How do you tell if someone has an anxiety disorder during a pandemic?
The commonest mental illness is anxiety, afflicting up to 30% of Australians at some point in their lifetime. Roughly a sixth of them have a specific phobia, often a fear of infection. For those who have been suffering in secret distress – finally, it is their time to shine.
I’ve had difficulties of late working out how to assess patients for mental health issues in a time where one can no longer shake hands. Even more confusing is those with pre-existing mental health issues who appear to (relatively) improve. I’ve had a contact confide that, for the first time in their life, they’ve felt normal – normally avoiding buttons or surfaces and with an uncontrollable need to sterilise their hands after any form of social interaction, their private shame no longer seems a problem. They’re the only one who still has stocks of disinfectant.
An unusual – but attractive – argument against the treatment of mental health issues has been the theory that many mental health presentations are in fact protective in some way. Depressive conditions leading to people staying at home certainly is associated with a reduced exposure to risk, which is part of why depressive symptom constellations have been linked to hibernation behaviours. Some personality disordered individuals live life on a permanent sense of distrust of others, which is a positive boon in civil unrest environments. Only Lady Macbeth would survive a pandemic.
So if that’s really the case, what should one do if one is worried about COVID-19 – a situation which certainly should invite anxiety? How does one decide if this is abnormal?
Public health issues with strong media penetration have always been associated with an increase in mental health presentations. These can be new events out of proportion to the issue, as in crisis reactions (called adjustment disorders, or acute stress disorders if lasting more than a few weeks after the stressful event is over), or worsening of prior mental illness (such as depression or anxiety disorders). Regardless of whether these are new or exacerbated mental health issues, they still require – and respond to – treatment.
In differentiating a healthy anxiety response from an abnormal (or pathological) one, a useful rule is to consider what it leads to – if it leads to helpful behaviour, such as improved vigilance, sourcing reputable information, improved hygiene, this is rarely a concern. If the anxiety leads to loss of sleep, repetitive obsessing to the point of interfering with daily functioning, thoughts of self-harm, or distress regarding one’s own anxiety itself, mental health support is appropriate. It’s tempting to falsely reassure – but this should be discouraged, as it complicates one’s responses, and leads to an escalation of worry and distrust. In times of fear, there is no need for more.
If you are worried about COVID-19, you are not alone. As we know, COVID-19 sufferers are not advised to see their GPs as initial port of call. But if your anxiety is interfering with your life, this is where your doctor can help. Mental illness doesn’t disappear just because everyone is afraid – but that doesn’t make it any less deserving of treatment.