Be Kind To Yourself: What Therapists Are Telling People With Mental Illnesses Now

For the past few weeks, Rucha Sharma, a 32-year-old journalist based in Mumbai, has been visualising doomsday scenarios in her mind. 

“I am petrified,” she told HuffPost India over email.  “I get this almost certain feeling that I may not be able to see my parents ever again if I become one of the victims. I cannot compromise the health of my diabetic mother, so even though I long to go home for emotional reasons, financial reasons, I am supremely worried about what I might do to my family.” 

Sharma, who was diagnosed with clinical depression in 2004, has been keeping up with her regular therapy sessions—which have now moved online—but dealing with several complicated emotions at once during the Covid-19 lockdown is exhausting her.

“I am also one tiny person stranded away from my family, but I am in a privileged position and that makes me feel guilty when I see images of migrant workers. I am doing my part by donating whatever I can and organising help for others, but nothing seems enough and the crushing burden of not being able to make everything right sends me down the spiral more often than I can handle. I cannot control any aspect of the current situation and that makes me angry, also makes me want to curl up in my bed,” she said.

It has just been a couple of months since the word “coronavirus” became a part of our daily vocabulary but since then, our lives have changed in ways no one could predict. People across the world are getting through their days in the shadow cast by the highly infectious disease, which has led to countries including India severely curtailing movement. The worst part: there is no end in sight yet.

India’s home ministry has announced that the ongoing lockdown will be extended , meaning that restrictions in some form or the other are set to continue. As we remain confined to our homes, we are constantly besieged by the fear of contracting an infection, worry about our loved ones, and a general sense of despair. While most people are finding this hard to live through, the lockdown has posed a particular challenge to those who have been dealing with mental illnesses or mental health concerns even before Covid-19 became a part of their reality.

HuffPost India spoke to several psychologists and counsellors who said that even people without diagnosed mental health concerns are struggling to come to terms with the massive change in their lives due to Covid-19 and the lockdown.

“So you can imagine what people with diagnosed anxiety, depression or OCD (Obsessive Compulsive Disorder) must feel like. The change feels very overwhelming, the situation feels very overwhelming,” said Tanya Vasunia, a Mumbai-based psychologist. 

While some people find that living alone is adding to their feelings of anxiety and depression, others are struggling to adjust to living with parents or other family members 24/7. In some cases, the lack of privacy and understanding comes at the cost of being unable to access therapy as well.

Therapy out of reach

Lakshit Bajaj, a 27-year-old business analysis consultant based in Gurugram, has been trying to take some online courses during the lockdown, but found it difficult to focus. “I couldn’t do much. I just felt the need to just lie on my bed and do nothing,” who said.

Bajaj was diagnosed with anxiety in 2018, and has been living alone for now as his housemates have gone home. He couldn’t go home because he joined a new job on March 23. 

“On most days my concentration and focus doesn’t last long too. I keep looking for distractions when I feel uncomfortable and the phone helps to distract me well and it becomes a cycle,” he said. 

He then reached out to a therapist online through an app. But for others, living with parents or not having enough space means there is no scope for this. 

Ritika (name changed), a 23-year-old MBBS student based in Ahmedabad, has been diagnosed with complex post-traumatic stress disorder, but has found it impossible to continue her therapy sessions. She lives with her parents who, she said, have “very orthodox” views on mental health.

“There is no privacy or space for me to be able to talk with my therapist,” she said.

Ritika said she is engulfed by feelings of helplessness now because she has no personal space, and that her boundaries are consistently violated by her parents. Apart from this, she is also dealing with “a lot of sexist and problematic behaviour which can be really triggering, extreme pressure to churn out maximum academic productivity during this time, the uncertainty of graduating on time, the uncertainty about being able to meet friends and other people in whose company I feel the most joy and love”.

For those already struggling to cope, being locked up at home suddenly and trying to adjust to a new lifestyle has become a Herculean task.

“Keeping in mind the uncertainty, anyway people with generalised anxiety disorder go through a lot of anxiety throughout the day over futuristic thoughts. Because of this whole lockdown and the pandemic, everything has become so uncertain. The whole uncertainty about the future has given rise to anxiety, said Ruchika Kanwal of Karma Care, an organisation that offers counselling, psychotherapy, psychological assessments in Delhi.

Are there people with specific disorders who are suffering more? 

The experts HuffPost India spoke to said that they have noticed increased symptoms not just in people with anxiety disorders but also those who suffer from depression, OCD and people who have suffered traumas and have self-harming behaviour. 

“A lot of people with OCD, their symptoms have relapsed. Especially people who have the obsession of cleaning, or thoughts about contamination or the compulsion to wash hands—a lot of my clients who are already diagnosed with OCD said that the whole world has OCD now because everybody is washing hands repeatedly,” said Kanwal. 

Those who suffer from OCD often have unreasonable fear of germs or contamination. The constant reminders to wash one’s hands carefully can exacerbate these fears. 

For people with depression, being forced to stay away from the rest of the world can add to their sense of isolation. Now, even if you feel like meeting a few friends would lift your mood, it is not an option. 

Ishita Gupta, founder of Breakthrough Counselling in Mumbai and a counselling psychologist, pointed out how this could lead to a vicious cycle. 

“If I already felt like I couldn’t reach out to anybody or talk to anyone, physically cutting yourself off from colleagues or friends, it becomes worse. It becomes then that self-fulfilling prophecy where I don’t feel like anybody cares about me so I don’t start a conversation. I feel more lonely, so I feel more like nobody cares about me,” she said. 

There are also more visceral fears, like the possibility of job losses or scarcity of food. Vasunia said that people with disordered eating patterns are now finding it hard to get the kind of food they are used to. This may not seem like a big deal in a country like India, where access to food is a privilege, but for those experiencing the panic, it can be debilitating. 

“People with disordered eating patterns are facing difficulty because of limited availability of food and certain kinds of food in particular. The price of food has also changed, so they’re also struggling with that adjustment and what that difference of food intake means for them,” Vasunia said. 

Constantly being at home also means that people who have less control over their home space —such as those living in dysfunctional families, those in abusive relationships, or even people who have faced trauma like emotional or sexual abuse—now have nowhere to go. 

Ritika said that living with her parents is giving her massive self-esteem issues. “Stuff they say and do is really bothersome sometimes and can really flare up old triggers, I miss my freedom.”

Young adults who live with their parents and whose connection to the outside world is now being monitored are also suffering. Sneha Janaki, a Mumbai-based counselling psychologist who has a private practice called Reflective Arena, told HuffPost India that she works with many young adults whose friends are more of a support system than their families. “That’s (connecting with friends) kind of cut off or more monitored, so we don’t really have privacy or room to ourselves, not all of us do.” 

Why people with mental health concerns are affected more

Often, despite their best efforts, it takes only a small trigger for people with mental health concerns to spiral. Even in the best of situations, and when everything around them is as it should be, they can find it difficult to get through daily life or stick to a routine. Little acts such as getting out of bed or brushing your teeth can feel like you are climbing a mountain.

Psychiatrists and counsellors usually work with their clients to form a routine that they can stick to, giving them a sense of control over their own lives. The lockdown, for many, has upended the routines that helped them have a semblance of structure. 

“If you are on medication or you are someone who struggles with a mental health concern, and on the spectrum it’s on the severe side, routine and structure is very important for them. Obviously in a lockdown, these things are not as easily maintained, because you are home the whole day. For those who struggle, unfortunately, not all family dynamics are healthy. It can be a difficult situation at home that can be extremely triggering for you and that can also make them struggle a bit more,” said Vasunia.

In a country like India, having access to a room, or even some space of your own is a privilege for many. When you’re forced to spend all your time with the same people without the normal daily routine to follow and other people to meet, the experience can be frustrating. This can be especially painful if you don’t get along with the people you are living with.

“Many people have had to move back in with family that they may not enjoy spending time with, or abusive partners or partners with whom they are like ‘my marriage is on the rocks or my relationship is kind of on the rocks and I have to live with you and be around you all the time’,” said Gupta.   

Apart from routine and structure, a sense of uncertainty and hopelessness and being cut off from your usual support system can also make one feel overwhelmed. Being able to go to work, or just take a walk are little liberties that are taken for granted, but go a long way in helping anyone feel a sense of normalcy. 

How do I know if I’m not ok? 

Gupta said that people should look for nuance in what they are feeling. “Don’t just think about it as sadness and anxiety. Also think about it in terms of ‘am I feeling more frustrated lately? Am I feeling more helpless and hopeless lately? Has my shame increased? Do I feel more guilty or more ashamed?’” 

Worsening mental health can also lead to very physical symptoms.

Sneha Janaki said that she has noticed an increase in self-harming behaviour or thoughts and suicidal ideation. Warning signs to look out for include “feeling frustrated or feeling frozen in the body, or feeling restless”.

What can you do to feel better? 

Routine, routine, routine! 

Having a routine, or at least a semblance of one, can help instil a sense of control over one’s life. This doesn’t mean you have to get up at 6 am and jump out of bed to exercise (though if that’s your jam, go ahead). 

“Even if you wake up at 1 or 2, just to kind of ensure that you have meals at the same time, so that there is some amount of control that you feel through the day.  It gives us a sense of control, also choosing what is going to bring me joy today. It could be as simple as deciding that I will have my tea undisturbed,” said Sneha Janaki.  

Planning for the day ahead—no, you don’t need a rigid plan—can also give you a sense of purpose. 

Vasunia suggested a morning routine, “Wake up, go for a shower, even if you do 25 deep breaths, even if you do some stretches, even if you’re not exercising, it helps set the tone for the day.” 

Schedule both work and play 

While many of us are now juggling work from home as well as household chores, it’s best that we also schedule fun things in our day, or things that we like to do. That way, we know that once we get done with our chores, we have something to do that brings us joy. 

“We tell everybody to schedule their days and put things that they need to do in a day as well as things that you enjoy. Neither should your day be filled with the chores that you need to do plus your work, nor should it be sitting and chilling and playing games and watching TV. Your day has to be a mixed bag of things that give you pleasure or make you feel more relaxed,” Kanwal said. 

Get fresh air  

We all need fresh air, but right now, parks are closed in many places. However, Vasunia said, “If you have any windows or any balconies, please spend as much time as you can near the outside. Near the fresh air, looking at the trees, really taking some time to be mindful of that.”  

Move your body a little

When you are stuck in a constrained space, it is very important to move. Sneha Janaki suggested that it could be anything from dancing to chanting to humming. “What’s perhaps happening is that there are various kinds of stress that we are soaking in. I don’t mean a workout routine, but just some movement in the body, because the body regulates a lot of the tension or the stress,” she said. 

If you find that washing dishes or cleaning the house can be therapeutic, you can do that as well.

Be mindful 

When many of us feel uneasy we tend to dwell on negative thoughts. Emptying the mind of these thoughts can be helpful but meditation is not always one’s preference. The good news? There are other ways to practise mindfulness. Vasunis suggests adult colouring books or online crossword apps.

Communicate

Being locked up at home with family members, flatmates or even partners could lead to conflict if there is not enough communication. Especially when it comes to common tasks like doing household chores. For many, such conflicts can be a trigger for a downward spiral of emotions. 

Kanwal said that it is important to make clear to family members what you can and cannot contribute and draw boundaries. “For example, if you feel that washing dishes or cleaning the floor is something that is going to increase your anxiety, it is ok for you to take on some other things like cooking or dusting that’s less of a burden or less triggering to your symptoms. They can convey to the family that this is how much I can do and this is how much I can’t do.” 

Categorise

Gupta said that she asks her clients to do one thing each in what she categorises as necessary, important and self-care on really bad days. “Necessary would be taking baths, eating your meals, maintaining a certain amount of hygiene. It’s not like you can’t go without it one day, but it makes a huge difference if you stop. Important would be work, assignments, attending class. Self-care would be whatever you consider as self care.” 

Don’t work round the clock 

Vasunia said that one needed to be diligent about maintaining work timings as usual. “One of the things that I am a big advocate for is to follow your actual work timing. If your work timings are 9 to 5, be diligent, get on the computer at 9 o’clock, but finish off at 5 o’clock. Don’t feel obliged to work extra, because right now, the situation is not like we are on holiday. You need to be kind to yourself.”