'Is my anxiety normal?': How Covid-19 may affect mental health

Covid-19 has resulted in new stressors - curtailed social connections, loss of normalcy, fear of death and economic uncertainty - that may affect mental health

Friends call extroverted medical student Katelyn Joy Chiu, 22, a sunshine girl. Nothing rains on her parade.

But she had "an overwhelming sense of uneasiness" when she started serving her 14-day stay-home notice on March 19, after curtailing a trip to London to visit her sister.

She was disappointed about lost opportunities, too, for she had to forgo hard-won clinical attachments in a Tel Aviv hospital, a Papua New Guinea medical ship and also stints in Singapore from April to June.

Anxiety heightened when more countries went into lockdown and infections grew exponentially, the bad news flooding her social media. "It became very scary. It felt like Covid-19 was in my bedroom," she recounts.

"Covid-19 is a vicious annoyance that disregards everything."

To turn things around, she made a to-do list from day one. She spent time doing videos of cover songs, creating an Instagram Live worship-and-sharing hour with a Christian friend that 400 people viewed, and working on her palliative care academic project at home.

"I made my bed to kick-start my day, so there was no temptation to lounge in bed or take afternoon naps."

Importantly, she accepted the situation and realised she was privileged. The minute her stifling confinement ended on April 2, Miss Chiu and her boyfriend took a midnight drive to West Coast Park and strolled, then drove to East Coast Park and walked again, savouring the fresh air.

FEELING TEARY

Like Ms Chiu, people with no underlying mental health issues may feel overwhelmed during the pandemic and wonder why they are teary or heavy-hearted.

They are experiencing Covid-19 anxiety, a prolonged time of heightened anxiety and even loss, experts say.

 
 

Ms Elysia Tan, senior counsellor at Touch Integrated Family Group, which serves families, children, youth and people who require mental health support, says: "In Singapore, which like the other major cities globally is highly efficient and enjoys much stability, people may find themselves out of their comfort zone."

Also, people are social beings and may not be accustomed to social distancing from loved ones, friends and colleagues, she adds.

  • 8 tips to boost your mental wellness

  • Reframe the situation. You are not stuck at home. Instead, you are indulging in a long-awaited opportunity to slow down, focus on yourself and the home.

    2 Shut out negative thoughts by focusing on your surroundings and immersing in the present moment. Listen to the birds outside the window, look at a pleasant object and describe it in your mind, make a cup of tea or coffee and notice how it smells and tastes.

    How our body experiences our surroundings can help our brain register that we are in a safe place so that our body can relax.

    3 Keep our hope alive. This is a good time to rethink our ways of life and reflect: What would a better tomorrow look like? Make the best of every moment - and we will come out of Covid-19 stronger.

    Practise self-care and self-compassion. Try to sustain routines that bring comfort and stability, whether it is prayer, art, journaling, exercising, cooking or supporting others.

    Also be gentle on ourselves, when we cannot always shut off fear and pain - our own and the world's. Fear is no fun but it signals that we are fully human.

    Try to be adaptive. This involves a flexibility to function optimally in changing circumstances like the pandemic.

    This is a good time to learn to get along with family members, when facing them 24/7. Pause before giving negative comments. Be more liberal with such phrases: Thank you. Well done. I appreciate your help.

    Keep socialising, safely, with video chats on Skype, FaceTime, WhatsApp, Google Hangouts or other tools. Or use the phone, text messages and e-mail.

    Limit exposure or take a break from Covid-19 updates. While it is important to stay informed, it is good to reflect if checking for updates has become unhealthy or obsessive.

    Focus on recovery numbers instead of mortality rates. Separate real news from rumour. Balance the news intake with reading or watching videos with themes that you delight in.

    Lee Siew Hua


    HELPLINES

    National Care Hotline: 6202-6868

    Fei Yue Community Services: Register for online counselling at www.ec2.sg

    Touch Community Services TOUCHline: Call 1800-377-2252 or e-mail counselling@touch.org.sg

    Silver Ribbon: 6385-3714, 6386-1928 or 6509-0271

    Institute of Mental Health's Mental Health Helpline: 6389-2222

    Samaritans of Singapore: 1800-221-4444


    Sources: Ms Elysia Tan, Touch Integrated Family Group; Dr Goh Kah Hong, Khoo Teck Puat Hospital; Ms Sarah Poh, The Therapy Platform; psycho-traumatology practitioner Christine Wong; The Guardian and The New York Times.

Dr Goh Kah Hong, head and senior consultant of Psychological Medicine at Khoo Teck Puat Hospital, says: "Whether we realise it or not, we are facing losses - from a sense of security and freedom that we took for granted, to more tangible unemployment and financial losses."

TOTAL DISRUPTION

So this is a vastly altered state of life that Singaporeans are trying to adapt to. "Covid-19 is a total disruption," says Ms Sarah Poh, mental health counsellor and founder of The Therapy Platform, a therapy booking platform.

American grief expert David Kessler articulated the sadness now engulfing people worldwide: "The loss of normalcy; the fear of economic toll; the loss of connection."

In an interview with the Harvard Business Review, he said: "This is hitting us and we're grieving. Collectively. We are not used to this kind of collective grief in the air."

Still, some grief or anxiety is normal and can even quicken a sense of purpose.

"People who have been feeling teary or heavy-hearted sometimes could well be having a normal response to the pandemic,'' Dr Goh notes.

Normal anxiety does not paralyse a person, experts say.

But if the anxiety is recurrent, overwhelming, causes mood changes like irritability, and even triggers physical symptoms such as insomnia, indigestion and body aches, it may be time to seek professional attention, they counsel.

FACING FAMILY 24/7

Meanwhile, mental healthcare professionals express concern about families under stress, including the functional households.

Dr Goh says children are experiencing a lot of stress from the abrupt cessation of school and, for now, there are teething issues with home learning.

"It is important to note that our anxiety can be 'contagious' for the little ones," he emphasises.

Children do best when they have a good routine, and get to play, he adds. "You may wish to consider simulating the school routine of having recess and lunch time between home learning. Do remember to have some play time with your children. When was the last time you did that?"

In compact Singapore homes, conflict over shared space can arise. Ms Poh of The Therapy Platform notes that in space-scarce Singapore, people face their families 24/7. This intensifies during the circuit breaker month.

"The key here is to have respect and set boundaries over what is private space and what is communal space. Without good conversation around space use, tension can rise quickly within the family,'' she says.

"Actually, the conversation will be more about person-to-person values, then about actual size of space. Instead of waiting for conflict to happen, have a planned conversation by the 'leaders', who are usually the parents."

People of every temperament have to manage, including chirpy extroverts.

Extroverts, who draw energy from social interaction, may have a hard time with diminished connection. "Instead of looking to the outside now, perhaps now is the golden opportunity for us to nurture our inner life. Having excess time being by ourselves, we have to learn to enjoy our own company,'' says Ms Poh.

 
 
 

Other expert tips encompass being aware of the roots of your anxiety, living in the present and limiting the virtual life.

Ms Christine Wong, a psycho-traumatology practitioner, mentions a client who had a never-experienced level of Covid-19 anxiety. "She said she was worried about employment, but her job was stable."

After delving into the situation, the client, a professional in her 40s, understood that her anxiety stemmed from around the age of six when her father went bankrupt after his business failed. In the middle of the night, the family had to move. Her mother cried in front of the children.

"If we understand what's happening, it gives us huge clarity,'' says Ms Wong. "It's half the battle won."

Dr Adrian Wang, a psychiatrist and counsellor who practises at Gleneagles Medical Centre, placed the pandemic in perspective.

"The virus is a finite thing,'' he said at a Web In Travel webinar last month on managing Covid-19 fear and anxiety. "Eventually this storm will pass. It's not a never-ending pattern of gloom and doom."

LISTEN TO HEALTH CHECK PODCAST

 
A version of this article appeared in the print edition of The Straits Times on April 13, 2020, with the headline ''Is my anxiety normal?''. Print Edition | Subscribe