printed
material. I am not going to bore people with details but rather touch (very
lightly) on more relevant topics.
Risk
and Resilience
It is common sense
that as individuals, we respond or react to situations differently. We cannot
expect everyone exposed to the same trauma to respond the same way and we also
cannot expect everyone to be at risk of experiencing post-traumatic symptoms. Some
people cope better than others and some people are better at hiding their
trauma than others.
Risk
factors are variables which contribute to the likelihood that exposure to a
traumatic event will have an increase negative outcome to an individual. On the
other hand, resilience factors are variables that offer a greater ability to
cope for survivors. These factors are an individual’s characteristics and
demographics such as age, gender, socioeconomic status. Factors also include
the individuals experience with prior events, environment during recover and
features of the traumatic event itself.
Studies
have shown that middle-aged adults appear to be most negatively affected.
Norris et al. (2002) assume that it may be because that middle-aged adults
carry more burden in the family such as having to take care of children and
also their aging parents. People who have lower socioeconomic status (lower
education level, lower income, lower occupational status) are at risk of higher
stress after a traumatic event. Which makes perfect sense, because they are at
risk of losing more than those who have a more stable and higher socioeconomic
status.
As
we sit in our rooms, air-con on, dinner ready in the oven, we often fail to
think about those who do not have the luxury to enjoy these privileges. We
often fail to think about those who have more to lose. And it really is a
domino effect. Once someone loses their job during this pandemic, their
families have less to eat and struggle to perform the most everyday tasks.
The
current Malaysian government has allowed the people to withdraw from their EPF accounts,
allowed an automatic moratorium on repayment of loans, mortgages and hire
purchases and even started the Prihatin
Economic Stimulus Package by offering monetary support through Bantuan Prihatin
Nasional (BPN) to those who are struggling to survive now. If you look at the
long term, more businesses will be adversely affected and forced to close (as
you can see now for the travel industry), how are these unemployed individuals
who have families expected to survive solely on their EPF money and the BPN funds?
Some
Malaysians are doing ok and are mostly bored because they still have jobs to go
back to. However, some Malaysians are stuck in the domino effect and it’s
harder for them to get back on their feet after these 2 months of unemployment
and without cash flow. What about the trishaw uncle who is earning money just to feed himself and his adopted
stray cats because his son doesn’t talk to him anymore? What about the
middle-aged woman selling nasi lemak just
to get her son to college? They are in lack of resilience factors and are
extremely vulnerable mentally. However, it is good to know that there are hotlines
offering counseling and emotional support for Malaysians during this time. MKN is
doing its work.
The Vulnerable
Talking about
vulnerability, there are populations of people whose psychological needs are
more complex than the majority. Three types of individuals come to mind: children,
the elderly and the disabled.
The disabled (those are physically and mentally impaired;
which includes the elderly and children) are more vulnerable than healthy and
able individuals. Some disabled individuals would need a care-taker as they cannot
travel alone anywhere. They would feel even more isolated during times like
these if they have to do things alone. They would probably need medication and
of course, need someone to take the medication to them. The disabled are already
psychologically vulnerable from having an impairment, and being isolated would
not help them.
Children are also vulnerable as they are dependent on
their parents or care-takers to fulfill their basic needs. Their cognitive
immaturity is also a factor in their vulnerability. However, as a personal
observation, I feel that most Malaysian children are generally doing alright if
their parents are of a higher socioeconomic status. They are learning at home,
playing, exercising and helping their parents post on social media. Safe to
say, if the care-taker or parent(s) are doing alright (mentally and physically),
so are the children.
The elderly also have increased needs and physical
limitations as a result of aging. Although, you might think that with age comes
experience. It is true to a certain point if you consider that the elderly may
experience even more trauma in the past, that it might make them more mellow
and resilient now. But like children, the elderly individual can also be
dependent on others to fulfill their basic needs.
In the case of COVID-19, another type of population is
very vulnerable. Those who have underlying medical conditions. Based on known
available information, this population and the elderly seem to be at risk for
suffering severe illness from COVID-19. Those who have diabetes, asthma, heart
conditions and et cetera are vulnerable because they already have weakened
immune systems. These people would need extra care from their families and
loved ones to cope with the anxiety, stress and trauma.
Coping with Stress
The final topic aims to help in a small way for all
individuals to cope with this difficult time – to provide a simple set of skills
to be more resilient mentally.
Take
breaks
Find a quiet place after attending a zoom meeting or after
caring for a patient. Maybe in a hospital toilet or in the house bathroom. Have
a cup of Milo, eat a biscuit whatever helps to take your mind off certain
things.
Eat
and drink well
We all know a
healthy balanced diet can help your immune system and the ability to cope with
stressful situations. But not all of us do it regularly. I am guilty of that.
Since most of us are staying at home, be careful not to eat too much junk food.
Exercise
and sleep well
If you have a home
gym, lucky you. If you do not, doing some simple cardio with furniture can also
help to alleviate some of the stress. You can also just walk around the house.
Stick to your normal sleeping patterns or get better sleep, take short naps if
you have longer shift hours.
Try
to stay connected
It’s a no brainer,
but stay in touch with your loved ones through phone calls, video calls, texting,
or emails. Sometimes talking it out, helps you to cope with stress. Know that
you are not alone. Join Facebook groups, share experiences and tips with
others. And lastly;
Breathe
Like
I said at the top, take deep breaths. Count between breaths. Being aware of our
surroundings helps us get in control of our mind.
Final
Thoughts
The
start of 2020 has not been easy. We all had to adapt to a new way of doing
things and new difficulties. So much is being focused now in dealing with the
pandemic in the medical sense, and I feel that more focus should shift to
mental health in the aftermath. We are dealing with so much added stress
especially for those who are directly involved in the containment of the
pandemic. And for some, this pandemic has taken away the lives of loved ones
and friends forever. There were not able to even hold them in their last
moments as they were taken away by hospital staff in vans and buried without a
proper funeral. It will probably not be the same in the near future, but know
that the worst will pass. Stay updated and stay alert to those around you who
need help but are unable to show it. Be there with a simple call or message. Ultimately,
together (1 meter apart) we are in some ways resilient and we will get back on
our feet.
Reference
Halpern, J. (2006). Disaster Mental Health: Theory and Practice. Cengage Learning.
World Health Organization (WHO). Coronavirus (COVID-19). Retrieved May 1, 2020 from https://covid19.who.int/
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