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Out of Place: The Trouble With Life Indoors

How life under quarantine can affect your mental health.

The pandemic also attacks us mentally and emotionally as it threatens our physical well-being. IMAGE BY ANGELO CANTERA

W eeks ago, in Metro Manila, a friend of mine appeared to be getting sick because of a measure that was meant to keep him healthy.

He wished to be referred to as J. Hizon. He is 30 years old, he lives alone and as we spoke via video chat that evening—touching upon matters he didn’t want to be linked to his full name—he had to contend with sporadic bouts of coughing.

“You OK?” I asked him, at one point. He nodded with both hands covering half of his face. He then moved out of the frame and started hacking until he felt relieved enough to resurface and talk. “I’m going to die,” he said in jest. And I must’ve looked worried since he immediately scowled at me and said that I should relax. “Don’t worry,” he told me. “I don’t have it.”  

He was referring, of course, to the coronavirus disease 2019 (COVID-19,) that which–as of the writing of this article–has already killed more than a hundred thousand people across the globe after originating from Wuhan, China late last year. Like a lot of the people living in Luzon, Hizon has been trying to avoid the virus by adhering to the ongoing enhanced community quarantine (ECQ) imposed by the national government in March. This means that he has been alone for weeks, confined in his studio apartment in Pasig City. “Safe for now,” so he told me. But as he coughed once again, and as I examined his surroundings, I couldn’t help but think that by avoiding one health problem, he might end up combatting another.

“If you want the truth,” he said, “I’m not entirely OK.”

He certainly was the last time I talked to him in person. Back in March, when plans for the ECQ were mere rumors, the two of us were having dinner at his apartment. Looking fresh and content, he was delighted over a new project he was working on as a graphic designer. On the side, he was also thrilled over the fact that, after our meal, the stick of Malboro Black jammed between his lips was only his fifth helping of nicotine for the whole day; a vast improvement for a heavy smoker.

But on the night of our video call weeks into the quarantine phase, the corner of my screen showed an ashtray filled to the brim with cigarette butts, the likely culprits behind his persistent, wheezing cough. Around his eyes were dark circles pronouncing the fact that he’s been having trouble sleeping. And on his lips, confessions. There’s the admission that he hasn’t been doing well at work, that he’s been having trouble concentrating and that his phone was “practically bursting” with follow-ups and lengthy sermons from one of his superiors.  And then there were the more personal stories like how he’s been doing things he promised himself he’d never do again; from leaving walls of text on the inbox of some guy who continues to ghost him to engaging in cam-to-cam beat off sessions with strangers on Zoom.

“Maybe I’m just bored,” he said, trying to lighten the mood. “That’s why I’m making problems for myself.” Or maybe my screen that evening was framing the portrait of a man unraveling in these trying times. Considering what I’ve been told, this is far from being unlikely.

I n an email interview with this publication, psychologist Zenia Lim Panahon said that people may experience varying mental health issues even though they are not in the front lines of this battle against COVID-19. These people, she said, may exhibit several symptoms like increased irritability and fear for one’s well-being. Others may also experience worsening chronic health problems and interpersonal difficulties. Sleeping and concentration problems are also indicators and so is the increased usage of mood elevators like alcohol, tobacco, and drugs. Obviously, Hizon was exhibiting some of these.

“People generally like certainty and predictability in life,” said psychologist Angela Arriola Yu. And, according to her, COVID-19 with its attendant complications has robbed people of those. The viral outbreak, after all, has been unlike anything the country has experienced in recent years and because of this, it carries a host of novel disruptions.

Chief among them is the ECQ in Luzon. Never in recent history has the Philippine government ordered a large portion of the populace to stay at home for more than a month because of a pandemic. The current quarantine phase started last March and, after a significant rise in the number of cases and deaths, it was extended until April 30.

Equally unprecedented is the near economic standstill that tails this measure due to the limitations it has imposed upon non-essential work. As a result of the enforced quarantine, several business owners have decided to temporarily close their respective operations. Those who can continue to operate have temporarily migrated much of their dealings online. Meanwhile, a number of daily wage earners were forced to rely on their respective local government units to get by. All of these translate to a departure from the norm and according to Yu, that is often a source of internal struggle.

“Being pushed out of [one’s] routine and comfort zone is generally an unpleasant experience,” she said. “And lockdowns could mean disruptions in one’s daily routine aside from the many implications that work stoppage may have on workers, particularly daily wage earners who depend on their income for their daily basic necessities.”

“For business owners,” she added, “a lockdown may mean slowing down or even temporary closure of business. Financial uncertainties, in general, will likely lead to stress, anxiety, or worse, panic attacks.”

That said, it isn’t just the ECQ that’s possibly causing stress to those who aren’t in the frontlines. The nature of the virus itself is also troubling.

Because of its high infection rate, its ability to drastically worsen the conditions of the immunocompromised and the fact that there is still no vaccine developed for it, COVID-19 has become nothing short of an alarming threat. It also doesn’t help that the virus continues to highlight the shortcomings of the bodies meant to combat it in the country.

Let’s start with the local health sector. When COVID-19 became a trending topic in the Philippines, it underlined the industry’s shortage of equipment and facilities. It even came to a point when some public hospitals were asking for donations to protect their staff.

And then there are the issues concerning local leadership; how a number of government officials allegedly failed to live up to their electoral promises through their actions or lack thereof during the pandemic. Example: the politicians accused of failing to respond to the virus with urgency and efficiency. This supposedly led to pandemic responses characterized by confusion, inadequacy and bureaucratic gridlock which is partly to blame for the delay in the distribution of food aid and financial subsidies. Then there were those who supposedly violated the triage algorithm utilized by the Department of Health, the officials who reportedly had themselves and their family members tested even though they were asymptomatic. This happened while the country was struggling with the lack of testing kits.

All things considered, what we have at the moment is a barrage of stressors that can leave the public unnerved. And the possible results? Psychiatric upheavals all around.

“[A pandemic] can cause many others to panic,” said Panahon. “Fear, which is the basis for panic comes about when we are concerned over something. Panic, on the other hand, while it arises out of fear, is mainly our desire to be in control of our situation.  This kind of feeling of being out of control leads to abnormal behaviors like panic buying, screaming at or fighting with people over the simplest of things. Sometimes, the feeling that one is about to die can happen in a panic attack.”

This is something Hizon can certainly relate to. He has yet to have a panic attack, so he said, but he has definitely lost sleep over the varying reports concerning the virus and the responses to it. “At first, [COVID-19] didn’t really bother me that much,” he said. “But after reading the news for several days straight, after seeing the number of cases and deaths rising consistently, getting a glimpse of how hospitals were being overwhelmed, I started to feel trapped. Like, maybe it’s only a matter of time before it gets to me or someone I care about. And when that happens while hospitals are stretched to their limits, how can I feel secure?”

He also talked about the front liners, how it makes him feel guilty knowing that the only thing he can do for them is to stay at home. “I’m not wealthy,” he said. “I only have enough to get by. So, it makes me feel helpless knowing that the best thing I can do for the cause is to stay put.”

This needs to be done regardless, so most reports and experts would tell us. For some of us, the best thing we can do for the front liners is to prevent ourselves from getting sick. But, caring for our bodies is not enough, apparently. As famed American physician David Satcher once said, “there is no health without mental health.” This is why both Panahon and Yu believe that people should proactively take steps to safeguard their psychological well-being.

According to Panahon, “understanding ourselves during this health crisis is a must.”

“Being mindful of what is happening to us is part of looking out for ourselves,” she said. “The signs to watch out for are important to track.” These include the ones mentioned earlier. Adding to them, Yu said people who openly question the value of their existence or life purpose might also be enduring mental struggles. And, once we recognize that we (or the people we are looking after) are exhibiting such symptoms, both psychologists believe that certain steps should be taken.

“For those of us who feel isolated, we can think of creative ways to be in contact with family and friends,” Panahon said. “Having an online party is another way to be in touch with friends and relatives.”

Yu, on the other hand, suggested a variety of solutions that may help ease mental health issues. “Seeing change as the norm may reduce the fear and anxiety one experiences, even in the worst of uncertain situations,” she said. “For instance, explaining that getting infected and recovering from COVID-19 may be as uncertain as figuring in a plane crash may help put things into perspective.”

Yu also believes that it is important to reinforce temporariness. “This too shall pass’ is a good phrase to repeat to oneself,” she said. Distractions, according to her are also crucial. And then there’s the virtue of reassurances. To those who are trying to help others battle anxiety, she shared that it helps to verbalize support. “Citing data, offering support such as financial or [the] promise to address problems may help minimize the sense of being overwhelmed by an uncertain future,” she stated. “In these days when face-to-face encounters and touch are not welcome, the use of technology can take their place.”

There are times, however, when one’s situation degrades to the point that it leads to frightening episodes like a panic attack. When this happens, people experience intense overwhelming fear accompanied by physical symptoms. Some of which resemble the symptoms of a heart attack. According to the Mayo Clinic, these involve a rapid, pounding heart rate, sweating, trembling, shortness of breath, throat tightness, chills, hot flashes, nausea, abdominal cramping, chest pains, headaches, dizziness or lightheadedness, numbness, and the feeling of unreality or detachment. When these manifest, it is often wise for one to be examined by doctors to rule out the possibility of serious medical emergencies. But, if one is certain that one is having a panic attack, Yu does have a suggestion to help combat it.

“In a panic or anxiety attack, teaching people to ground themselves on the physical reality is another technique,” she said. “The strategy is to identify five things one sees, four things one hears, three things one feels, two things one smells, one thing tasted.”

Panahon also has thoughts on the matter. “Taking long and slow breaths can calm the panic,” she said. “Making a reality check—asking “where am I now?” or “what is actually happening?”—also helps.  Prayer and, or meditation is another way of calming the mind.”

In the long run, however, Panahon stressed that prevention can be better than cure and this is where avoidance comes in. While it is crucial for people to stay informed about COVID-19, constantly monitoring reports on the virus may also be harmful to one’s mental health.

“It is important to stop listening [to,] reading or watching the latest news,” she said. “Give yourself a break by reading a book, spending time with [your] family or being by yourself as much as you can.”

Of course, that’s not entirely relevant to someone like Hizon; the man’s not really much of a book reader. He also doesn’t have much of a family anymore since both of his parents have passed away, he is an only child and his surviving relatives have moved abroad. But this quarantine phase did provide him with a unique consolation, something that he did end up appreciating.

“So, how are you?” he asked me that evening.

I told him that I’m fine; that while I remain busy because of work, the mere fact that I don’t have to leave the house for it eases my schedule. I also told him that there has been a new development in my life “but it’s a long story.”

“You want to listen to it or are you maxed out?” I asked.

“Go ahead,” he said. “We’ve been busy. We haven’t spoken much recently. Now we have time. Lots of it.”

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