Mental health and coronavirus: Negotiating isolation and fear
 
 
An older man, wearing a protective mask amid concerns over the coronavirus disease (COVID-19), walks on the Qasr el-Nil Bridge across the Nile river in Egyptian capital Cairo, Egypt March 31, 2020. REUTERS/Amr Abdallah Dalsh
 

“The second wave of coronavirus casualties will be primarily psychological,” psychiatrist Mostafa Hussein speculated in a recent interview. The epidemic has brought with it social distancing and a rush of emotions ranging from fear of illness to loss of human contact, to exhaustion from the never-ending tide of alarming news.

For many of us, the world has shrunk to the size of our living space. The sudden suspension of life as we know it has generated heightened anxiety. Routine breeds comfort and losing it makes falling into depression easy. Turmoil in the world is mirrored by turmoil in our minds, and amid the confusion we try to negotiate isolation, fear and inertia, and discover how to live with the disruption.

These feelings — new and temporary for most people experiencing them now — were already a reality felt by people suffering from mental illness and personality disorders, without the global disruption that has increased acceptance of the need to slow down.

Three individuals struggling with mental health illnesses talk about their daily lives in the shadow of the coronavirus, how their disorders intersect with the global disorder around them, and about their tactics for survival.

***

Ali,* 33, starts his day the way he usually does. He eats breakfast, drinks coffee and smokes a cigarette or two on the balcony before going out to the sunlit street. He stands there, simply enjoying the sun and being in an open space, before returning to his room. He might play a video game on his phone for a while before doing a little work. He has lunch and then leaves his room at the end of the day to jog in the surrounding streets. He returns before the curfew for a long phone conversation with his girlfriend, who lives in another country. He works a little before going to sleep.

That’s one of Ali’s good days, but there are other, worse ones, when he confines himself to the space between his bed and the balcony. He is less active, only smoking, drinking coffee, and trying to sleep, with no ability or desire to speak with anyone or move beyond those few meters.

Waves of anxiety build up to “bad days” before they recede slightly to allow the return of good or normal days, then the cycle starts all over again.

Getting to this point has required massive effort from Ali since the pandemic began. 

“Over the course of my medical history, these have been the worst moments by far,” Ali said in describing the past few weeks. By medical history he means the 10-plus years since he was diagnosed with hypochondria accompanied by depression and anxiety disorder. A hypochondriac imagines medical symptoms and often feels they are real, generating a constant fear of dying.

In the early days of COVID-19, a state of fear and anxiety swallowed up all of Ali’s other fears.

“With the realization that the whole world was experiencing the same crisis and that there’s no escape coming soon, the fear of the coronavirus began to intersect with all the other fears,” Ali says. 

The specific fear of COVID-19 combined with hypochondria manifested in various ways. For example, thoughts about a possible heart attack — a long-standing obsession of Ali’s — would be pushed a step further, as Ali considered that he could not go to the hospital in fear of contracting the coronavirus, meaning he would die at home alone.

Or he would think of how constant depression and anxiety were affecting his immune system, making him more vulnerable to the virus. This would only fuel his anxiety, further weakening the immune system and increasing the chances of infection, and so on.

His work as a journalist has a direct effect on his ability to cope.  “My work requires me to follow social media all the time,” he says. “And this when everyone is acting like a representative of the World Health Organization, everyone is publishing news about growing rates of infection everywhere in the world, about new symptoms, about how the illness affects smokers. After all that, I started to experience symptoms myself, a cough or difficulty breathing.”

Ali says he is no longer capable of meeting friends because of social distancing, and his therapy sessions have stopped because psychiatric clinics are closed due to the epidemic. He does not feel comfortable in online therapy sessions because, he explains, they do not provide the same degree of connection with the therapist. And he does not feel safe using apps like Zoom to speak about the most intimate details of his personal life — the result of all this being that he has little space to deal with these feelings or get support. 

Ali’s isolated life now may not be much different from the last two years, he says, but the difference is choice or lack thereof. “When it’s imposed on you by the logic of fear, it’s different,” he says. “It’s not a fear that someone will stop you and punish you if you leave the house. No, it’s a fear of getting sick and dying.”

Ali says the coronavirus is making us live as if under a totalitarian regime: “You don’t see friends or family, and if you do, you don’t greet or hug them. If you sit together, you sit apart. You only leave the house for necessities, and if you go out, there are certain conditions, like wearing a mask. You try not to touch anything and you’re always thinking about the distance between you and other pedestrians. Then you come home before 8 pm because of the curfew.”

The life produced by the virus is “devoid of any entertainment or social life. In short, the virus makes us machines, like the Communist Party of Mao Zedong. And it’s not because someone is forcing this life on you, it’s a result of self-monitoring, which is harder.” 

***

“Waiting for disaster to strike is the hardest thing for a person with a borderline personality. I’ve always had the sense that I’m waiting for death, that we’re at the end of the world and will see tragic events.” Shaima,* 30, began to feel the world was ending in mid-March, when the Egyptian government suspended schools, shut down commercial air traffic and closed most government offices.

She had already taken several measures, even before the government’s action, to protect her three daughters. She had decided to keep them at home, and she gave the nanny a vacation for the duration of the crisis.

“Usually I can’t cope without the girls’ nanny,” Shaima says. “I might go 10 days straight and be unable to do anything because of severe mood swings, and the nanny is essential for their care. But in the end I was forced to do without her services at this time because I don’t want her to go out every day, take public transit, and be with the girls.”

Although the government measures initially brought her a measure of calm — she had felt her fear in the preceding weeks was justified — seeing pharmacies that were out of personal protective equipment and the crowds in supermarkets stocking up on household goods sent her into a panic again.

As Shaima scoured pharmacies for alcohol-based sanitizer, she was plagued by the fear that food would disappear from the markets. This was on top of her earlier fears that a member of the family might contract the virus, or that they would not have enough money to cope with a long period of unemployment, or that the epidemic would worsen and lead to economic collapse.

“That’s where too much thinking would lead,” she says. “At the time I had a lot of suicidal thoughts.”

Shaima says that suicidal ideation in these circumstances becomes more frequent while waiting for a disaster that never comes, but her long-time, ongoing therapy sessions helped her to get past this stage and control her thoughts. People with borderline personality disorder experience intense mood swings, with rapid ups and downs. In a general climate of panic, it requires redoubled effort to control mood shifts.

In the past weeks, Shaima has sought to keep herself and her daughters occupied at all times, to avoid leaving any space open for anxiety, thoughts about the future, or boredom. In addition to household chores, which she usually asks the girls to help with, she is trying to find new pastimes in the evening, like painting empty bottles, making a puppet theater from cardboard boxes, and other kinds of crafts.

Shaima’s constant efforts to create a daily routine for the girls and keep them engaged has limited the time she spends alone, particularly since she does not have help from other family members.

“Normally, the girls would sleep at 8 pm and wake up at 6 am, so I had from 8 pm to midnight to myself. Now that time has disappeared completely because the girls’ daily routine is gone as well.” She is trying to bring a routine back to her and her family’s life, but is meeting resistance from the kids, which only exacerbates the day’s disruption and the sense of exhaustion and tension.

Shaima’s anxiety is compounded because of the difficulty of accessing psychological support these days. With psychiatric clinics shut down, she only has access to online therapy sessions. These are subject to the vagaries of home internet speed, which has become slower with the additional pressure from the high volume of  users isolated at home. At times she is forced to complete the session over the phone, without the ability to see her doctor, which reduces her sense of connection.

In addition to one-on-one therapy sessions, Shaima participates in regular group therapy meetings. Before the epidemic, Shaima enjoyed these meetings, spending about two and a half hours with peers who, with time, had become friends. But the shift to remote meetings has brought new problems. Some participants do not have the luxury of privacy in their homes, and most individuals in the group are feeling heightened anxiety and tension, making it difficult and exhausting to control the meeting.

Amid all this upheaval, and despite the difficulties, Shaima attempts to derive a feeling of self-worth and self-esteem from her attempts at self-care — a feeling unrelated to what she achieves. She decided to temporarily postpone work-related projects, having grown angry at all the appeals on social media to use the time in home quarantine “productively.”

“This is a time of survival,” she said, and no more.

She compares this to her feelings prior to the epidemic: “The world always makes me feel that I need to work harder to prove I’m smart. You’ve always got to run, because the world itself is running, and you can’t just stop. If at any time I was sick, that was my own personal problem, not anyone else’s.” She adds, “But now the whole world has stopped and it turns out you can actually just stop, no big deal.” 

***

Isolation, loneliness, disruption, loss of human contact with others — these are the features of the life forced on many people by the coronavirus pandemic. For many, this is an exceptional situation, but not for Ellen.

Ellen, a 40 year old who works in education, wrote the following in a social media post a few days before she spoke with Mada Masr: “Those of us who have mental illness do not need the apocalypse to have our lives disrupted over and over again, especially in a neuronormative world that constantly shames us and pushes us out because we cannot perform productivity in the way it wants us to. Those of us who aren’t heteronormative struggle daily to connect with each other because again we live in a world and among people that are trying to keep us apart, as aggressively and persistently as a pandemic. We live in a world that wants to flatten us out of their curve in all its practices.” 

This does not mean Ellen’s life in the time of pandemic is similar to how it was in the past. It is more difficult for two reasons: first, she is bipolar and second, she is queer.

“Normally I make efforts to be accepted in the world,” she says. “I have to monitor my mood shifts every day, my hours of sleep, the pace of my thoughts. I must make sure to exercise. I need to regularly take my meds and make sure I don’t have symptoms of psychosis. It’s like I’m living in boot camp. This is my normal life.”

This is what she needs to do in ordinary times to meet the world’s demands that she remain productive, coherent, and stable, with as little disruption as possible. To all this, the pandemic adds another layer of “collective anxiety and panic,” she says. 

“I’m not dealing with this situation on my own, and I’m also dealing with a human geography of circles of people who are suffering in one way or another,” she says. “Imagine the magnitude of effort we need to exert to make sure that the people close to us — both those in mental illness circles and queer circles — are okay, are not losing it, and are finding adequate support.”

What makes Ellen most angry is that the world is only now realizing that “it is okay to be afraid of isolation, okay to be frustrated or depressed, okay not to be productive.” She doesn’t think it’s fair that the world is celebrating this new awareness and ignoring the fact that the fears of non-productivity, isolation, or loss of connection are felt daily by those suffering from mental illness, in a world that often does not meet their own needs. 

“No one has ever told me that it’s normal not to be productive,” she says. “Nobody told me it’s okay to be depressed and sick of isolation … It’s like we needed a global pandemic for people to understand this after just two months of isolation, while I’ve lived my whole life trying to provide it for myself.”

She doesn’t believe the world will learn from this experience how to change its laws and modes of operation to be more inclusive of different kinds of people, or become more open to diversity. It will be more like a temporary state, after which the world will quickly go back to the status quo. Ultimately, Ellen believes, “No one is saying, Now that I’ve felt this sense of isolation, I’m more sympathetic to people who were already isolated, or now that I’ve felt this fear of exclusion, I empathize with people who feel ostracized. The discourse continues to revolve around the experiences of heterosexual, neurotypical people. It’s like we have no place in the world and will continue to have no place.”

“Part of me doesn’t want the pandemic to end and life to go back to normal. I have a chance now to say ‘I’m not the only one whose rhythm is out of sync with the world — yours is too.’ So I’ll use this chance to claim what I can, to make up for all that time prior to the epidemic. I’ll take care of myself, put less pressure on my spirit, and permit myself to be less productive, just like all of you.”

*Names and some personal details have been changed to protect the sources’ privacy.

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