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  • Psychiatrist Dr Swaminath G Writes On Psychological impact and tips to cope with social distancing, quarantine and isolation - Part 1

    Psychological impact and tips to cope with social distancing, quarantine and isolation

    As the Corono Virus is spreading India in a jet speed, Prime Minister Narendra Modi has locked down India for 21 days from March 25th to April 14th. People have to stay indoor all the time. How will be there mental stress when there isolated 24/7.

    Chitraloka requested Dr Swaminath G Consultant Psychiatrist, Former Prof and HOD, Dr. B R Ambedkar Medical College, Bengaluru to write an article.

    Here is a small bio on Dr Swaminath

    Dr Swaminath is an Diploma in Psychological Medicine (DPM), NIMHANS, 1984, M. D. (Psy), NIMHANS  1986. He has actively participated in Indian Psychiatric Society – state, zone and centre.

    Dr Swaminath is also a Past Editor, Secretary and President of Indian Psychiatric Society, Karnataka Chapter , Past Editor and Past Assistant Editor, Indian Journal of Psychiatry (IJP),  Past President , Indian Psychiatric Society, South Zone.

    Dr Swaminath has been awarded with Eminent Psychiatrist Award 2017-18 and the Dr. L G P Achar Memorial Oration award 2012 2013 both given by Indian Psychiatric Society – Karnataka Chapter Cadabams Distinguished Psychiatrist Award 2013.

    Dr Swaminath has Completed Yoga instructor course under SVYASA University  - 2019 and he is a Visiting psychiatrist to Vivekananda Memorial Hospital (a Tribal Hospital) &  conducts a free mental health camp on second Sunday under the aegis of SVYM , HD Kote  for 24 years. He is also Past Chairman of Chittaprakasha Charitable Trust, which runs Chittadhama, a residential rehabilitation centre for homeless persons with mental illness at H D Kote.  He is also a Chairman, Chittasanjeevini Charitable Trust, which provides free medicines to NGOs running free mental health camps in rural and tribal areas.

    Dr Swaminath is also a Trustee of Balasakha Charitable Trust, assisting education in Government schools and an avid trekker, having trekked most of the Western Ghats and the Himalayas thrice and completed the Kailas Manasasarovar Yatra from Indian side.

    What he suggest on People have to stay indoor all the time. Watch out for the article

  • Psychiatrist Dr Swaminath G Writes On Psychological impact and tips to cope with social distancing, quarantine and isolation - Part 3

    payhological impact of social distancing, quarantine and isolation

    Once the period of isolation is over too, those quarantined tend to avoid people who cough or sneeze, stay away from crowded enclosed places, and shun all public spaces in the weeks following the quarantine period. Several participants have long-term behavioral changes after the quarantine period, such as vigilant hand washing and avoidance of crowds for few months.

    Regretfully many are stigmatized and find that others were treating them differently: avoiding them, withdrawing social invitations, treating them with fear and suspicion, and making critical comments. Even doctors who were treating patients with COVID 19 were subjected to this recently. Financial implications of the isolation, especially if not compensated for the period of absence, or job loss is another major consequence. This is one reason for denial of illness or contact with ill persons and avoiding isolation.

    Social distancing on the other hand keeps one within the family and in one’s home but not in public places. There is contact within the family, unless one lives alone. But they are expected to maintain social distance within the family too, which might be impractical if their residence is too crowded. They too suffer in a similar manner but less in numbers and severity.

    Two groups among family members require mention as they suffer the social isolation more than others, the elderly as well as children. Since these groups are more vulnerable to be ill with severe disease if contacted with the virus, social distancing is especially suggested with them. However, the elderly when isolated are more likely to feel being ostracized, abandoned and neglected. If elderly also have illness of old age such as dementia, they become more anxious, angry, stressed, agitated and withdrawn.

    Children may seek more attachment and be more demanding on parents in such a situation. Children should be educated with an honest and age appropriate information. They should be helped to express their disturbing feelings such as fear and sadness, in their own unique way. Creative activity such as playing or drawing assists in such expression of disturbed feelings.

    The stressors which give rise to the distress include:

    Duration of quarantine – especially if it keeps extending

    Fears of infection – can come from anywhere

    Frustration and boredom – as it is imposed rather than sought

    Inadequate supplies of items of daily living – leading to hoarding

    Inadequate and improper information – more myths than facts

    Coping with social distancing requires a multi pronged approach with inputs both from authorities as

    well as the individual. They include:

    1. Restricting the length of quarantine - to what is scientifically reasonable given the known duration of incubation periods, and not adopting an overly precautionary approach, which would minimize the effect on people.

    2. Giving people as much information as possible – in this information age, more myths and falsehoods reach people than scientific facts. Ensuring that all have a good understanding of the disease, and the reasons for social distancing, should be a priority. People too should access trusted sites such as those of WHO, from the websites of government or reputed scientific / health institutions. People need to avoid seeking information sent out by social media sites as they tend to exaggerate or underplay the issue. Knowing that our country and the world has gone through many such pandemics and have come out of it, instills a sense of hope.

    3. Provision of adequate supplies – to ensure that people can maintain a basic standard of life and ensure that there is no shortage of resources

    4. Reduction of frustration, boredom and improvement of communication - is something which individuals should strive to achieve. Provision of methods of communication with robust wifi networks and internet access to allow them to communicate directly with loved ones could reduce feelings of isolation and stress. Continuing a routine, which to a great extent coincides with one earlier followed, with fixed times for awakening, sleeping, getting ready, meals and exercise helps providing a sense of time, which is lost in such times. Luxuries such as afternoon naps which one could not do otherwise could fill in the gap.

    One should use this opportunity to start and finish what one could not do when busy earlier, such as reading, writing, taking up an old hobby, finishing assignments, gardening, cooking, cleaning the house, exercise and yoga, including meditation, spending time with family, networking with friends and relatives, and skill building. This is a god given opportunity to slow down, relax, and rejuvenate getting ready to action once the crisis ends.

    5. Altruism – This social distancing is voluntary to a large extent, rather than mandatory. Only unnecessary movement has been restricted. Feeling that others will benefit from the attempt to maintain social distance makes stressful situations easier to bear, especially in home-based quarantine. Reinforcing that quarantine is helping to keep others safe, including those vulnerable, such as those who are very young, old, or with pre-existing serious medical conditions, and that authorities are genuinely grateful to them, can only help to reduce the mental health effect and adherence.

    Depriving people of their liberty for the wider public good is often contentious and needs to be handled carefully. If quarantine is essential, officials should take every measure to ensure that this experience is as tolerable as possible for people. This can be achieved by: telling people what is happening and why, explaining how long it will continue, providing meaningful activities for them to do while in quarantine, providing clear communication, ensuring basic supplies (such as food, water, and medical supplies) are available, and reinforcing the sense of altruism that one should rightly be feeling. It’s up to the citizenry to make good of an unavoidable situation and spend this three week free time purposefully and with enjoyment.

    Also Read :-

    Psychiatrist Dr Swaminath G Writes On Psychological impact and tips to cope with social distancing, quarantine and isolation - Part 1

    Psychological impact and tips to cope with social distancing, quarantine and isolation - Part 2

  • Psychological impact and tips to cope with social distancing, quarantine and isolation - Part 2

    Psychological impact and tips to cope with social distancing, quarantine and isolation

    The novel Corona virus pandemic as declared by the World Health Organisation (WHO) has brought to the forefront a number of challenges in all aspects of life for the entire human race. Many of these challenges include identification of persons with the disease as well as managing it and its complications. Equally important is the prevention of the spread of this highly virulent disease to others in the community.

    The pathway of spread is from case (index individual who is suffering from the illness and spreading it to others) to a cluster (group of individuals contracting the disease by spread) to the community (which could be a locality, city, state) to the whole country. The present opinion of specialists in the field indicate that the disease is now in stage of cluster, while some specialists opine the spread is now at the community level. One public health strategy to prevent the spread of the disease is by consciously reducing the contact between people to limit the spread of the virus and consequently infectious diseases including COVID – 19 (Corona Virus Disease – 19).

    Quarantine, Isolation and Social distancing are such methods. Quarantine is the separation and restriction of movement of people who have been potentially exposed to a contagious disease to ascertain if they become unwell, so reducing the risk of them infecting others. Isolation is the separation of people who have been diagnosed with a contagious disease from people who are not sick. However, when one does not know who in their vicinity or community is ill and spreading the illness, or who has been potentially exposed, keeping a safe distance from others is a safe strategy to be followed by healthy individuals. Therefore, social distancing should be observed by all, to reduce the spread of the disease.

    People should remain home and should avoid public places as the infection spreads from one person to another. One should maintain distance to stay at least one meter away from other people when outdoors. This is what has been operational in our country and to be implemented for the next 3 weeks. While this is a safe preventive strategy to avoid getting the disease, the procedure is not without any adverse consequences. Predominant among these are psychological consequences as this strategy goes against the core trait of humans, namely socialization.

    Both isolation and quarantine involve total isolation from other individuals of the family, either in a room within the house, or in facilities meant for such persons. Due to near total seclusion and loneliness there is increase in both the occurrence as well as the severity of the psychological symptoms. More than half of persons in isolation or quarantine report low mood and irritability. Less frequently, about a fifth of persons describe fear, nervousness, sadness, and sometimes guilt. Some suffer from confusion, anger, numbness and sleeplessness.

    Post-traumatic stress disorder (PTSD), a mental illness triggered by a undergoing this severe stressful experience may also be a consequence, with symptoms like flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the experience. Surprisingly some experience positive feelings such as happiness, hope and feelings of relief. These were seen even in those who survived the 9/11 attack in the US, and speaks about humans being able to be optimistic and positive, perceiving encouraging outcomes.. To Be Continued...

    Also Read -

    Psychiatrist Dr Swaminath G Writes On Psychological impact and tips to cope with social distancing, quarantine and isolation - Part 1