The weight on India's mind: Rising psychological problems amid Covid-19

Amid growing stress over isolation and job insecurity, people are developing serious psychological conditions and many with existing problems are experiencing a relapse

Financial uncertainty, health concerns and boredom— these are some of the issues Indians are sharing with their therapists. Psychologists say more people with mental health issues have been forced to restart psychotherapy since the lockdown came into force on March 24.

Faced with poor internet connectivity and frequent power outage, which make video chat difficult, people are opting for phone-based counselling.

“People’s assumptions are getting challenged. Earlier, they felt even if they were disturbed internally, the outside — their job, their ability to freely move around the city, their physical health — was under their control. Now they are feeling as if the inside and the outside are both stressed. The boundary has ceased to exist,” says Meghna Mukherjee, a Delhi-based clinical psychologist.

People across cities are experiencing what doctors call empathetic stress. Watching the condition of migrant labourers or the free fall in the economy is becoming the cause of panic attacks. It is particularly grim for those who are forced out of their homes and made to live with families that are at best negligent or at worst physically and mentally abusive. As many do not want to reveal their identity, chat sessions via messaging apps with therapists offer them a veil of secrecy.

But does it work? “At this time we are not doing much therapeutic work. It is more of supportive care for now,” says Medha Gupta, a Hyderabad-based clinical psychologist, whose patients include young professionals, who she says are facing sleep disorders.

The lockdown has had a huge impact on the vulnerable groups — women and children. The data released by the National Commission for Women shows they received 587 complaints between March 23 and April 16, twice the number compared to the previous period. Of this, 239 related to instances of domestic violence. The burden of household work too has fallen disproportionately on women in the lockdown and many working women are struggling to cope with it in the absence of any help.

“This difference in work structure has had a major impact on women’s productivity,” says Aakriti Astha, a counselling psychologist from New Delhi. She says women who are not financially independent do not tend to seek help outside their families. While many reach out, most don’t want to file a police complaint.

Experts argue that children need to be made comfortable to express their emotions. Boys should be taught to deal with their feelings in a healthy way, as the violence — mental or physical — they unleash has been normalised, they say.

Girls need to be more expressive of their anger. “The fear of being reprimanded makes girls deny their anger,” says Shweta Dharamdasani, a psychotherapist.

With schools closed, and no clarity on pending exams, children are facing an unprecedented amount of uncertainty. The curbs on physical movement adversely impact their mind-body continuum and it is much harder for children to focus on e-learning classes when they find their family members moving around the house.

“Children have been invisible in this lockdown,” says Nupur Dhingra Paiva, a chartered clinical psychologist, whose clients include young adults and teenagers. She says her work with many kids has stopped as they require concrete physical presence.

There is another worrying trend. The Childline India helpline, run by the Indian government, received 92,000 SOS calls on child abuse and violence in the first 11 days of the lockdown. This might be due to the sense of helplessness people are feeling, other than some mental health conditions. In times of crisis, we get in touch with our dark side, experts say. 

To counter child abuse, Paiva says she is trying to ensure that at least one parent is a protective ally, as filing complaints and acting on them is difficult during the lockdown.   

Some problems though are more vexed and rooted in serious mental health conditions. For those with obsessive-compulsive disorder (OCD) for cleaning, for example, when the world is ravaged by a virus that can spread from touching contaminated surfaces, how does one encourage them to stay calm?

Experts say that therapy is based on certain assumptions. Under normal circumstances, a person with OCD is made to understand how there is good dirt and bad dirt, and that touching anything is not going to automatically harm them. These assumptions stand challenged today.

“Now we help people understand that the need to wash hands is the reality. But the urge to doubt it and wash your hands again after, say, 20 seconds is an obsession,” says Geeta Singh, a clinical psychologist.

Therapists are digging deep into what they had learned during their training to deal with the new challenges in counselling in a pandemic. They admit experiencing a sense of powerlessness as their caseload has ballooned. The timings have been stretched with therapy sessions starting as early as 6 am, rather than the usual 10-11 am.

Not all solutions to deal with stress are complex though. Gupta says having a morning routine of exercising and wearing fresh clothes may help. She also suggests switching off electronic devices at least 45 minutes before going to sleep.  The other steps most experts enumerate are gratitude, being more involved in our day-to-day activities, and setting boundaries in our work and personal life.

Psychologists say the lockdown has in a small way helped in changing perceptions about mental health. Many people who were earlier not comfortable with the idea of seeking help from a mental health practitioner are now having a change of mind. 

“Now is the time you can say that I am anxious just like everyone else, and so I am going to therapy,” says Mukherjee.