Sick Before the Sickness

Ann Mary // It’s been a long day. I am dreaming of drifting off to sleep, safely under my blanket. I close my eyes. Then, something crawls into the quiet. Is the gas turned off? it whispers. Before I can access memory, another has arrived. What about the door? it asks, louder now. Is it locked? Hot water! Here comes another: you MUST have some hot water before sleeping. I shut my eyes tight; I know where this is going. It’s like an old, worn-out machine suddenly being jolted awake, when it’s already been shut down. I can hear and feel the whirring, clanging, and thudding in my body. Remember the last time how bad the viral fever was! I am shutting my eyes really hard now. Are you reallllly taking this chance now, with COVID going on?????? How can you be so irresponsible? (Not sure this one is my own voice.) Not just hot water, you should be doing a saline gargle before sleeping. Poor sleep is hiding somewhere outside this room of activity, peeping inside for a signal, before it departs for good. The thoughts are stifling me; they are going round and round, faster now. Gas… door…hot water…gargle…gargle..water… gas..disaster..fire..your fault..can’t sleep..irresponsible… …gas…must sleep.

I JUST DID ALL THIS! I CHECKED THE GAS! I protest finally. I am sitting up now, angry. My breathing is becoming faster; what is this tightness inside my chest? I HAD some water earlier, did it get caught in my chest? Oh, how will I even go to a hospital in COVID times if I am dying? What if it is COVID? What if it is dyspnea? Should never have learned what that word meant. I can hear a rhythmic sound, it’s my heart beating fast, thudding, trying to keep up with everything that’s happening, even as nothing is.

I am done trying to sleep now. I get out of bed. I stand up. I feel a strange sensation; I can’t really call it spinning, but my head feels like it is divided into two parts. One part is moving at breakneck speed, and the other is still. The overall effect is what it feels like when you look directly down at shifting sand beneath your feet or down a spiraling stairwell, but it is more than vertigo. You FEEL like you have already been pushed down the stairwell, slipped away into the sea, but you KNOW differently. You have to steer yourself using your thoughts to keep standing. I bend down once (which makes the vertigo sensation much worse), but I must try to stretch to make the tightness go away. I remember the million meditation videos with their soothing calm voices that don’t really seem to get that “take a deep breath” isn’t always accessible. And that it may not always help. When I straighten up, the tightness is still there. Must go see if the gas is off. I already checked that today, didn’t I? Or was it yesterday? I am not sure anymore. I am not sure of anything suddenly. Except that I have to check the gas first. Maybe it will all stop.

Anxiety has been a familiar disruptor to many of us even before COVID-19 ushered in specific fears of illness, of ourselves and loved ones, to almost all of us. Although anxiety is a natural response to perceived threats that is supposed to help us defend ourselves, anxiety disorders can be understood as an experience of a fear response even in the absence of any “real threat,” which could lead to daily life functioning being hampered. Thus, instead of helping us defend, anxiety itself becomes the real threat, something that must be defended against.

It is well-known that increasing perceived social support is a protective factor for anxiety (Roohafza et al.). The ability to understand others’ perspectives is essential for fully and successfully identifying with the experience of others (McDonald and Messinger 5). In the context of COVID-19, those who suffer from anxiety disorders and those who do not are united by an unprecedented common fear. It is, therefore, reasonable to assume that many more people than usual are now sharing the experience of what a pervasive looming fear feels like. This unsolicited access to the experience of a persistent sense of worry due to the threat of the pandemic can also be perceived as an opportunity to develop empathy toward those who will more or less continue to feel like this, even in post-pandemic days. A positive relationship has been found between empathy and mental health literacy, with particular facets of empathy—namely, Empathic Concern and Perspective Taking—being most clearly related to mental health literacy (Furnham and Sjokvist). Worldwide, cooperation has become the key to fighting COVID-19.

Can we then extend this cooperation to the treatment of affective disorders as well? In the post-COVID-19 world, can we hope for a paradigm shift in the care extended toward those suffering from anxiety disorders, as we have now been able to access the experience that has so far been the socially embarrassing problem of a few “worriers”? Here are a few suggestions for possible first steps in approaching this giant task:

1. The worrying “Don’t worry!”: While you were washing your hands desperately to get rid of both imagined and real viruses, would it have helped if someone had asked you to stop worrying? People with anxiety are often told to worry less or told that their worries are baseless. Anxiety is often handled flippantly with a simple “You are worrying too much” or “Don’t worry!” The person with anxiety feels like a “buzzkill,” like they are stuck alone in a world of worry that does not make sense to others. This leads to a feeling of not being at the same footing as everyone else. Perhaps the best solution is to let the person with anxiety speak about what is worrying them. You don’t need to offer a solution; all you need to do is listen and make them feel heard.

2. “Why are you even doing this?”: With anxiety comes the need to stay in control. There is also a tendency to procrastinate tasks that will cause anxiety. For me, during COVID, one of the most dreaded tasks has been washing the plastic packages that come from outside. I would first put away the things that come into the house in a separate room, lock the door, and decide to deal with it later. I don’t live in a mansion, but I would rather reduce the overall space in my house than deal with my fears immediately. I literally created an anxiety room in the house. When I would eventually get to it, the ritual was endless. There was getting everything to the kitchen, keeping a separate dishwashing liquid and scrub just for washing away the fomites (despite knowing that the virus lives on plastics only up to 72 hours according to the latest findings [van Doremalen et al.]), using a disinfectant to clean everything, including the doorknob of the anxiety room, and many more endless small rituals involving meta-disinfecting processes. The most stressful part of the routine is usually when I am finally washing the plastics, because in my mind, I am helpless and compelled to deal with my fear that I had locked away for as long as possible. I am in no state to explain why I feel the need to do this routine the exact way that I do it, and any interruption during this routine causes too much stress. So if you are living with someone with anxiety, try not to seek an explanation or question their rationale when they are dealing with something that stresses them out. You can always discuss this later, calmly and in a relatively less stressful time, if you disagree with the overall rationale.

3. No labelling please: Living or working with someone with anxiety can be a stressful experience. If economic and social circumstances allow for it, those with anxiety generally do seek out professional help. Given the interventions for anxiety that social support can offer, we should try to build a world where we cooperate to assist with mental health care instead of assigning the whole responsibility to our therapists and mental health care professionals. We can begin to do this by learning about how anxiety works, making sure that the person with anxiety is not belittled or shamed for their difficulty/diagnosis, talk to them about what their mental health professional has advised them to do, and help create a supportive environment for reducing anxiety.

4. Change your laughter preposition: Kindness and laughter go a long way and are welcome and nourishing distractions. Don’t laugh at any routine or thought process that does not make sense to you; this only leads to reduced confidence for the person with anxiety. Laughter goes a long way to help—just make sure that you are laughing with and not at the person with anxiety or any of their methods.

These suggestions are in no way comprehensive and neither can the claim be made that implementing them may have equal effects for people with different levels of anxiety. However, now that more of us have a window into understanding the context of anxiety because of the COVID-19 pandemic, let us aim to become more supportive towards those who have this context thrust on them even when there are no shared clouds over our common horizons.

Works Cited

Roohafza, Hamid Reza et al. “What’s the role of perceived social support and coping styles in depression and anxiety?” Journal of Research in Medical Sciences, vol. 19, no. 10, 2014, pp. 944-949.

Furnham, Adrian, and Paula Sjokvist. Empathy and Mental Health Literacy. Health literacy Research and Practice, vol. 1, no. 2, 2017, e31-e40. https://doi.org/10.3928/24748307-20170328-01

McDonald, Nicole M and Daniel S. Messinger. “The Development of Empathy: How, When, and Why.” (2010). Retrieved from http://local.psy.miami.edu/faculty/dmessinger/c_c/rsrcs/rdgs/emot/McDonald-Messinger_Empathy%20Development.pdf

van Doremalen et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine, vol. 382, 2020, pp. 1564-1567. https://doi.org/10.1056/NEJMc2004973

Photo Caption: “Hold my hand so I don’t wash it away!” Social support for anxiety in the post-COVID world

Ann Mary is a consultant academic research editor based out of India who is interested in language, gender, representation, di(ff)ability, and the psyche. More at home with fiction than with its absence, Ann has taken to penning a call for support for people with anxiety disorders upon realizing that the COVID-19 pandemic has imposed new beginnings, ends, and a suspended middle on our so-called non-fictional world. In her spare time, she awaits sunshine and ponders whether her cats went through Lacan’s mirror stages better than she did.

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