Quarantine, lockdown pose another psychological threat

We are going through testing times, doing everything possible to contain the killer coronavirus, which nevertheless, continues to spread its tentacle across the length and breadth of the planet. Thousands are falling down dead, lakhs testing positive by each passing day. Most of the countries across the globe are on a lockdown mode, including ours, with 'quarantine' and 'lockdown', being the most heard words.

Quarantine is the separation and restriction of movement of people who have potentially been exposed to a contagious disease to ascertain if they become unwell, thereby reducing the risk of them infecting others. Normal people also confine themselves at their homes as part of prevention of prevalence of the epidemic. Though now we are using it amidst the recent outbreak of coronavirus disease (COVID-19), the word 'quarantine' was used in Venice, Italy, in 1127 with regard to leprosy and was widely used in response to the black death.

On this context, it is very essential to understand the psychological impact on mental health because quarantine is often an unpleasant experience for who undergoes it.

Separation from loved ones, the loss of freedom, restrictions on day-to-day activities, uncertainty over disease status and boredom can create dramatic effects. Potential benefits of mandatory mass quarantine need to be weighed carefully against the possible psychological costs.

A survey conducted in recent times in corona-affected Italy shows that people are struggling with the lack of freedom, fresh air, exercise, and social activities and that some report shows being bored and lonely and some studies reveal that, there are high prevalence of symptoms of psychological distress and disorder equipped with quarantine ranging from emotional disturbance, depression, stress, low mood, irritability ,insomnia to PTSD (post -traumatic stress).

PTSD is an anxiety disorder characterised by avoiding stimuli associated with a traumatic event, re-experiencing the trauma, and hyper arousal, such as increased vigilance. This disorder may develop after exposure to traumatic events that involve a life-threatening component, and a person's vulnerability to the development of PTSD can be increased if the trauma is perceived to be a personal assault.

Increased length of time spent in quarantine is associated with increased symptoms of PTSD. We anticipate the effects of infectious disease threats to manifest as sheer anxiety and panic about getting an infection, worry about loved ones getting ill, and worry when related symptoms, even minor, are present. The absence of a definitive treatment for coronavirus easily exacerbates anxiety. This anxiety leads to unnecessary fear of ourselves, which in turn, leads to contamination obsessions, unwanted, intrusive worry that one is dirty and in need of washing, cleaning, or sterilising, are common in patients with Obsessive Compulsive Disorder OCD. Perceptual experiences (eg, feeling dirt on skin) understandably would amplify obsessions. cleaning and washing compulsions are the core feature of OCD.

Prolonged self-quarantine would lead to post traumatic stress symptoms and avoidance behaviour, which means any action a person takes to escape from difficult thoughts and feelings. People obviously start searching for ways to get out of the situation by hook or crook ignoring the consequences of abandoning the quarantine.

Confinement, loss of usual routine and reduced social and physical contacts are causes of boredom and frustration. The sense of isolation from the rest of the world make us vulnerable to frustration and anger, and we are unable to cope with it leading to depression and emotional outburst. When resources for peaceful livelihood are hampered and incapability to adjust to the prevailing situation would lead to anxiety. Constant fear shortage of resources would lead to overstocking and always make us sink in over precautionary measures which make us panic and sleepless.

'Medical mistrust', or lack of proper information of the epidemic, lack of knowledge on medical advancements and available medication would lead to insomnia, suspicious thinking, poor concentration, irritability, loss of control on self etc. If not addressed on time, this emotional outbreak may lead to longitudinal effect with the worst rate in future even after lifting of lockdown period.

Now it is time to self-evaluate and introspect like what we are, where we are, what are we doing and set a tab on our assumptions, illusions and reaction abilities. The featuring guidelines would certainly be helpful to cope with psychological adversities at present: Be constructive. According to WHO Director General Tedros Adhanom Ghebreyesus, "It is easy to blame, it is easy to politicise, but it is harder to tackle a problem together and find solutions together." Hence, stay calm and collective.

Engage in healthy distractions such as reading a light-hearted book or watching a funny movie, going for a walk in the fresh air or learning a new language or skill which would enlighten our thinking on a lighter vein and gallop the hardheartedness towards the prevailing irreversible situations. Obtain your information from reliable sources. Get the facts and stick to the norms. We need to watch our language to avoid dramatics and hysteria. Information from unreliable and biased sources would brutalise our thinking.

Rather than saturating yourself in updates excessively, ring fence incessant media exposure to certain times in the day which would tune your brain to open the window of thinking over the pandemic, which reduce the stress and anxiety throughout the day. Imaginations are what leads to belief, hence believe in rightful way which would in turn develop rational thinking and discriminate us from virtual to reality.

The disruption in your normal daily routines can be one of the most difficult aspects of the lockdown. It can leave you feeling directionless as you try to figure out how to fill all the hours of the day, to avoid the same with establishing a routine. Mental preparedness is the key to success to overcome any hardiness in life and most important, remember that human life is day to day war, so make yourself prepared with the situations, we have to face and estimate the probable outcomes of the situations after quarantine period. Make yourself ready mentally to face them with ease and dignity.

In fact, in Italy, the researchers suggest online campaigns that involve collective exercises and social reading, and say the government could try to connect younger and older generations, instruct people about the safest ways to get fresh air outside, and even give out cheap tablets so everyone can chat via video.

Even short period of physical inactivity would have a great impact on physical and mental wellbeing. So, chalk out an indoor or within boundaries workout regime which should be well maintained without any disruptions and excuses. Stay in touch with your loved ones even over the phone frequently which can make you feel blessed and secured.

On the edge, it is time for fullness, togetherness, patience to combat the pandemic with grace and adherence. Maintaining equilibrium within self and with surroundings is very essential at this juncture. The psychological effects of not getting quarantined and allowing disease to spread might be worse, however, depriving people of their liberty for the wider public good is often contentious and need to be handled carefully. Psychological professionals should be included in preventive services for tackling the prolonged effects of PTSD.

(The writer is a Hyderabad-based psychologist)