The early psychological effects of lockdown, by a psychiatrist and patient.
Posted Apr 04, 2020
I don’t think there’s any evidence (yet) that COVID-19 has a direct effect on mental health, and that is something that only time will tell. But a lot is being written about the potential effects of lockdown, the economic implications of this and the waxing and waning anxiety that surrounds us all.
I don’t think many of us can really imagine the economic effects. I am one of the lucky ones, given that I work in health, as I am being paid, and there is little prospect of losing my job. But, even for me, there is some threat—over the last couple of years, work has been hard for me, and I have been glad of the buffer of my husband’s work, should I be unable to continue due to illness. Now that buffer is suddenly less assured. And many people are faced with far more immediate loss of livelihood or lifestyle.
Lockdown, for most of us, is unprecedented, although it does make you suddenly realise—just a little bit—what loss of freedom may be like. Not really—we’re not locked in cells, most of us aren’t under immediate threat, we’re actually in our own homes and can leave them for short periods. But a niggling voice also reminds us that for some, for example victims of domestic violence, being confined at home may be the worst thing that could happen to them.
In my own area of work, looking after people with alcohol dependence, what should we do? Will people drink more, stuck at home? Will they be unable to acquire drink and go into withdrawal? We are unable to offer our usual services and are having to make uncomfortable decisions only with phone consultations—including having to advise people to continue drinking because we cannot offer them a safe detox, and suddenly stopping drinking is dangerous. None of this sits well.
My perspective as a patient with bipolar disorder is equally difficult. Before this happened, I had been reasonably well for a little over a year, managing to work and trying my hardest to stay well. In the couple of months just prior to this, I had been feeling less well, although I was finding this hard to articulate to others, or even to myself. But anxiety, for me, is a frequent precursor to relapse—cause or effect, who can say?
So there I was, trying to manage my anxiety and avoid illness, and along comes COVID-19 and lockdown. And suddenly, everything that is normally advised, like activities, seeing friends, fresh air, is completely unadvised. Maybe I’m lucky in that I still need to go to work—but my work is not the arena of heroes; far from it. It is an anxious, worried place, where we are all trying very hard to prepare for something that may, or may not, happen. We are not, perhaps, frontline, but we may have to care for psychiatric patients with COVID-19, a vulnerable group.
Oddly, I’m not worried about catching COVID-19 myself. This is no boast, it’s just that other things are worrying me more, and perhaps I should be worrying about the illness itself. But I’m too busy worrying about not being good enough, largely because I’m a psychiatrist and haven’t done much physical medicine for a long time. I’m worried about my trainees because I don’t want them to be asked to do things with which they are unfamiliar, and I’m worried that they may not feel supported. I’m worried about my family, especially my elderly parents.
The problem is I’m not good with worry, and of course, I worry about that too. I feel guilty that so many people have underlying health conditions and are at risk from COVID-19, and that mental illness is less important. And that—that is the one that shocks me when I write it.
I believe that I’ve always taken the mental illness of others very seriously. However I’ve spent many years struggling to believe in my own, and this is a bit of a retrograde step. But mental health care has been scaled down for COVID-19 care, there’s no denying it. I understand why, I understand that it’s hopefully temporary, but it feeds into all my old beliefs that mental illness (mine) is somehow an indulgence and is less important. I’m trying very hard to resist these thoughts, but it’s hard.
Meanwhile, I’ve formed a new coping mechanism. This involves accepting that if this continues, I will become ill, so there’s no need to fight it, which takes away some of the pressure and self-blame. In the meantime, each day I remain well, even if a bit wobbly and anxious, is a bonus. Who knows, this may even be the best way to stay well in this difficult time.