20 April 2020

Transitioning to and from uncertainty in the COVID-19 era

Mental Health

Life presents us with a seemingly endless set of transitions, some predictable expected and welcomed, others not so.

There is the transition within the life cycle from infancy to childhood to adolescence to adulthood to senescence and finally to death. Each of these milestones and each transition to a new milestone presents its unique challenges. From kindergarten to primary school to secondary school to higher or technical education and into the workforce, friends are made and lost, relationships are formed and broken, success  is achieved and failure is confronted.

There is an element of certainty attached to these transitions which is met by rites of passage. It is anticipated that as we grow older we will move through the education system, then through one or more jobs or even several career changes. It is anticipated that we will partner with one or more individuals, perhaps raise a family, purchase a house, save money directly or through superannuation so we have enough to eventually retire.

There is, of course, no guarantee or certainty that any of these things will happen.

When these transitions occur they do so over a period of time, rather than overnight. The current coronavirus crisis has occurred almost overnight and has left all of us unprepared emotionally for its impact. Transitions may be glacial but the transitions brought about by COVID-19 are lightning fast. From freedom of movement to lockdown, from mass gatherings to isolation, from employment to unemployment, from financial independence to seeking handouts, from school and higher education on campus to learning online and at home.

The human condition needs a level of predictability to thrive and survive.

Remove predictability and create uncertainty and we become fearful, anxious and then depressed, even chronically so. Many of us are now fearful of permanent loss of employment,  loss of savings, loss of meaning, loss of health and loss of life.

Professor Myrna Weissman , a clinical psychologist who developed Interpersonal Therapy as a  means of treating depression, believed in certain trigger factors that underpin the onset of this condition. They include loss or   grief, transition, interpersonal conflict.

It seems that the current crisis may contain all of these trigger factors, whereas normally there may only be one or two triggers. We are witnessing loss on a monumental scale, including loss of thousands of lives.

This leads to grief. We are now grieving for and longing for a past we took for granted. It was a past with come certainty, knowing consciously or unconsciously that apart from taxes and death, the only other certainty in life was change, and change is what we are experiencing.

We planned and looked forward to coffee or meals with friends, family gatherings, attending sporting events and theatre or simply going to the local playground with children. These pleasures have been stripped from us. Coffee over Zoom is not the same.

And for those who have lost their jobs, they grieve for the loss of security as they face an uncertain future.

The transitions that I have mentioned have occurred on a massive scale and with electrifying speed. When we add loss and grief to transition, and place them in the incubator of a lockdown, we face the possibility of interpersonal conflict.

Adding all of these factors, we have the makings of a pandemic of depression, with the potential for domestic violence and even civil unrest as the lockdown is extended.

Our leaders and society at large are confronted with an enormous challenge. Keep the lockdown going and delay or prevent spread of the virus, or ease the lockdown and prevent economic meltdown, mental illness and social unrest.

As we are still in the early phase of the lockdown and amid school holidays, we may feel comfortable in maintaining lockdown but what will it be like in two or three months time?

We are confronted with uncertainty on many fronts,  importantly the decision and timing to ease the lockdown and then encourage return to work, while avoiding a second wave of infection. This will require the judgment of Solomon. Let us hope our leaders, acting on best available evidence, have the capacity to act wisely.

In the meantime, we need to bring a measure of certainty into our lives.

Setting goals for each day, enjoying the outdoor for a limited time, maintaining an indoor fitness regimen, catching up on domestic chores that have been postponed, reaching out to friends by phone or digital media, seeking psychological support when needed, and always being vigilant with hand hygiene and social distancing.

We need to maintain faith in our health system and our public health measures. Morbidity and mortality in Australia are still relatively low. We must turn despair into hope and hope into joy, in the firm belief that this too will pass.

Dr Leon Piterman is Professor of General Practice at Monash University and has been in clinical practice for 40 years

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