by Dr Levent Yurdakul, Clinical Psychologist
Last week a report by the Royal College of Psychiatrists revealed what many had suspected. There has been a very significant increase in people seeking support for mental health problems during the pandemic with children and adolescents bearing the brunt of what is being described as “a mental health crisis”. The figures are alarming.
Most people would agree today that negative life experiences such as pandemics, bereavement, losing a job and isolation are more than likely to have a detrimental effect on our mental health. Yet it was not that long ago that the emphasis was placed squarely on genetic make up and environmental factors were paid mere lip service. In the mid 90s when I was a researcher looking at the effects of life events and chronic stress and their contribution to depression, this area of research was for the best part marginalised. This was despite the growing body of research during preceding decades that showed how life events and difficulties starting from birth can have a significant detrimental effect on mental well-being. The issue was that the medical model had a stronghold on psychiatry and on mental health services. Cognitive-behavioural therapy (CBT) was the psychological orientation that was best tolerated by the medics because ultimately it is a very pragmatic approach that focuses on changing the way we think and behave in order to improve mood. CBT can be highly effective. However by locating the solution to difficulties as primarily within the control of the individual, such rational approaches can underestimate the barriers to making meaningful changes. Some require a much more interpersonal approach.
The idea of challenging unhelpful beliefs and assumptions is an abstract skill that does not take root overnight. Hence those who are greatly distressed perhaps with very high levels of anxiety or marked symptoms of depression will find it very difficult to challenge their own unhelpful thought process and develop a more adaptive mindset and behaviours. This is why they often seek professional help or are encouraged to do so. For those with less challenging symptoms it may be possible to make use of self-help books and begin to see a way out. However, it is usually in conversation, in a supportive, constructive dialogue that we are more likely to see the limitations of our own thoughts and circumstances and begin to see a possible way forward. The origins of all talking therapies, and arguably CBT in particular, can be traced back to Greek philosophers such as Aristotle and Socrates. Socrates embodied what has become his often quoted words, “the unexamined life is not worth living”.
During the pandemic many will have had time to pause and reflect. This will have raised some questions and provided an opportunity to review life goals and priorities. Factors that determine quality of life such as less commuting and spending more time with family, having more green space nearby, and having more control over how we use our time have become much more relevant. The other factor that has increasingly gained attention during the last year is the significance of close friendships, social support and how hard isolation has felt.
For many the pandemic has been very challenging creating uncertainty in terms of work, finances, health and relationships. Children and adolescents, and young people starting out in life have arguably been affected the most. For others, perhaps more so those with stable jobs, finances and with the option of working from home, the pandemic may have had a number of benefits. But most likely all of us have been affected adversely in terms of relationships and social support. Even those self-proclaimed introverts have started to complain about the limitations of consecutive lockdowns and that they have grown tired of zoom interactions!
For those who are naturally inclined to seek out relationships and social interactions the lockdowns and the inability to be near and to touch or hug others has been hard to bear. The pandemic represents an ongoing stressor and we cannot underestimate the impact of this on our mental health. If we add to that bereavements, redundancies and financial hardship we are looking at significant life events in the context of an ongoing stressor. Add to that daily hassles such as home schooling whilst trying to hold down a job, endless meal preparations and possibly doing all of this in cramped living conditions, the stress mounts further. The effect of this on the nervous system can be significant. A body that is persistently mounting a stress response eventually succumbs to the deleterious effects of adrenaline and cortisol. Even those with greater protection who are buffered against the adversities of life through wealth and privilege are not immune to the effects of stress.
What are the things that can help us in times of such uncertainty and adversity? Almost every week there is another article on self-help strategies. Exercise, yoga, meditation, mindfulness and other such practices can promote relaxation and reverse the effects of the stress response by altering the autonomic nervous system response. Reading self-help books and inspiring literature, introspection and developing greater self-awareness can help us to reframe our personal circumstances more positively. This can give a fresh impetus (increase our sense of agency) to pursuing meaningful goals or interests. Having a sense of purpose and meaning in one’s life can enable us to overcome even the most challenging circumstances as Victor Frankl taught us.
However, there are arguably more fundamental elements required to looking after ourselves and the people around us in times of adversity. Eric Berne wrote that if we don’t receive strokes (either physical touch or social interaction) our spinal cords will shrivel up. Thus the need for physical and mental stimulation and recognition is vital for our well-being. Without that connection from relationships there is a limit to our ability to thrive. Prolonged stress and hardship often leads to emotional dysregulation and can result in distress, anxiety and depressed mood. Intimate and close relationships can play a very important role in restoring emotional balance through co-regulation of affect. The idea that having a close confidant as a protective factor against depression was highlighted in the 1970s by the pioneering work of Brown and Harris. Yet it has taken a long time for this finding to make it into main stream consciousness. Supportive relationships, where individuals are empathic and attuned to the needs of the other can promote more positive and stable mood. Thus social interactions can help not only to regulate mood but quite possibly prevent the onset of severe anxiety states and depression. The healing power of social support should not be underestimated.
The pandemic has made many people more insular not just physically but in terms of their mindset. This spring as we ease out of social restrictions and begin reconnecting in person with family, friends and colleagues we will perhaps be more mindful of just how nurturing these relationships can be for us to thrive. For it is in the context of such supportive relationships that we may be best placed to safely examine our own lives and make changes for the better.
by Dr Levent Yurdakul, Clinical Psychologist