Lockdown Toxicity

This year has been one of lockdown and restrictions, that have been grim for many. All the normal human things we do, like touch each other, smile and gather in groups, have been snatched away or rationed in a way that we could never have imagined. There is growing concern about the effect on people’s mental health, but it’s very difficult to combat this, when many of the solutions you might usually suggest are off the shelf.

Some things feel more necessary than others. Personally I like spending time on my own, but not as much as I thought I did. I like avoiding exercise, but not being told not to do it. I hate wearing a mask all day at work, and I hate telling my elderly parents that we can’t meet up. I really wish I could go out for dinner, although I realise this isn’t actually essential for my health. At the start I thought that I was unlikely to avoid a relapse into depression. As a consequence, I not only took my medication dutifully, but increased it, and, so far, so good. What this says about me and my usual compliance, and whether medication does actually work, is something I’m trying not to dwell on. I remain anxious that I will become ill again.

When we first went into lockdown in March, I think we all hoped that it would end by the summer. The days were lengthening, the weather was clement, and we all anticipated a return to some sort of normal – but then it didn’t happen. Now it is cold and dark, a time often lifted only by festivities and hugs, and apparently even Christmas may be cancelled. And as I wallow, thinking of this, I find myself wondering what it must be like for other people, of all ages. I am a middle-aged person who actually still gets to go to her job (a good thing), and I am in relatively good health, as are most in my family

What must it be like for a child? It’s hard to remember childhood clearly, but I suddenly thought about the proportion of any child’s life that has now been like this. It’s not that long for me, but for an eight-year-old it’s about a tenth of their life – more if you consider that memories are few before the age of two or three. At what point, for them, will it just become normal? This is a terrifying thought. And for a five-year-old, what will they remember of what we think of as normal? I remember the years being so long and different at primary school – when each year passed, it seemed to have gone on for ever, and time was far slower.

Today’s children may grow up thinking that it’s normal and necessary to wear a mask, and that bad things can happen if you don’t. Even if we do return to ‘normal’ early next year, they have learnt something that will be hard to forget. They may feel that there is danger implicit in touching others, and they may not even quite remember why. Fear as a child can be interpreted very differently.

For older people, this is a small fraction of their lives, but they may fear that it will outlive them, and that many of the things in life they hold most precious are gone forever. As we come to the dusk of our years, we want to see our families, and the world, to have the assurance that life will continue. No-one wants to die without loved ones, while holding a gloved hand, and thinking of forgotten lives that will never come again. 

And what of those who are too young to even understand, those who can’t understand through disability, or the many in the throes of dementia? Sometimes touch is the most important sense, that keeps us human and lets us communicate when it would otherwise be impossible, and this is even more important when other communication is lacking.

For patients with mental illness, these months have been hard, and go against all the advice we would normally give. There has been a higher incidence of people becoming acutely mentally unwell, and although it isn’t clear whether overall alcohol intake has increased, there are concerns that many of those who were already drinking at harmful levels may have upped their intake. This is hardly surprising, given that boredom and lack of structure are major risk factors for harmful drinking, and most of the usual support groups are unavailable or online, so not accessible by as many.

In fact, so many people are currently living in a state of chronic stress, anxiety – and probably boredom. None of these things are good for mental or physical health. As a doctor, I feel torn between wanting to comply with regulations and fear that they are doing harm. The difficulty is that the terror of Covid-19 is immediate, and the manifestations of less visible fears may occur some way down the line, so cannot be measured. It is easy to see why people might become depressed if they lose their jobs and their livelihood. But staying inside, not seeing people, never shaking someone’s hand – all these can also trigger depression and other mental illness. There are other risks – for example, not letting children play with each other as much in the dirt might have long term effects on their immunological systems – we just don’t know.

Ultimately, we cannot tell how toxic the restrictions will prove to be, or what the aftermath will involve. There is no denying the tragedy of the deaths from Covid-19, and this also makes it difficult to see any other options, until we are all vaccinated. But we need to prepare for the months, even years, that will follow this pandemic, and to boost our mental health services so that more people can access quick and effective treatment. We can’t just talk about mental health after this – we need to do something. 

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