Paul Valent

Paul Valent

MBBS, DPM, FRANZCP
Consultant liaison psychiatrist, psychotherapist, traumatologist,
Co-founder and past president Australasian Society for Traumatic Stress Studies,
Writer.

Mental health in the pandemic

November 30, 2020

The widespread mental health effects of the corona virus pandemic have highlighted the inadequacies of our mental health system. The system needs ‘sweeping changes’, an ‘overhaul’ (The Age, Nov 17th), according to Prime Minister Scott Morrison.

The overhaul will require a huge budget, nearing ten figures. It may require changes in sites and systems of delivery, according to Stephen Duckett (The Age, Nov 17th).

Yet there is a degree of uncertainty at the core of the mental health problem. It is not in the quantity of such problems; they have certainly increased and will continue to increase, we know that from past disasters. But what is the nature, the quality of these problems? We can have all the infrastructure and money, but above all we need knowledge of what is required for what.

We hear that the mental health effects of the pandemic are suicide, anxiety, depression, and family violence.

But here are some voices of those who had asked for help. ‘My mind is racing.. my mind is blank.’ ‘I can’t concentrate. My memory is failing.’ ’I roller-coaster from anger, fear, and crying to total numbness.’ I am totally demoralised with this second wave. It will never end.’ ‘I’ve hit a brick wall and I’m like Humpty-Dumpty.’ ‘I anguish at letting my employees go. They were like family.’ ‘I am guilty because others are so much worse off.’ ‘I crave my boyfriend’s touch.’ ‘I can’t stand my husband nagging me all day.’ ‘I care and care and care but I crave being cared for.’ ‘I’ve put on weight.’ ‘My chest is lead.’ ‘My chest is exploding.’ ‘My mummy is angry.’ ‘I miss my friends.. I miss my teacher.. I miss learning.’ ‘He is bedwetting again.’

We see much wider symptoms than the above four often quoted. The problem is that unlike for psychiatry, we do not have a Diagnostic and Statistical Manual for stress reactions. Yet it is important to treat the stress reactions before they become chronic illnesses.

Following the 1983 Ash Wednesday bushfires I was lead author of a Red Cross pamphlet Coping With A Major Personal Crisis. It helped survivors in many Australian and overseas disasters recognize that their symptoms were normal in the circumstances and that they were not crazy.

Since then we have learned a lot about the sources and meanings of the variety of mental health consequences of stressful situations. We have long known that fight and flight are drives that can result in biological, psychological, and social symptoms. Now we recognize further drives: drives to save others, attaching to others to be saved, striving for essential goals, grieving having to give up what was essential, competition, and cooperation. Each drive manifests in its brand of symptoms, as well as moral judgements and existential outlooks.

Disasters throw set pieces up in the air. Compensation for the consequent suffering may involve setting the pieces together to greater advantage as they return to earth.

Overhaul of the mental health system may include treatment of upset mental equilibria early in age, early in time, closer to home, and with more sophisticated tools.

I believe we now have the knowledge for sophisticated early intervention and holistic help. So indeed let us take the opportunity to overhaul the mental health system and move toward a healthier and happier community.

Prepare for this. The Age, 29th Nov 2020 (Post-disaster euphoria).

November 29, 2020

Euphoria set in on Friday 27th of November 2020 as we were officially declared to be COVID-19 free. Perhaps we have even eliminated the virus. Self-congratulations ranged across the community. We achieved together, through sacrifice, a rare victory in the world.

We deserve to party, have a holiday, enjoy friends and relatives, to see each other full-face without masks. But soon we should put in context what is known as post-disaster euphoria, a result of shared survival, common across bushfires, earthquakes, and ends of wars.

We should prepare for the next long phase of reconstruction. This includes recognition of what has been destroyed and lost: people, health, and family and economic infrastructures. Grieving them and replacement with new equilibria, even if sometimes better than pre-disaster ones, is difficult and frustrating. This is the phase when pent-up suffering and exposed fault lines manifest in increased mental health issues, psychosomatic illnesses, and social tensions.

Understanding and being prepared for this phase can ameliorate its noxious effects.

 

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