When news of the coronavirus broke out at the end of last year, and as the stories of the outbreak became more alarming over time, most people were anxious on the possibilities of the pandemic reaching this country. The coronavirus (COVID-19) pandemic is becoming a brutal psychological test. This is a dreadful moment with a potentially deadly pathogen on the loose. This public health crisis can take a mental toll on people, especially those struggling with common mental health disorders (CMHD) such as anxiety, depression and other conditions.
The public media news coverage has focused foremost on the confirmed cases of the disease in other countries, the virus causes, the case fatality rates, the contagiousness of the virus, the missteps in rolling out testing in Zimbabwe, and so on. The social media has at the same time gone on an overdrive producing mainly “fake news” on the presence of the disease in the country to the extent of producing evidence of the so-called “confirmed” cases. What is harder to measure is the psychological contamination, the sheer stress and worry and outright fear and how this can pass from person to person as quickly as the virus itself.
Zimbabwe has so far recorded eight confirmed cases and one death (at the time of writing), but already several people are suffering from grief, although this might not be immediately obvious. Grief comes in different forms, people are feeling grief over the loss of routines, certainty, and a perception of themselves as being generally healthy and protected.
Mental health experts say there are steps people can take to ease that anxiety and give a person a better sense of being in control of this chaotic situation. Some of the advice comes from research on natural disasters, mass shootings, terrorist attacks and other traumas. One clinical psychologist, Julia Mutambara from the Midlands State University says “What we are seeing is an extreme response. It’s because people feel like their survival is threatened and they need to do something to feel like they are in control.” But the question is; what exactly causes us to panic and how can we keep our cool in a high-stress time like a pandemic? It depends on how different areas of the brain play along with each other.
The evolution of fear and panic
Human survival has depended on both fear and anxiety, requiring us to react immediately when we encounter a threat as well as being able to consider perceived threats. Panic starts when a negotiation of sorts in the brain goes twisted. The amygdala is the emotional centre of the brain, which wants us to get out of harm’s way immediately and it does not care how. The frontal cortex, which handles your behavioural responses, insists that we think the threat situation through first, consider when we might run into such a threat again, and what to do about it.
Sometimes anxiety can get in the way, rather than talking directly to the parts of our brains that are good at planning and making decisions, the frontal cortex gets confused by all the cross-talk between other parts of the brain that are determined to play out all the possible scenarios of how we might become victims of the threat. Faced with such, everyone develops a plan for how to deal with this moment. Having a strategy for day-to-day living is not just a matter of protecting oneself from the coronavirus and limiting its spread in the community, it is a form of mental therapy.
A pandemic plan could involve ensuring that social distancing does not result in extreme loneliness and a feeling of isolation. What we need to remember is that what is most disturbing about what we are going through is the uncertainty. When we know what is happening, when we know what to expect, we feel safe even if what we expect might be threatening.
Pandemics by their nature create a kind of “forced depression” because they disrupt plans for the future that normally give people hope. No one knows how things will be in the future. We don’t get to do that planning and daydreaming in our heads right now.
Depression is feeling hopeless about the future, and right now, that’s how a lot of people feel, rightfully so. If you have underlying depression, that might be exacerbated at this point.
Everyone should be aware that a crisis like this can result in what are known as distress reactions. Distress reactions include sleeping problems, feeling hopeless and helpless, failure to do activities that you once did, hypervigilance about body aches and pains, loss of appetite, difficulty in concentration, a feeling of being unsafe, anger, blaming others and a desire to socially isolate. This can lead to risky behaviours such as excessive use of alcohol or tobacco. Interpersonal violence can flare. One common response to disasters is work-life imbalance — working long hours and letting other important duties and needs in one’s life slide.
On a positive note, a crisis can also bring out the best in people. People in Zimbabwe have a history of collective action and resilience in hard times. The COVID-19 pandemic, however, is unfamiliar to most people, and social distancing runs counter to human nature. But that does not mean that we don’t have to take this pandemic seriously. There is one thought that is comforting: everyone is affected by this. This is a time for communities to find common purpose, even if people are forced to stay apart. Understanding and reminding ourselves that we are all going through something together, sometimes that can help us feel less alone. It’s too early to know how long this crisis will last or what its ultimate toll will be. Experts have suggested it might be comparable to the 1957 influenza pandemic, though it is not out of the question that it could be as severe as the Spanish Flu.
The virus remains mysterious, its favoured modes of transmission are still under investigation. What we know is that COVID-19 can be a mild illness, or a severe one, or even a fatal one. The virus usually spreads from direct person-to-person contact, but it can also remain viable for many hours on surfaces. Thus, people must struggle with basic decisions about how to go about their lives. Is it safe to go so often to buy groceries? Hit the gym? Visit neighbours (staying a few feet apart, of course)? Attend school, wedding or funeral? A lot of people are already freaked out, anxious and fearful. As in all things, it comes down to the balance between having a reasonable concern, especially if it is motivating to take actions that can reduce risk, versus having this take over your entire world to the point where you become paralysed.
Figuring out what is a reasonable concern is not easy for anyone in a public health crisis like this which is so full of unknowns. Chido Dziva Chikwari an Epidemiologist with the Biomedical Research and Training Institute said she avoids using the word “anxiety” or “panic” when discussing how people react to a crisis like this because it implies the reaction is excessive or inappropriate. And she cautions that a person in distress does not need to be told to be rational and logical: Logic is often an ineffective antidote to emotion.
We are overwhelmed with information and messaging during this pandemic, but why are some people hoarding toilet paper and hand sanitizer while others are dismissing the risks and packing into bars? Humans are notoriously bad at assessing risk in the face of uncertainty and we are often bad at it in different ways that cause us to overestimate or underestimate our personal risks. Experts researchers on how anxiety affects decision-making, says that is particularly true now during the coronavirus pandemic. Inconsistent messaging from governments, the media, and public health authorities such as all the varied recommendations on social distancing, fuels anxiety.
Some amount of anxiety can be good in the face of disaster. Fear can be a motivator, raising our alertness and energy levels. It reminds us to wash our hands, pay attention to the news and, yes, even stock up on essentials. A public health preparedness expert points out that a little more panic could be particularly helpful in a country whose population is not so good at following public health interventions such as isolation and quarantine. In that sense, maybe, a little more panic might be productive in terms of understanding that our behaviour does impact others. On the other hand, anxiety is a terrible thing to suffer from over the long term. For one thing, as we become more anxious, it is also harder for our brains to keep from spiralling into panic mode. Studies have indicated that chronic stress can shrink the parts of our brains that help us reason, which can further fuel panic.
Here some tips that can be helpful to reduce anxiety and enhancing coping with a pandemic;
Avoid (health-related) news
We all want to keep up to date, but when you have health anxiety the need to check and read the latest updates can become compulsive, feeding the anxiety. Try having a news detox or allocating yourself a time limit for reading or watching news. If you are really worried about missing something crucial, you can always tell friends and family to contact you in the event of an emergency in order to keep you informed.
Try not to seek constant reassurance
Seeking reassurance can make you feel calmer for a little while, but in my experience, it is always temporary. Your brain creates a feedback cycle where you become increasingly reliant on reassurance, which only serves to reinforce the anxiety. It is natural to want your loved ones to tell you things will be OK, but when you start needing that reassurance several times a day it is time to take a step back.
Introduce an absolute ban on Googling symptoms
Dr Google is not, and never will be, your friend, especially not when you are a sufferer of health anxiety. Nor will social media and forums. Try to remember that people visit these places when they have reason to be concerned. Once you start understanding it’s a skewed lens, you will be better able to put things in perspective.
Try a countering technique
This is a cognitive behavioural therapy (CBT) exercise which involves giving a persistent thought the courtroom treatment, by confronting it with a rational counterstatement. For example, if your persistent thought is something like “Everyone I love will die from this virus” you can counter it with factual statements such as “Actually, most people who get Covid-19 are likely to make a full recovery, and that’s assuming mum, dad and my little sister will even catch it at all.” Just because you think something, does not make it true.
Do some exercise
Even if it’s just star jumps in your bedroom or shaking your body parts like you are in the warm-up section of an acting class, exercise will help get the adrenaline out of your system and channel the panic elsewhere.
Allocate yourself a daily ‘worry period’
Give yourself half an hour to worry about this to your heart’s content, and then you have to go and do something else.
Anything that will give you a little boost can help. It does not need to involve spending money: you can also cook yourself something nice or listen to a song you love.
Kudakwashe Muchena is a lecturer in psychology at the University of Zimbabwe. He writes here in his personal capacity.