Читать книгу Coping with Coronavirus: How to Stay Calm and Protect your Mental Health - Dr Brendan Kelly - Страница 9

Introduction

Coronavirus presents the world with two problems. The first problem is the illness caused by the new coronavirus itself, COVID-19. The second problem is the anxiety and panic that the virus triggers in the minds of virtually everyone who hears about it.

Both problems are very real and both can be solved.

The solution to the first problem – the illness itself – lies in the hands of health authorities and the governments that fund them at global, national and local levels. All around the world, medical staff are using established methods of infection control and treatments that were developed during previous outbreaks and are being adapted to this new challenge. These efforts involve a mixture of past experience and new learning as the novel coronavirus slowly but inevitably reveals its secrets. Ultimately, coronavirus will be controlled.

This book concerns the second problem, which is far more widespread than the virus itself and which will likely persist long after this particular virus has passed. This problem is anxiety and panic. Right across the globe, people are worried, often deeply so. Some are panicked. Others are paralysed by fear.

There are many questions. Will I catch coronavirus? Will a family member die from the infection? How obsessional should I be about washing my hands? How can I be extra-cautious? Should I wear a face mask? What about my children? How will this affect me financially? Even if this threat passes, will this happen again? Will there be a new coronavirus this year? What about next year?

The anxiety triggered by the new coronavirus can take many forms. Some people are just generally worried about catching the virus and its impact on their family life, their country’s economy and the world in general. Others experience full-blown panic attacks, overwhelmed by a sudden sense of impending doom that now has a name: coronavirus. And, perhaps most commonly, a great number of people have developed a persistent sense of unease, a brooding hopelessness or – at worst – a feeling of helplessness and nihilism: If we cannot control this virus, then what else can we not control? Is our entire way of life changing forever? Will anything ever be the same?

All of these responses are understandable, but many are either unhelpful or misguided, or both. As a psychiatrist, I am accustomed to treating people with all kinds of anxiety: panic disorder, phobias, social anxiety, generalised anxiety, post-traumatic stress disorder and many other conditions. Anxiety has myriad forms and shows itself in many different ways. It can involve anxious thoughts (worries, obsessions, ruminations), emotional problems (tension, depressed mood) and physical symptoms (perspiration, heart racing, hands trembling, poor sleep). Each person tends to have their own combination of these symptoms, which can change over time.

You might think that addressing the anxiety provoked by coronavirus would be similar to treating established anxiety disorders and, in some ways, it is. The feelings of anxiety are similar in many of these conditions, even if the triggers and patterns are different. And the broad approach to care is similar in many respects for most disorders that are associated with anxiety.

But, in certain other ways, the anxiety associated with coronavirus is quite different to the anxiety seen in traditional anxiety disorders. Take the example of a person with agoraphobia, a well-recognised anxiety disorder in which the person experiences severe anxiety in an environment that they perceive to be unsafe with no easy way to escape. This condition manifests quite commonly as a paralysing fear of crowded places, so that a person might experience overwhelming anxiety in a supermarket and feel they have to leave. As part of treatment, a psychotherapist can, over the course of months, guide the person to go progressively nearer to a supermarket, then to enter one, and then to remain there for five minutes, ten minutes and eventually longer. Slowly the person will become accustomed to being in the supermarket and realise that there was nothing to fear apart from the anxiety itself.

This approach works well with many anxiety disorders, such as agoraphobia, social phobia and various others. But the key to treating these conditions is that, in all of these disorders, treatment helps the person to see that their anxiety has no basis. There is nothing to fear.

The problem with the anxiety associated with coronavirus is that there is indeed something to fear: the virus. There is nothing good about coronavirus. While the illness is generally mild, with over 97 per cent of people who are diagnosed surviving the infection, that is no consolation if you are one of the few who develops a severe illness or if you fear for a relative who is vulnerable, elderly or ill. Clearly, there is plenty to fear with coronavirus.

And that is what makes the anxiety associated with coronavirus so ubiquitous, so persistent and – to an extent – so challenging to manage. This obstacle is not, however, insurmountable once we bear in mind that traditional techniques for managing anxiety simply need to be adapted to the new situation. Our task today is not to teach ourselves that there is nothing to fear – clearly, there is – but rather to teach ourselves how to keep our anxiety proportionate to the risk, how to live with a certain amount of worry, and how to navigate the uncertainty that coronavirus has brought to our broader lives.

Some people might respond to this situation with denial and apparent indifference. They might ignore public health warnings. This, too, is psychologically understandable, but it is very unhelpful and clearly dangerous. A realistic appraisal of the risks we face and proportionate, considerate and responsible behaviour are what we need – not denial, not complacency, not panic.

The good news is that, just as we are capable of finding sophisticated ways to make ourselves more anxious, we are equally good at finding sophisticated ways to manage our anxieties, once we put our minds to it. Established anxiety-management techniques help greatly once they are modified to suit the new situation that we face.

That is what this book is about.

HOW DID WE GET HERE?

Wuhan is a city of 11 million people in Hubei province in China. It is a city of some significance. On two occasions, in 1927 and 1937, Wuhan served briefly as the capital of China, and it is near to the famous Three Gorges Dam, a power plant and popular tourist attraction. The city is an established centre for finance, education, culture and transport, leading some to call it ‘the Chicago of China’. It is now infamous as the centre of the current outbreak of coronavirus.

In late December 2019, a patient in Wuhan Jinyintan Hospital was diagnosed with pneumonia, a severe infection of the lungs. Pneumonia is a very common condition, but this case was different. In this patient, the illness seemed to be caused by a novel virus, i.e. a certain type of transmissible infective agent that was new to humans. Following rapid genetic testing, the new virus was found to most closely resemble a particular virus that was previously found in bats. The virus was characterised as a new ‘coronavirus’ and named ‘COVID-19’.

The novel virus spread rapidly in China. By 20 February 2020, there were over 75,000 cases reported in the country. The age of those infected was usually around 51 years but ranged from just two days to 100 years old. Over three-quarters of cases were aged between 30 and 69 years. Just over half were male.

Over the following months, the new coronavirus spread around the world, well beyond the Chinese border. There was a particular cluster of cases in northern Italy, from which the virus spread rapidly onwards again. By early March 2020, most of the world was experiencing blanket media coverage about coronavirus, how it spreads and – to a lesser extent – what can be done to prevent transmission. By the middle of March, over 170,000 people were infected across 158 countries. More than 6,600 had died. The World Health Organization (WHO) declared a pandemic.

Throughout this period, WHO’s official website (www.who.int) has consistently provided comprehensive, accurate and up-to-date information about the outbreak. It is now clear that the disease spreads from person to person through small droplets that come from the nose or mouth when someone with coronavirus coughs or breathes out. The droplets land on surfaces and objects around the person. Transmission occurs when other people touch those surfaces and objects, and then touch their own eyes, nose or mouth. People can also breathe in the droplets, so the WHO advises staying more than 1 metre (3 feet) away from anyone who is coughing or sneezing.

The symptoms of the condition are quite non-specific: fever (high temperature), tiredness and dry cough. There may also be aches and pains, nasal congestion, a runny nose, sore throat or diarrhoea. These symptoms are usually unpleasant but mild, in that they resolve on their own. Approximately 80 per cent of people get better without needing special treatment, but approximately one person in every six will become seriously ill, often with difficulty breathing. This progression is more common among older people and those with pre-existing medical problems such as hypertension (high blood pressure), heart problems or diabetes. People with relevant symptoms should seek medical attention at once, in line with local or national guidelines (see the section on ‘What to do if you think you have coronavirus’ at the start of this book).

Antibiotics are ineffective against viruses, so treatment of coronavirus is supportive. This means that the symptoms of the virus can be treated and interventions such as oxygen therapy can be used while the person’s own body fights the virus. In extreme cases, life support is needed – generally in the intensive care unit of a hospital.

The mortality rate with coronavirus is under 3 per cent of those diagnosed and might be under 1 per cent (as not all those with the infection are diagnosed). In other words, over 97 per cent of people diagnosed with coronavirus will survive it and around 80 per cent will have a mild illness (which probably will not require hospitalisation). For comparison, there was an outbreak of severe acute respiratory syndrome (SARS), a somewhat similar virus, between 2002 and 2003, and that had a mortality rate of 10 per cent but spread less widely. Clearly, however, the current coronavirus pandemic is a public health emergency of the highest order and we must all help to bring it to an end.

Prevention is key. Ireland’s Health Service Executive (HSE) recommends a series of simple but highly effective measures to protect yourself and others from transmission of the virus: washing your hands properly and often; covering your mouth and nose with a tissue or your sleeve when you cough and sneeze; putting used tissues into a bin and washing your hands; cleaning and disinfecting frequently touched objects and surfaces; avoiding close contact with people; avoiding crowded places, especially indoors; and following official travel advice, in particular concerning travel to affected areas. Try to avoid touching your face.

It is also important to stay at home if you are sick in order to help stop the spread of any infection you may have. In many countries, these hygiene practices are supplemented by the isolation of newly diagnosed cases, prompt contact-tracing by the authorities, self-isolation, self-quarantine and ‘social distancing’ aimed at preventing community transmission.

The recommended hygiene measures sound very simple but they are highly effective in preventing the spread of the virus. It is no exaggeration to say that washing our hands and observing good hygiene can save lives – both our own lives and those of other people. Each day, newspapers and websites are filled with pictures of people wearing often unnecessary face masks on our city streets. If all of these images were replaced by pictures of people washing their hands, the message about hand hygiene might reach more people around the world. This message is both simple and life-saving. It bears infinite repeating.

So, two facts are now clear. The first fact is that there is good reason to be worried about coronavirus. It is a new, unfamiliar virus, and some people diagnosed with it will die from it. Many others will become ill, sometimes for several weeks. While the illness is generally mild, it still causes significant suffering and disruptions to personal and family life, as well as broader problems for communities, societies and economies more generally.

The second fact is that simple behaviours focused on good personal hygiene make an enormous difference to the risk of catching or spreading coronavirus. As a result, there is neither reason nor benefit in excessive anxiety or hysteria. Even so, panic and worst-case thinking have gripped the world. This has gone well beyond the point of prompting awareness and good hygiene and is starting to impair reasoned responses to the outbreak. Therefore, in addition to the public health measures recommended by the WHO and others, there are several psychological measures that can help us to manage the panic that has engulfed the planet and our own excessive personal anxieties about the outbreak.

HOW THIS BOOK WORKS

This book presents a psychological toolkit for the management of anxiety and panic related to coronavirus. The book aims to assist readers to recognise the legitimate risks presented by coronavirus, place that risk in context and in proportion, and diminish the unnecessary, disabling panic that many people feel. We have more power than we think.

Chapter 1 is titled ‘Knowing’ and emphasises the importance of staying informed about coronavirus but not obsessing about it, not filling in knowledge gaps with speculation or random musings from social media, and – most importantly – limiting the time you spend each day consuming information about the outbreak (15 minutes twice per day is plenty). More broadly, this chapter recommends taking time to get to know your ‘information habits’ better and becoming more familiar with how your emotional life actually works. This can be a surprising exercise for many people, and it will help us navigate current and future challenges with greater self-awareness.

Chapter 2 is titled ‘Thinking’ and explores the importance of thinking clearly about coronavirus while avoiding the common errors that routinely lead us astray and fuel a sense of anxiety and hysteria. In particular, it is important that we focus on what we can control in this situation (especially when explaining coronavirus to children) and that we avoid unhelpful thinking habits such as negative automatic thoughts, over-generalisation, personalisation and negative filtering. Simple exercises such as thought-labelling can help us to consciously recognise irrational thoughts and label them as such in our heads. It is also useful to actively think about the problems that others face, because we gain a deeper perspective when we see ourselves as part of a larger whole.

Chapter 3 moves on to look at ‘Feeling’ and recommends becoming more aware of our emotions and labelling them clearly as emotions rather than thoughts, in order to recognise their power. It is important to remember that emotions can disguise themselves as behaviours or facts and can therefore mislead us, especially when the world is filled with free-floating anxiety about the current outbreak of coronavirus. Talking to others about our feelings is central to the cultivation of honest, direct awareness. Listening is just as important as speaking. If you want to be heard, listen.

Chapter 4 centres on ‘Doing’ what we can to assist with our psychological response to coronavirus, and avoiding behaviour we shouldn’t engage in. It is important that we do things that help, such as following public health advice, and refrain from activities that increase panic without delivering any benefit. It is also useful to focus on activities that are not directly related to coronavirus but are vital for our physical and mental wellbeing: maintaining a healthy diet, exercising, prioritising good sleep, spending time outdoors and finding an activity that absorbs us and clears other worries from our minds (if only for defined periods). We should reward ourselves for achievements (however small) and consciously practise compassion towards ourselves and others. There is no ‘me’ with a problem like coronavirus; there is only ‘us’. All health is public health. We can only manage this together.

Chapter 5 explores the idea of ‘Being’ as opposed to ‘Doing’, on the basis that we are ‘human beings’ rather than ‘human doings’. Coronavirus presents real challenges to how we see ourselves and how we understand the world around us, which suddenly seems more fragile and threatening than before. But there are ways to navigate this anxiety, once we retain a sense of proportion, try not to project other unrelated life problems onto our anxiety about coronavirus, and rediscover the profound value that lies in solidarity with each other, especially at times like this.

The book concludes with a summary of the advice provided and suggestions for ways to move forward, balancing the problems of today with the possibilities of tomorrow. Working together is key. People quarantined at home in China and Italy sing together out their windows. We need more of that.