COVID-19: The stages of isolation, and how to cope

Self-isolation, says eminent Monash University psychiatrist Professor Jayashri Kulkarni, is “an unusual and alien response for human beings” – a conclusion many of us may have already drawn in these unprecedented times of tightly restricted contact with others.

Even simple things such as shopping and schooling are rendered complex and confronting. Visiting loved ones or friends is now a hollow virtual experience rather than something fulfilling and personal. New alleged “cures” for COVID-19 are spruiked without rigour. Home lives are changed as new family dynamics run riot. And what of those who live alone?

Professor Kulkarni, who founded and heads the Monash Alfred Psychiatry Centre (MAPrc), says people draw strength and comfort from each other, and turn to each other in a crisis. These things are different with telecommunication or online; there’s no physical contact.

Here, Professor Kulkarni writes for Lens on the “phases” of self-isolation, which she likens to psychiatrist Elizabeth Kubler-Ross’ renowned ‘five stages of grief’ through which people pass and return.

“The initial phases of the pandemic led to fear and panic, evidenced by the mass panic buying and spreading of fearful messages,” says Professor Kulkarni. “While the initial fear has mostly subsided, people can expect to feel myriad emotions as we progress through the remainder of our time in self-isolation.”

She says it’s normal for emotions to fluctuate, but if low moods are persistent, seek professional help.

Week one: Adjustment and anxiety

We’ve experienced this already. A period of adjustment to the “new normal”. Fear is still apparent, and uncertainty is abundant. People have to deal with loneliness, a totally altered world, and may also experience “illness behaviour” from anxiety about perceived symptoms.

TIPS:

• When you have a sore throat or dry mouth, it can be easy to assume you have COVID-19. Try drinking water or a hot drink to see if it settles, and perhaps take your temperature once a day if you’re worried about a possible fever.

• Excessive exposure to the literature on COVID-19 can heighten fear and lead to more abnormal illness behaviours.

• Try to stay optimistic and focus on other activities to distract your mind – some denial is helpful.

Week two: Boredom and frustration

A move away from anxiety and fear into boredom, hopelessness, aimlessness, or loss. People might feel “sick” of their situation, or feel that life will never go back to normal.

TIPS:

• Beware of a tendency to think or give in to the feeling of hopelessness. Try to maintain your normal habits and routines, and not give up control over addictions or negative behaviours.

• Keep an eye on your food intake, as eating for comfort or because of boredom can lead to weight gain and make you feel worse. Don’t fall into the trap of thinking: “I deserve a treat because everything is so awful.”

Weeks three and four: Anger

Anger and paranoia start to set in. As the curve flattens the reality of what could have happened in a worst-case scenario becomes more distant and questionable, so people start to become frustrated with those who are keeping them inside, or believe that the pandemic is a hoax.

This phase is typified by the marches currently happening in the US, where people start demanding their rights, and ignoring the potential dangers of the pandemic.

TIPS:

• There’s a real need for meditation – of any kind – to help discharge some of the anger. This can range from practising transcendental meditation, to simply being present while enjoying a cup of coffee.

• Find creative ways to express anger – draw an angry painting, play loud music, write about or discuss your feelings with a friend.

• Try to visualise your anger as a colour or object, and imagine it receding.

Week five-onwards: Acceptance

People will start to accept their “new” world and find it easier to manage their fluctuating emotions.

TIPS:

• Go with it and make the most of living in the “now”.

• Find ways to learn from the experience. How do you cope under pressure? What can you improve?

• Consolidate new activities and feel grateful for having the time to carry out long-anticipated tasks such as putting up photos or shelves – the life tasks you normally put off

• Be accepting of a slower lifestyle, and enjoy it. Think about the extra time you get to spend with family and friends

The phenomenon of abnormal illness behaviour

Abnormal illness behaviour refers to the psychological reactions many people have to having an illness, or fearing the development of one – in this case, being infected by the coronavirus. People will have difficulty in perceiving, evaluating and responding to their one health status accurately – it’s essentially temporary hypochondria.

In a pandemic with such broad impacts, it’s not surprising that many people feel very anxious about every perceived symptom, especially if they have come into contact with someone who has shown symptoms, or if they’re in contact with high-risk individuals, who they fear infecting.

These anxieties can lead to abnormal illness behaviours, like taking one’s temperature several times a day, or requesting multiple tests from healthcare professionals, which increases the strain on an already overburdened system.

If people are struggling with real or imagined symptoms, they should try the following:

• Not every raspy throat is a sign of illness. If you hyperventilate, get a dry mouth or experience a sore throat on waking, try drinking some water or something hot, and waiting to see if it settles.

• If you’re fearful of a fever, it may help to take your temperature – but doing so more than once per day probably will not help. Remind yourself that if you do have a fever, it will be obvious.

• Try to avoid reading about the latest “cures” or “preventions” online. Using immune boosters, herbs, vitamins or other untested treatments will not help.

• Excessive exposure to the literature on COVID-19 can heighten fear, and lead to more abnormal illness behaviours and heightened anxiety.

• Try to stay optimistic and focus on other activities to distract your mind – some denial is helpful

Struggling in isolation – when to seek help

Everyone is going to experience ups and downs during isolation – feelings of hopelessness, frustration, anger, sadness and anxiety will be commonplace. It’s important that everyone builds an element of routine into their lives to combat mental deconditioning, and ensure that they are continuing to function normally. This will also help them transition back to ‘normality’ when lockdown is lifted.

If you find that you’re having difficulty sleeping, struggling to eat normally, drinking more frequently, or otherwise finding it hard to look after yourself, this could be a sign that you are starting to experience a more serious mental illness. If you’re worried that you or someone you know is having mental health difficulties, it’s important to seek help from your GP or another mental health professional.

How to manage workforce re-entry

Peoples’ day-to-day lives have changed significantly as a result of the pandemic – and it may be hard to transition back to “normality”. When lockdown is lifted, people may struggle to get back into their routine, and to return to a more productive way of life.

When they first return to work, people can expect to feel more tired by their day-to-day tasks, and could even experience sensory overload from the reintroduction of office noise and lighting – particularly if they’ve been very isolated. From waking up earlier and dressing in standard work attire, to the daily commute, life may feel more difficult for a time, and it will take time for people to return to full speed.

Employers have an important role in smoothing workers’ “re-entry”, and should not expect that their organisation’s former productivity will be restored right away. With such a shock to the system, it may be necessary to reduce expectations or relax targets in order to ease workers back in, and patience will be required to protect the mental wellness of employees.

CONSIDERATIONS:

• Companies should consider offering employees a phased return to work, particularly if they were furloughed, allowing them to come into the physical office perhaps once or twice a week in the first instance.

• Employers can ease the transition by ensuring that people have projects to work on during isolation that can be continued after their return to the office, to ensure a sense of continuity.

• Standard tasks may take longer as employees get back into the swing of things. They may need to look up protocols or remind themselves of the most efficient ways of carrying out their day-to-day activities.

• Pay attention to the reactions and sensitivities of workers. Returning to the workplace, with its additional noises and harsh lighting, can cause sensory stimulation, resulting in anxiety or a lag in productivity.

• It’s important to be sensitive to workers. If you and your family have been largely unaffected by the virus, try to remember that others may not have been so lucky, and may be grieving or require additional emotional support.

Post-lockdown paranoia

While many people have started to make plans about what they will do when the lockdown is lifted, they may find that when the time comes to venture out, some of the paranoia and anxiety stays with them.

People may lose confidence in their ability to remain healthy. Staying safe at home is one thing, but it’s likely that many will become hyper-aware of those sneezing or coughing for fear of becoming infected – particularly on public transport or in an office setting.

It’s also likely that people will be concerned about international travel for some time, particularly on long-haul flights and cruise-liners, which are known for recirculated air and hygiene issues.

Until there’s a vaccine, it’s unlikely that people will feel safe, and therefore that true normality can be restored.