Eve (not her real name) is a rather popular and much in demand freelance swimming coach who is particularly good with children; she would proudly show me photos of them in her smartphone whenever she comes to see me at the clinic.
After her graduation from a local university, she worked as an engineer for a few years at a multinational corporation, but a relapse of her bipolar disorder upended this career.
Working as a swimming coach was a second lease of life for her and she has come to love her job. She works hard and her income has also enabled her to support her elderly parents, who are living in East Malaysia.
Some years ago, her mother had cancer and Eve flew her down for treatment in Singapore, which landed her with a hefty bill. She still owes the hospital a few tens of thousands of dollars that she is paying by monthly instalments. Until recently, she was confident of clearing this debt.
When she saw me a few weeks ago, after the first case of Covid-19 surfaced here, she told me that things had been bad for her. Her swimming classes dwindled and then dried up completely. She was living on her savings and has thought of returning to Malaysia for a while. This could stretch out her savings, but with the uncertain and fraught situation, she wasn't sure if it would be a good idea.
It has been said that losing one's livelihood can be equivalent to the grief of losing a loved one; it arouses similar feelings, like disbelief and anger, before settling into resignation and acceptance.
But Eve wasn't angry; she figured that she shouldn't be feeling this way when so many of her fellow swimming coaches are in the same dire situation, and with so many people elsewhere having lost their jobs or in the process of losing them.
Perhaps the nature of this shared experience gave her the sense that "we are all in this together", which offers some comfort and obviates the feelings of guilt or self-blame that often come with losing one's job.
She was also relieved that she was no longer exposed to a higher risk of catching the coronavirus or passing it on to her children. She had been buffeted by the stress of her diminishing income and the fear of being infected and dying and leaving her parents alone and unsupported.
She was despondent though not clinically depressed, and I felt helpless - all that usual doctoring wasn't going to help, nor was it something that dispensing of medication would cure.
So, I worry for her and for those of my patients who have overcome many mental health and other obstacles to secure a job and who - as some studies have suggested - would be the first to be let go in times of economic hardship.
This time, it is not just those with mental health issues, but many others, who are vulnerable to job loss.
WORK AND UNEMPLOYMENT
Studies after the Great Recession of 2008 found that people who suffered financial, housing or job-related hardship were more likely to develop mental health problems such as depression, anxiety and substance abuse; and these problems often persist for years.
Unemployment can even be lethal albeit in an indirect way.
What we should be looking out for should not just be the economic cost in terms of productivity, but also the possible adverse mental and emotional effects emanating from an extended period of working from home and away from face-to-face social interactions.
In 2015, a husband-and-wife team of economists from Princeton University, Dr Anne Case and Dr Angus Deaton, found that since 2000, the mortality rate of working-age white men and women without college degrees in the United States went up, and they were dying from suicide, drug overdose and alcohol-related liver disease (what they called "deaths of despair"). The only precedent for this level of mortality was from the period between 1915 and 1918, during World War I and the Spanish flu pandemic that followed it.
Although the reasons for this 21st-century phenomenon of rising midlife mortality were not clear, a consistently strong economic and direct correlate was the number of jobless.
Meanwhile, my patient Eve was trying to see if she could get some financial assistance. Any form of assistance would help in the short term to pay her bills, rent and other essentials, but she knew it could not replace the value and pleasure of working at a job she loves - something that has now been snatched away.
Work gives us meaning and purpose and is an important component of our well-being. Most people, it seems, would settle for less money doing work they care about, where they have respect and some autonomy, and where they can hang out, banter, gossip, commiserate and form friendships.
In short, other than the intrinsic value and dignity of our work, we have also a second family and even a community with all the rituals of connection and dynamics.
I felt a relative loss of this family and community recently. Relative because I still have my job - a meaningful one that continues to make me feel useful - but a sense of loss nonetheless when we were compelled to work remotely during the circuit breaker period.
WORKING FROM HOME
I am part of a close-knit, high-energy and high-performing research team of almost 30 who are housed together in a couple of connected offices at the Institute of Mental Health. This team buoys me with its enthusiasm, vim and vigour, and humour.
The move to work from home wasn't a matter of choice, but we have to do what we can to reduce the risk of being infected and to safeguard our patients from being infected; so other than myself, as I have patients to see at the clinic during the work week, the rest of the team upped sticks and left for their homes to work.
They don't complain much, but I know it hasn't been easy.
Some lack the suitable spaces for a home office and must make do working in the bedroom or some other shared common room, with all the noise and distraction from their sequestered family.
And there are those with young school-going children, for whom school closure and home-based learning mean they are forced to work alongside their children while doubling as a teacher and child-minder. The likelihood is that some will end up working in the night after their children have gone to bed. (A meme that has been circulating on social media shows a woman working contentedly on her desktop computer and with her three bound and gagged children lying next to her feet.)
According to Stanford University economics professor Nicholas Bloom, an expert on remote working, for a work-from-home policy to be successful, it is required that children be in school or day care. "Working from home with your children is a productivity disaster," he said.
In 2015, Prof Bloom and his colleagues published in the Quarterly Journal of Economics a paper titled "Does Working From Home Work?", which extolled the benefits of working from home.
The authors looked at Ctrip, a huge Chinese travel agency that randomly assigned a group of its call-centre staff to work from home. The experiment revealed that working from home during a nine-month period led to a 13 per cent increase in performance (plus savings from reduced office space); the employees initially said they were happier and less likely to quit their jobs.
Ctrip decided to roll this out throughout the company. After nine months of allowing those employees to do their jobs at home, Ctrip asked the original volunteers whether they wanted to continue working from home or return to the office. Half of them pleaded to return to the office, despite the long commuting time. Their main complaint was the lack of social company, which led to feelings of isolation, loneliness and depression.
Subsequent research also shows that in some types of work, what remote workers gain in productivity comes at a cost of missing out on more intangible things like creativity, innovative thinking and team cohesion. People working together in the same room tend to solve problems more quickly than distant collaborators.
Prof Bloom's research has shown that face-to-face meetings are essential for developing novel ideas and keeping people motivated and focused. (There is a biological principle called the economy of action, where the brain would prefer to process information with the least effort and it does this more efficiently in the physical presence of people than engaging with others on a screen or a phone, which requires more work from the brain.)
And there is something else: Being near other people allows us to show our most human qualities, like empathy and collaboration, which make for meaningful interpersonal contact that we miss out on when we are cloistered at home and away from them.
Prof Bloom suggests a few things that can increase productivity. These include regular check-ins between managers and their teams' productivity by setting and monitoring specific goals, and maintaining schedules and structures.
And those at home must make that conscientious and disciplined effort to parcel their day into focused work, office communications, personal time and family life. We must also recreate and maintain that social contact with videoconferencing rather than e-mail exchanges or phone calls because we want (and need) that face-to-face interaction, even if only virtually.
The Covid-19 pandemic has inadvertently created a worldwide experiment for remote work, which is yet another "new normal" in this era of the pandemic. What we will learn from it all will no doubt shape the future and the very concept of work; but what we should be looking out for should not just be the economic cost in terms of productivity, but also the possible adverse mental and emotional effects emanating from an extended period of working from home and away from face-to-face social interactions.
For now, and in the indefinite future, I'm meeting the rest of the research team via videoconferencing. Listening to them and seeing each of their pixellated faces on my computer screen, I realise how much I miss them. And I wonder when we can again have that monthly celebration of birthdays. Maybe we can try virtual celebrations, but it wouldn't be the same.
• Professor Chong Siow Ann, a psychiatrist, is vice-chairman of the medical board (research) at the Institute of Mental Health.
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