Psychologist Steven Kaplan on mental health

The face of a smiling man

Steven, with everything going on right now, conversations surrounding mental health seem to have taken a backseat.
I’m not sure it’s completely accurate to say that it’s taken a back seat, although it certainly seems that way. When we have a global disaster like this, everyone is naturally going to go into survival mode; food, shelter, money, physical health, etc. and the emotional aspects get crammed in as almost an afterthought. First, we protect ourselves, and then we worry about what that might cost us emotionally. So the emotional and mental elements are in play, but we’re kind of on auto-pilot right now.

Let’s start with what everyone is feeling right now?
Everyone is feeling traumatized, which they absolutely should be feeling because we are all currently living through a trauma. We deal with most trauma after it has happened (hijackings, death, car accidents). 

This trauma is very far from over. It’s a long-term trauma. We’re not talking about first-hand contact trauma experienced by people who are actually infected and ill; that’s the tiniest minority right now. The vast majority of us are living this trauma internally, in our minds and imaginations, fears and anxieties. It is, in fact, fairly textbook Post Traumatic Stress Disorder (PTSD), except that it’s not yet post, it’s still happening.

The main difference between trauma and pain is that trauma has an unexpected element, a surprise element. It’s when you are doing something that you’ve done hundreds of times before, but this time there’s a different result. This time something new and unusual has entered into your life. It’s not supposed to be there, yet it has to be taken into account. 

When we experience trauma of any kind (mental, emotional, physical, sexual, etc.), we’re literally forced into a brand new reality, be it physical, emotional or both. Our natural response is to try re-assert our previous reality; we want things to go “back to normal” and invariably, in fact, they do. It takes time and adjustment, but it happens. If we attempt to rush it, or fight it, or oppose it, we are much worse affected than if we accept it. 

Currently, we are all, every person in the world, trying to respond to the new reality that has been forced upon us by the pandemic. 

We have lost significant parts of our reality against our will, which we’re definitely not happy about. So, we’re attempting to adjust to this trauma and trying to live as close to normal as we can manage.

And specific to those who have mental health challenges, are these feelings heightened?
All feelings and emotions will be heightened and intensified during trauma. There is no getting around that.

When we are in a trauma state, we exist outside of our normal emotional reality. It feels like being in a fishbowl where the effects of the trauma curtail your normal responses. When we have a scenario where that is now literally the case, the effect is even more heightened than usual. We are living with constant verifiable proof that this is not normal. But in fact, that is actually quite useful for mental health. 

Under normal trauma, the person dealing with it would be having a unique experience compared to those around them. In this case, we are living a SHARED experience. Everyone can compare their experiences which helps enormously in terms of not feeling alone or abandoned, which trauma victims often do feel.

Explain in detail, please, how someone with anxiety, depression or any other mental health challenge is experiencing the situation we currently find ourselves?
Firstly, it is important to realize that it is not possible for anyone right now NOT to be feeling anxious or depressed in some form or another. People who already deal with some form of mental challenges are either battling to distinguish between general feelings of depression and anxiety (which could stem from a myriad of sources), and specific anxiety or depression stemming directly from a very real and obvious cause. 

If, for example, one already tended towards depression, they would now be experiencing a relatively unusual form of triage or prioritizing. Am I depressed because this is a very depressing situation? Or am I depressed because I suffer from depression? It will be extremely confusing, possibly disorientating and very scary for them.

Depression can mean many things. One of these things is perceived hopelessness about one’s life that can generalize into hopelessness about everything. Often depression is an inborn condition that must be treated with medication as well as therapy. Unfortunately, depression also invariably manifests as a difficulty in accurately perceiving oneself and the world around you. So the lockdown and global pandemic will naturally heighten those specific beliefs and perceptions.

The same can be said for anxiety and, in fact, most other emotional conditions and mental health challenges. There is always a general fallout in one’s ability to get an accurate gauge of one’s surroundings. So the best approach is to make sure that this is immediately acknowledged, Specifically, ensuring that you make a conscious effort to own the fact that what is happening is absolutely not about you.

If someone close to us is facing these challenges, how can we help them?
Most importantly, maintain contact with them. They will be feeling very lost and alone. Normalize this for them as much as possible. Specifically, talk to them about how they are not alone in their feelings and that everyone is going through exactly the same crisis and fears. 

Focus on the reality that everything we’re experiencing is completely unprecedented and unknown for everyone. It’s vital for people to stop fighting this or try to find ways of getting around it. 

Yes, it is far, far worse for some than for others, especially people with limited physical resources. But the emotional battle is universal. We will all be feeling out of control because WE ARE out of control. We cannot make this go away. But we are not meant to. We can only control our tiny section of the world right now, and that is enough.

How can we look after our mental health at this time; exercise, routine, communication…?
Routine is vital, as is any form of physical exercise. It doesn’t have to be much. It just has to be consistent. Even just 20 minutes of conscious exercise will help; run on the spot in front of the TV, do some sit-ups, push-ups, shadow box, even chair exercises. A routine doesn’t have to entail 8 hours of structure. Quantity is not an essential element here. Consistency is much more useful and helpful. Do at least one or two things every day that are the same to explicitly remind yourself that we can control at least this element of our lives. 

Make a point of contacting the people you would normally interact with. Maybe not daily, but at least every couple of days. And try to have video as well as audio contact. Ask people to show you the environments they have created for themselves and tell you about their routines. Exchange ideas, even if they seem silly, Stay connected to your and their humanity.

Don’t spend the entire day glued to the media. You could easily do that, but you will just end up re-traumatizing yourself. Don’t rush to share every bit of bad news you discover with everyone. Call people if you’re having a bad day AND if you’re having a good one. Stay connected. Don’t go an entire day without at least one conversation, even if it’s only for 5 minutes. If you are able, go outside for a part of the day, just to listen to the world’s noises, to remind yourself that you are not alone in the world.

If needed, where can one turn for help?
Fortunately, there are several channels and agencies available, some of them without charge. The standard ones are still mostly operational: LifeLineSADAG; Family Life Centre (Johannesburg). Also, check out Mental Health Care for HCW Covid19, Gauteng Branch on Facebook. It’s primarily for healthcare workers but has some excellent links to other organizations. And, for general interest, go to the Jewish Report‘s website for links to various talks and panel discussions on mental health during lock-down. All the speakers can be contacted personally and are available for telephone or online therapy if necessary. 

Importantly, how do we help each other through this time?
Connect. Connect. Connect. We have global connectivity like no other time in human history; we should be using it to its fullest potential.

Make a point of reaching out to people you might not normally speak to. Show people that they are on your mind. You’ll be surprised by what a difference it will make to their lives and yours. Share what you’re learning about yourself with others, even with the people you are locked-down with. If you find something that helps you, share it. However trivial.

Journal your experience in whatever form you can. Write, draw, talk, record. Document this time for yourselves and each other. Acknowledge each other’s pain and joy and other experiences. Know that we will emerge from this wiser than before and hopefully, with a new respect for each other. Tell people that they will be OK, because they will, and so will you.

We’re all embarking on what may be one of the greatest learning experiences of our lives. We’re also making history! One day in the not very distant future, people will study this, sometimes with disbelief that we actually lived through this.

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