How we can help each other to avoid a mental health pandemic.
By Charlotte Williams – Organisational Consultant, Tavistock Consulting
In the Western world many of us have grown to pride ourselves on maintaining a sense of independence through making a living and purchasing what we need, when we need it. We have developed the capacity to survive much illness and prolong life through medical interventions and even defy (or perhaps deny) the aging process through beauty products and cosmetic surgery. From another perspective we might describe these activities as less authentically successful than we imagine them, and in effect to be what Isabel Menzies would describe as ‘social defences’ (1959). Isabel Menzies Lyth formulated a way of thinking about social structures as forms of defence – as ways of avoiding experiences of anxiety, guilt, doubt and uncertainty. She believed that the individual is engaged in a lifelong struggle against primitive anxiety and that collectively we find social means by which to defend against this.
COVID-19 has attacked and undermined these social defences leading to a general increase in primitive and existential anxiety. As an organisational consultant, my work with clients in and across organisations increasingly tells me that COVID has exposed the ‘papered over’ cracks in our worlds. Difficulties in the home were often counterbalanced by satisfaction at work, going to the gym or a busy social life. Difficulties at work were often managed by the good life of travel and fine dining that work afforded us. Being part of a large social network enabled us to operate as ‘social butterflies’ landing here and there to get our needs met before the cracks became to apparent or required attention. Now, unable to easily travel, shop, go to the gym, visit friends, dine out, or go to the theatre we are left facing an increased anxious state of mind and forced into noticing the imperfection and fragility of our lives.
The existential threat of COVID has increased anxiety levels, and with that, the tendency to regress into ‘paranoid schizoid mentality’ (Klein 1946) , a binary way of thinking consisting of absolute right and wrong, leading to ‘them and us’ attitudes and behaviours. Examples of this in society include the ever-increasing polarisation into right- and left-wing extremes, the intolerance for refugees and increased racism. Alongside this one’s own tendency to jump more easily to judging others either for not wearing a mask, meeting friends at the pub or staying at home or taking too much or too little care is readily apparent.
The very real threat of the virus can leave us fearful of human contact. The requirement to socially distance ourselves amplifies this threat by implying that the ‘other’ is dangerous. This goes against our instincts, as social animals who survive by being part of large social network. We long for and need greater social contact to feel safe and, in this respect, we are experiencing a very confusing internal conflict. As social animals our defence against danger is to come together in large groups yet that is exactly the act that is most dangerous to us right now. So being in groups is a threat and yet not being part of a larger social network is also experienced as a threat to our existence, it’s no wonder we are feeling anxious.
Many people report that since lockdown eased, the experience of interacting with a socially distant social network remains complex. Some describe it as dissatisfying, perhaps it reminds us of what we’ve lost or still isn’t enough as we are unable to embrace or touch each other – such a fundamental part of human relating. Others have reported finding it fulfilling but have been left bereft when they return on to their small bubble or homebound isolation. One client reported to me having finally got to travel to see her parents ‘It was so good I wish I hadn’t had it, it’s like tasting champagne and not knowing if and when I might ever be able to afford it again”.
So, what does all of this mean to our mental health?
Research is emerging to suggest an increase in the numbers referring to mental health services, and a decrease in the mental well-being of people in the UK particularly amongst the BAME community, women, parents with small children, people on lower incomes and key workers. There are common experiences of increased anxiety and lethargy, sleeplessness and nightmares. Many of my clients’ report feeling more irritable, less motivated, having difficulty sleeping, fears for the future, feeling jumpy around people and wondering what they are doing with their lives. Many of these symptoms of course correlate with those reported by people who have been through trauma or bereavement. The word trauma originates from the Greek word Tραύμα meaning ‘to pierce’ certainly many of the social defenses that we have diligently co-created have been ‘pierced’ exposing us to the reality of our mortality, our vulnerability and our need for each other.
I was asked by Radio Cymru in an interview recently, whether a mental health crisis is the next global pandemic? While it’s still too early to say for sure, the Centre for Mental Health suggest that an additional 500,000 people will require support, with the majority requiring support for depression and anxiety, thus the demand on services and need for an increase in resources is highly likely.
However, we also know from research that some people can recover from traumatic experiences and bereavement without going on to develop a mental health illness or requiring professional intervention. It seems that one of the key factors in recovery is determined by the environment within which the individual exists. Providing the environment offers psychological and physical safety and permits and supports people to process their experiences without judgement with others and feel understood, then recovery can and often does occur.
Whilst many people will not have access to this kind of supportive environment and many with pre-existing mental health conditions will require treatment from psychological services, there are many people who could be prevented from reaching the point of illness if we as communities and as a society pull together and support each other.
First – we need to adhere to and maintain social distancing and work to keep the R rate down, it is hard to process and recover if we are still under significant physical threat. Even if you are not feeling particularly under threat yourself as you don’t fall into the vulnerable or shielding categories, it is important to remember that we all have different circumstances, and some people may feel more anxious than others. .
Second – we need to avoid pathologizing normal responses to an abnormal situation – some anxiety, nightmares, sadness, frustration, loneliness, or social awkwardness post isolation are normal and an understandable response to the situation and it can help to acknowledge, rather than dismiss that. We need to talk to each other, share our experiences and emotions as we go through this experience together. Reach out to a friend, neighbour, shop assistant ask them how they are finding this experience and listen. Talking about your own experience briefly and naming your feelings can pave the way and communicate that you are asking about their emotional experience right now.
Third – we need to recognise that many of us, due to the stress incurred by the pandemic are currently in, or very easily fall into, a state of binary thinking. Try to hold back on making judgements about others and recognise the complexity of things – put yourself in their shoes for a moment. Experiences that increase anxiety and uncertainty can fragment groups and communities as we often regress back into this primitive mentality as a defence against the difficult emotions evoked by the situation. We need to keep working at coming together with mutual understanding and respect to share the difficulties of this time and bear the uncertainty together. We need to resist the temptation to split into factions and groups that make us feel temporarily safe, right and certain whilst threaten societal harmony.
Fourth – provide containment. The notion of containment was first introduced by Wilfred Bion (1962), a psychoanalytic psychotherapist at the Tavistock. The concept is grounded in early infant experiences and is the process whereby the caregiver takes in and bears the raw primitive emotions of the infant, demonstrating the capacity to manage intense emotions without disintegrating. Over time the infant develops a greater capacity to bear its own emotional responses and internalises the container. This concept has subsequently been acknowledged as an essential aspect of the role of leaders and managers. leaders, managers, pastors, teachers, lecturers, parents need to increase their containing function in role. Take the time to create spaces in schools, churches, the workplace, the home, the park and online to come together and process this experience without judgement or blame. Talk to your experiences and listen to other peoples’. However strange you think your dream was, someone else will be having one too!
Finally – we need to provide containment for the containers. People across a wide range of professions have been providing increased containment for over six months, taking in the uncertainty, anxiety, fear, grief and shock of those around them and bearing the experience. Bion emphasised the importance of containment for the container and it’s key to provide containing spaces for those professionals, workers and managers who are bearing the emotions of others. A space for them to come together and work through their experiences in the presence of a containing other and be replenished so they can continue their work.
Charlotte Williams worked as a counsellor for twenty years and headed up a clinical service in a London University prior to joining the Tavistock and Portman NHS Trust and taking up the role as an organisational consultant with Tavistock Consulting. She is part of the Tavistock’s NCL in Mind initiative. Along with her colleague Claire Shaw, she provided containing spaces to support keyworkers in the NHS during and following the first peak of COVID.
Bion, W.R. (1962). Learning from Experience. London: Heinemann
Klein, M. (1946). Notes on some schizoid mechanisms. J. Mitchell (ed.) The Selected Melanie Klein. London: Penguin. 1991.
Menzies, I.E. (1959) ‘The functioning of social systems as a defence against anxiety’ in Containing Anxiety in Institutions: selected essays by Isabel Menzies-Lyth. London: Free Association Books (1988) pp. 43-88