By Joseph Emmanuel L. Garcia, Reporter

THE INITIAL panic that set in during the beginning of the March lockdown has become something else altogether in the months we have spent indoors.

On the outside, the world continued to move at its usual rapid and sometimes violent pace. But on the inside, millions of people were trapped indoors, worrying about their futures and unable to connect with friends and family. What effect might that ordeal have had on the mind?

“At this point, we’re trying to get by. But the trials come one after the other,” said Dr. Gia Sison. Dr. Sison works in the field of occupational medicine, but is also a mental health advocate. She appears on social media, mainstream media, and podcasts raising awareness of mental health issues.

Dr. Lou Querubin, Chief Medical Officer of Mindcare Club, an organization offering remote mental health services, said: “The most common mental health issues during a disaster, like the coronavirus disease 2019 (COVID 19) pandemic, are anxiety and depression. The COVID-19 viral contagion brought with it a fear-anxiety contagion that stimulated the human instinct for survival. We instinctively shifted into ‘fight-or-flight’ mode, which explains the early episodes of panic-buying, (which was ultimately) an effort to get the fear under control,” she said. “As the pandemic dragged on, people experienced both concrete and ambiguous losses: concrete losses in the form of unemployment, lost income, and the death of relatives and friends.”

Dr. Querubin highlighted the experience of ambiguous loss, a concept introduced by psychologist Pauline Boss. Ambiguous loss “pertains to losses for which we have had no closure, or those that leave us feeling lost and in limbo…The best examples are COVID-19 deaths where people are admitted to hospitals and no visitors are allowed. The fact that many died alone and the bereaved did not have the opportunity to go through rituals of grief and loss — such as a vigil or wake…Another good example is ‘loss of time’. It’s almost been a year now since COVID-19 broke out.  We have all lost so much time for things originally planned — like weddings, travel, vacations, training and education.  Time is a very clear example of ambiguous loss — we have time and yet, we have lost lots of time.  The irony of that concept needs thinking and reflection for each of us to make sense of what we have lost and what we gained at the same time,” she said.

Dr. Sison, meanwhile, said: “We’re already dealing with reality. That’s difficult. It’s something uncertain. We don’t even know when this will end. That in itself is a big stressor. That’s what we’re confronting now.”

Both agree that the COVID-19 struggle looks different when viewed through various lenses. While others mourn the loss of their freedom of movement, others lost their lives and livelihood. Dr. Sison said the pandemic affected privileged people as well as those without it. “It is a battle. Even without the pandemic, every day is a battle for everyone. We have different struggles.”

Dr. Querubin doesn’t view the mental health struggle as anything so straightforward as winning or losing the battle. When the problem has become collective, the analysis becomes more complex. “My thinking is that there are several battles going on at the same time at different levels.

The master narrative underlying everything is the global battle to contain the virus, a public health disaster that is cruelest to the poor and vulnerable everywhere, devastated economies no matter how rich, and overloaded health systems no matter how advanced.

Dr. Querubin added, “The more abstract battle happens in our minds, and in the context of relationships.” She calls this “meaning-making.” “Individuals who are able to reflect and make sense of how they are thinking, feeling, or responding to everything happening around them are the ones most able to understand themselves and how the pandemic is affecting them.”

An unintended consequence of the pandemic is the increased discussion of mental health. Your typical picture of the occasional depressed individual, shut in and confronting one tiring day after another, is multiplied by the millions.

According to a joint statement issued by the Department of Health (DoH) and the World Health Organization (WHO), the National Center of Mental Health (NCMH) reported that as of September, its crisis hotline “has revealed a significant increase in monthly hotline calls regarding depression, with numbers rising from 80 calls pre-lockdown to nearly 400.”

Dr. Sison said she has received an increased volume of messages asking for referrals for psychiatrists and psychologists. “That’s a long-term problem. It’s not just COVID-19 as an illness, physically. There’s already a mental health aspect that we have to incorporate when you want to deal with it holistically.” Dr. Querubin concurred, saying, “There is increased awareness about the mental health needs of populations.”

Dr. Sison added that while there have always been calls for increased awareness and advocacy — she lobbied for the Mental Health Law of 2018 — “It was amplified by the pandemic. More people started to talk about it, again, and again, and again. Consistency is key when you’re in an advocacy. For me, it should never stop.”

Pointing to her own background in occupational medicine, Dr. Sison noted that a bank implemented a mental health policy in October. Dr. Sison posits that the sense of urgency may have stemmed from the blurred lines of working from home, in which the personal and the professional have become intermixed. “That’s something we would only dream about before. I hope more workplaces would have mental health policies in place for their employees,” Dr. Sison said. “They appreciate it, and they acknowledge it, especially in the workplace.”

Both pointed to the coping mechanisms people have adopted since March, such as new hobbies like gardening or cooking. “That is a coping mechanism,” said Dr. Sison. “You find activities, or you find things that you’re happy to do. That’s one thing that this pandemic actually squeezed [out of us]: a lot of people have gone into their untapped talents. They explored a lot of possibilities.”

Dr. Querubin said keeping occupied serves a purpose: “Keeping our hands busy helps us focus our minds on something concrete, and hopefully, pleasurable. Art and music have always played that role in human history. They are proven balms to our soul and psyche.”

While the darkest days of the pandemic may have passed, the stasis it has produced  in our lives remains unresolved. Dr. Sison said one possible remedy might be to relinquish control. “We really have to realize that there are some things beyond our control. We have to draw a fine line between what we can, and what we cannot control.” While many of us cannot defeat the virus on our own or influence policy, we do have a choice in how we choose to react to events.

Dr. Querubin, meanwhile, points again to meaning-making. “The human capacity for meaning-making is an eternal source of inner peace and courage.  It helps us make sense of the external environment and hopefully, enables us to reach a point where we realize the choices we have.  Our awareness of our choices, and the very capacity to exercise that choice — is very empowering.  Meaning-making and realizing that we do have a choice, no matter the circumstance, is one good way to win our internal battle.”

Both also consider keeping in touch with family and friends to be vital. “You cannot go through trials or struggles alone. At some point, you need to reach out,” said Dr. Sison.

Some hope has emerged as drug companies report moving forward with their vaccines, but the pandemic has left wounds that a vaccine alone cannot heal. Dr. Querubin said, “The virus is here and it will stay, like the flu, measles, chicken pox, etc. Perhaps this phase of the pandemic will be over, but COVID-19 as a virus will remain in our midst. From a medical perspective, I will encourage everyone to improve their immune systems by eating healthy, getting enough sleep, maintaining a reasonable level of physical activity that promotes fitness.  If you have a pre-existing illness that makes you high-risk, stick to the recommended treatment regimen with greater dedication.”

Dr. Sison points out that the vaccines may not be released to the general public until the third quarter of next year, adding the delay to the basket of things people worry about daily. Nevertheless, “I think the healing starts today; and every day of the year. We don’t have to wait for 2021,” she said. “You get by; you take it really one step at a time.”

Dr. Querubin added: “From a psychiatrist’s perspective, my recommendation is we heal as we go.  There will likely be no clear endpoint when we can say it is all over. We need to mind ourselves moment to moment, day to day.  Be kind to ourselves and to others as best we can everyday.  We cannot start to heal when everything is over; we heal as we go.”