Earlier this month Shalini Anant, an Udaipur-based psychotherapist, posted a message on Facebook in memory of fellow therapist Lovepreen Kaur, who had died after a COVID-19 infection. “You have taken a piece of my heart with you…,” it began emotionally. “She was a friend, a lovely human being, a wonderful therapist, a constant learner. It was so sudden; she was so young — just 41,” says Anant over a phone call. She took a break from taking on clients over the next few days, to process her loss.
Today, mental health professionals are burdened with collective grief, personal losses, struggles with COVID-19 and care-giving, the need to listen and partner with clients’ heightened emotions, and longer work hours for less money. Many are doing pro bono work, extending their hours, or are offering a reduced fee, with the understanding that people have lost jobs and need their support now more than ever before.
They have been trained to be resilient and to be able to dip into a toolbox of self-care, but “a pandemic of this scale is going to affect us,” says Dr Alok Kulkarni, senior consultant psychiatrist, Manas Institute of Mental Health, Hubli. “The nature and scale has been tremendous.”
His sister and brother-in-law are both doctors working on the frontline, and while he worries, he talks of resilience built over the years, by leaning on one another and personal routines such as exercise, mindfulness, and meditation. Grounding rituals such as dancing, a martial art, or gardening, help with the mind-body connect.
Peer support is a tool that mental health professionals are used to turning to, and not just now, with many going into therapy themselves. “It is a practice, like doing yoga,” says Anant.
Coping with COVID-19
Shalini Masih, a psychotherapist from Delhi, is still recovering from the exhaustion that comes with COVID-19. Both she and her husband tested positive, and they needed to isolate from their toddler, who was ‘adult’ about it at first, and then one day, threw a tantrum, refusing to be touched by her nanny.
“There was no choice but to put on a PPE suit, double mask and go out to hold her,” says Masih. After much coaxing, the little girl, through tears and screams, asked, “Where is my nest?”. Unusual, because it was not a part of her active vocabulary. “We may have talked about how a mama bird feeds the baby bird and pointed it out on a few occasions, but that was it,” says Masih, who carries her daughter’s words as a symbol of the pandemic: “It was a reminder of how unsafe she was feeling because of something that had significantly altered in her world. It is what many of us are going through, because we are seeing our nests crumble.”
Masih records two subtle changes in the way relationships function now. The first is in the therapist-client interaction. “When I had COVID-19, my clients were all checking in on me, telling me to take steam or have coconut water and giloy,” she says of the care and concern that comes from human bonding.
The second is the increasing reliance on community. It is the reason she is soon starting a weekly series of listening circles, where mental health professionals can sit down together (virtually for now) and talk.
“People feel being in the profession means you have to be stoic, that you can’t have a breakdown, but to have a tantrum like my daughter did is a healthy thing, a way to express rage and helplessness, not just grief.” She hopes the listening circle will help with all this and more.
Frontline forward
Even as therapists help people grapple with spiralling COVID-19-related anxiety, the increase in PTSD (post-traumatic stress disorder) and neurotic disorders such as OCD (obsessive compulsive disorder), there have been a few positives from the situation. Their own peer support groups have gone online, opening them to a pan-India or sometimes global participation.
There is also a discussion on a professional will, a legal document that puts forth the future of treatment for a client, in case of the untimely death of a therapist.
Then there are changes at the college level. “Students have understood that they have a voice,” says developmental psychologist Shraddha Kapoor, Associate Professor in the Human Development and Childhood Studies department, at Lady Irwin College in Delhi. “They will tell us, ‘We cannot cope.’ That they cannot make a deadline, and the teachers and the university are accepting it,” she says.
She and the teachers of her college have left their DMs open for students to communicate with them and share personal challenges, or just to talk. About three of four “reach out” daily. “They will open the conversation with something about a project, test the waters, and then put out something personal,” says Kapoor.
Recognising the age gap, Kapoor and her post graduate class did a presentation on how to be happy, as an extension of their study on counselling. The idea was to help students take back some control in the face of so much uncertainty, and to get younger students to reach out to future professionals who will work with children and families.
It is the days to come that we need to keep our eye on, with just .75 psychiatrists (last count in 2019) per 1,00,000 people and no data available of numbers of other mental health professionals. It may be years before people begin to acknowledge the trauma they have been through, before they turn to professionals for help.
Then there are the healthcare workers, who right now only have time only to tend to the sick. Masih talks of the trauma of moral injury — of having to make daily life and death decisions of whether to withdraw or withhold life support from a person who may not survive and give it to someone who may. “Mental health professionals will be in the frontline for years to come,” she says.
