For four days after Prime Minister Narendra Modi announced a nationwide lockdown on March 24, Preeti Borkar* barely got out of bed. The 46-year-old Mumbai-based English teacher didn’t want to eat or speak. “Ever since I heard that COVID-19 had reached India, I started getting panic attacks. It was getting difficult for me to breathe, and that being a COVID symptom, I thought I had contracted it,” she says. “I kept thinking of what would happen if one of my family members contracted the virus; that we would be dumped in some hospital on a dirty bed and I would be left all alone to die.” Soon enough, she imagined she had fever and a sore throat. Having been in therapy since 2005 for depression, Borkar knew she needed medical intervention. She sought out a psychiatrist who gave her a new prescription which helped alleviate her symptoms.
Psychiatrist Dr Harish Shetty of Mumbai’s Dr L.H. Hiranandani Hospital feels the COVID-19 outbreak can be particularly difficult for the likes of Borkar, patients who already suffer a mental health affliction: “There is a sudden sense of shock, fear of death or separation from family.” Weeks into the lockdown, we now even have evidence of otherwise ‘healthy’ people exhibiting signs of anxiety and depression that resemble pathological symptoms. For those with existing diagnoses, COVID is that very kind of stressor doctors often ask them to guard against.
SHOCK TO THE SYSTEM
Bengaluru’s National Institute of Mental Health and Neurosciences (NIMHANS) last tried to survey the Indian mental health landscape in 2015-2016. According to its findings, 13.7 per cent of India’s population suffered mental illnesses. And while 30 million Indians had access to the country’s mental health infrastructure, 120 million others had been ignored.
In India, the demand for mental healthcare has always far exceeded its supply. By making impossible access to even the few mental health practitioners in the country, COVID-19 has not just revealed the tragedies of our mental health crisis, but also exacerbated it. A week into the lockdown, the Indian Psychiatry Society estimated our mentally ill population had grown by 20 per cent. If true, we have a second, quieter pandemic to battle.
Psychiatrist Dr Aniruddha Deb points out that in India, “a majority of the service for the psychiatric population is provided by non-government sources”. To try and fill that gap in West Bengal, Dr Deb helps runs Mon (Bengali for mann, or mind), a psychiatric nursing home in Kolkata. Within days of the lockdown, Dr Deb and his colleagues had to close down their in-patient services. “We usually have only nine to 10 patients, but to look after them, we need a staff of about 25. Our food providers were finding it impossible to procure food for all of them,” says Dr Deb. “It is also very difficult to make psychiatric patients understand the importance of physical distancing and hand washing. Very often it is also difficult to manage a patient without close contact.” While Mon’s nine psychiatrists and six psychologists have entrusted families and relatives with the care of their patients, they are running a skeletal emergency service, responding to five to eight calls a day.
ON FEAR AND LOATHING
Tannika Majumdar Batra, 35, a Kolkata-based freelance graphic artist, was diagnosed with bipolarity, anxiety and post-traumatic stress disorder (PTSD) in 2012. She is trying hard not to think of her financial future: “As a freelancer, we have nothing now, and the uncertainty of work affects my anxiety levels.” Though presently not on any medication, she says, “I’m trying to be okay, but the paranoia from my PTSD has been severe.” Batra is afraid of dealing with deliverymen. Days, when her husband takes his mother to the hospital for her dialysis, are particularly difficult. “I fear for my cats, my husband, my brother. I am afraid that, suddenly, something is going to happen to one of them,” says Batra, one of the first mental health advocates to have detailed her mental health history on social media.
The possibility of death and disease is often exaggerated by minds that are already in turbulence. Hypochondriacs, in particular, internalise ideas such as persecution and social vengeance somewhat easily. Knowing this fact well, Sandip Chaudhuri* has tried hard to protect his hypochondriac father from COVID-19 news. “We are not taking newspapers and switch on the TV rarely, but seeing people in masks is enough to make Baba cringe,” he says. Though Chaudhuri and his family wash their hands and dry masks on the terrace, his father has seen enough to develop his theories of conspiracy and biological warfare.
Delusions, a common effect of stress, are also a symptom that often defines the manic highs of bipolar patients. Dr Shetty speaks of a young man whose diagnosis of bipolarity confirmed itself a few days after the COVID-19 outbreak made headlines. “He started imagining that he is responsible for the COVID-19 crisis and that he had special powers to resolve it.” Two other patients of Dr Shetty developed suicidal tendencies, saying that “they would rather kill themselves than die of COVID-19”.
The news can, of course, precipitate delusions and paranoia, but Dr Deb says editorialisation of facts matters, too. “When you blame a particular community for the spread of a disease, specific phobias become active,” he says. Schizophrenics, for instance, are already prone to paranoia, and by implying that a disease is being spread deliberately, “you amplify their fears”. The psychiatrist says he is witnessing an unfortunate resurgence: “People who were well for a couple of years are suddenly going berserk, sure someone will attack them.”
SILVER LININGS SCRAPBOOK
During the lockdown, video-conferencing has proved a boon for many who can now speak to their therapists online, but Dr Vinod Kumar, psychiatrist and head of Mpower Centre in Bengaluru, says “online interactions can be helpful, but not as gratifying as real-life ones.”
On April 3, Mpower, an organisation that works with people with mental health concerns, launched a helpline to help alleviate COVID-related anxiety. Already having seen more than 4,000 people call in, Dr Kumar says, “Any kind of disruption to normal lives—unemployment, relationship troubles, domestic violence—is going to lead to increased stress levels, and this needs to be addressed. But the biggest trauma is perhaps being experienced by those who have either contracted the virus or lost a loved one to it. These experiences can lead to chronic PTSD.”
Other practitioners are trying hard to look at the bright side. Dr Shetty says he saw a clinically depressed patient lose his symptoms after the pandemic broke: “He suddenly showed a lot of resolve and took charge of family responsibilities. His depression suddenly seemed to fade away.” Dr Deb talks about how people’s loneliness might be alleviated by the sudden proximity of family members. “People who are obsessed about washing their hands might find comfort in the fact that everyone else is now washing their hands, too,” he says. Batra, for her part, says, “When I first started recovering in 2015, I began enjoying my solitude. It helped me understand myself. I’ve been taking one day at a time since. I’m happy that everyone else now seems to be doing the same.”
with Aditi Pai and Romita Datta
*names changed on request