Mrinal Pande, NH Group Editorial Advisor, in conversation with Dr Jitendra Nagpal, Senior Consultant, Psychiatry at Moolchand Medcity. Having developed training manuals and guidelines for the MHRD and NCERT, Dr Nagpal’s major area of concern is the impact of Covid on younger people. The lockdown and collapse of the economy have impacted the mental health of many. But while educated, middle-class Indians have begun consulting psychiatrists, children and teenagers from poor families and living in slums are virtually uncared for. Some such children have also committed suicide because they did not have access to online classes, he informs. Dr Nagpal explains what is at stake.
Why has the pandemic affected us so much? Natural calamities and even pandemics did visit us earlier as well, didn’t they?
In our lifetime we have not come across such a sudden and sweeping tsunami. It has restricted mobility,enforced physical and social distancing and changed the three institutions integral to our life,namely the family, schools and the campus and our workplace. Nor was anyone prepared for such a long, lockdown. Three weeks had seemed manageable but three months have proved hard for most people to cope with. Anxiety levels have increased,people are suffering from claustrophobia confined to small spaces and people find themselves isolated. This is the case across the world, judging by reports we are getting from Britain, Australia,China and elsewhere. Unfortunately,children and the healthcare workers seem to be under more pressure.
But we have faced disasters and epidemics before…
They were confined to different countries and different regions; the severity also varied and they did not last so long.
One understands the pressure on healthcare workers but why are children more affected?
Children in the 4-10 age group have the natural desire to runaround, play with children their age out in the open. It is highly unnatural for them to be confined at home, to have parents breathing down their neck all the time and miss schooling.
Children are throwing more tantrums. Some have become defiant. Others are displaying hostility. Children and teenager salready under psychiatric treatment are showing destructive tendencies.
But then the teenagers are marginally better off as many of them in the cities have access to smart phones and laptops. But with the campus closed, exams uncertain and admissions deferred, they too are bearing the brunt of an uncertain future. Those who expected to get jobs this year are showing heightened anxiety,depression and withdrawal symptoms. It is worrying to learn of IIT and IIM students taking their lives. Suicides have also been reported from poorer areas and slums, where young students have taken their own lives because of their inability to attend online classes.
Their parents too must be facing a lot of stress…
Yes, families are under a lot of stress. Women are as usual bearing the brunt of it. They have to run the household, do their own work from home if employed, take care of the needs of children and the elderly and assist children with school work. Faced with uncertainties in the workplace, pay cuts and even joblessness, the men have lost confidence. They might be prone to vent their frustration and thus affect the mental health of others.
But how are you so sure that these cases have gone up? The clinics must be still closed?
The OPDs are closed. But online consultations and video sessions that we have confirm the trend. Earlier, when OPDs were open, on an average two to four patients turned up for consultations. Now during the lockdown the number has jumped to 9 to 10 cases every day.
Parents are calling up from not just Delhi but also from Uttarakhand, Haryana and UttarPradesh. They are seeking advice and looking for medication to calm down teenagers suffering from depression and those who have become drug addicts.
I had a call from a parent from Bareilly whose son, a brilliant student, is getting increasingly aggressive and despondent by turns because his class 12 exams are currently on hold indefinitely. Mood swings, irritability, resistance to time tables of any kind and defiant attitude towards parents are coming to us in large numbers.
That seems to be a heartening sign in view of the stigma attached to consulting a psychiatrist…
Unfortunately, even people who recover after medication are also stigmatised for life. Again, women are the worst sufferers. I keep receiving calls from parents who have fixed the marriage of their daughter asking if they should stop medication. In-laws often throw out newly wed brides if they are discovered taking medicine for mental health. I remember a case in which the newly married woman was dumped at her natal home the day after the wedding. Men too suffer from mental disorders, even middle-aged men go through what we call the mid-life crisis but they seldom face the kind of harassment,humiliation and ostracization that women are subjected to.
I know of several cases of people taking sleeping pills during the lockdown. Are they helpful?
Self-medication is a compulsive disorder among Indians. It is true that an increasing number of people are using sleeping pills and even mood elevators, known as‘Happy pills’. Pharmacies are not supposed to sell them without prescription. But under-the-counter sales are rampant, I am told. But unless prescribed, the use of such pills an be dangerous, even fatal.And they may do little to reduce the stress.
Long queues outside liquor shops, when they finally opened, were an eye-opener…
When you are no longer sure about your future or that of your children, what do you do? People either tend to withdraw into a shell or they become externally aggressive. Some find an outlet in binge drinking, now that alcohol is available freely. Even those who were moderate drinkers are becoming binge drinkers. Smoking,chewing tobacco, Gutka, Ganja and Bhang have been used by Indian sunder stress for a long time, with unfortunate consequences. It was a mistake to permit large scale sale of alcohol. I believe the result has been a rise in domestic violence against women and children and adverse effect on the physical and mental well being of the people.
Dr Nagpal feels those exposed to mental illness within family, should not worry too much about day to day mood swings, nor be in a hurry to label all unusual behavioral changes as mental illness. Everyone is experiencing them in some degree. But prolonged regression in behaviour, binge drinking and violence should be reported early and treated with proper medication. If elders and women notice symptoms like prolonged early morning panic attacks, lack of communication and avoiding of any human contact, then the family should quickly take online psychiatric help.