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Life in Lockdown: The Impact of Quarantine on Mental Health

 

Isayah Alman

“There are days when solitude is a heady wine that intoxicates you with freedom, others when it is a bitter tonic, and still others when it is a poison that makes you beat your head against the wall.” Sidonie-Gabrielle Colette, Nobel Prize in Literature 1948 1

Quarantine. By now, Canadians have lived through months of it. Non-essential services have shut down, and society is in a state of perpetual lockdown. In 2020, novel coronavirus spread across the globe, bringing significant changes to social protocol and daily routine. Gone are the days of a friendly handshake or the leisurely coffee shop visit. Health officials urge us to “stay home and stay healthy”.2 For those working from home, the day has become a cacophony of virtual rooms, rigid online interactions, and tiled faces on a computer screen. The words “sad, bored, and worried” have been used to describe life in isolation.3 With no end in sight, some experts suggest that long periods of social isolation may contribute to the development of mental health issues.3

The Science of Social Isolation

“Human beings are fundamentally social, and the need to gather with others is extremely important, especially during times of distress.” Cheri Marmarosh, Ph.D. Clinical Psychology4

As days go by in quarantine, the impact of long-term isolation on mental health comes into question. Humans are social creatures that require contact with other humans to maintain mental wellbeing.4 Prolonged isolation leads to feelings of loneliness, decreased activity, and increased vulnerability for mental and physical deterioration.5 The risk for mental health concerns increase the longer an individual is kept in isolation.6 Indeed, aside from the death penalty, the worse punishment we have invented is being locked in solitary confinement. Although quarantine is a far cry from confinement, it may be close to truth for those living alone, unemployed, or without access to reliable social support systems.

Social isolation can be a painful experience. This is because social loss triggers the same brain neurons as physical pain.7 Social pain arises when one feels excluded from social connections: feelings that may be relatable to people in quarantine. Because social pain is tangible, akin to physical pain, it can trigger our stress response systems. These systems flood the brain with neurotransmitters that help us handle difficult situations.8 Unfortunately, protracted firing of these systems can cause anxiety, nausea, and fatigue. Social pain is a subjective experience and may be expressed in ways not dramatically apparent, yet still intensely taxing on the mind and body. If your quarantine mornings have you feeling stressed, nauseous, anxious, or fatigued, keep in mind: these emotions may be justified. It may be timely to practice self-compassion in the context of social isolation, disruption of routine, and a global pandemic.

The Impact on Mental Health

The psychological impact of quarantine affects people in different ways. In past pandemics, quarantine conditions have been a predictor of acute stress, exhaustion, detachment from others, irritability, insomnia, poor concentration, deteriorating work performance, and indecisiveness.6 Essential workers, hospital staff, health care professionals, and people directly affected by the virus are at highest risk for these symptoms, as they are placed in harm’s way and are proximate to continuous fear, crisis, and grief.6,9

A study of pandemic psychology in Wuhan, China found that pre-existing adversity predicted unfavourable mental health outcomes.9,10 Long periods of stress and isolation have heightened the allure of negative coping behaviours. Smokers and substance users may increase usage in pursuit of anxiety relief, increasing their propensity for misuse, withdrawal, and addiction.11 Other maladaptive quarantine behaviours include compulsive drinking, excessive media consumption, and gambling.11,12 Constrained household contact has increased the likelihood of relationship conflict and intimate partner violence.13 Unfortunately, limited social services and decreased access to mental health professionals have compounded issues for people in dire need of support.12,14 

Peoples with intersecting identities face increased vulnerability during a pandemic. Communities that have been historically oppressed based on race, class, and ability are the most disadvantaged.15 Immigrant families living with elderly relatives may find it difficult to social distance due to inadequate housing. Racialized communities have been hit hardest by the virus, suffering disproportionate COVID-19-related deaths due to a disparity of social resources.4 Many low-income workers have lost their jobs and struggle to make ends meet.16 People without reliable access to a computer have less opportunity for social contact and stay-at-home work.6 An unfortunate heuristic, it is often those most vulnerable who are prone to further victimization.4,15 The pandemic is no exception.

Finding the Silver Lining

“Hope is better than fear. Optimism is better than despair. So let us be loving, hopeful and optimistic. And we'll change the world.” Jack Layton, Member of the Canadian Parliament 2004-201117

Despite many alarming aspects of the ongoing lockdown, benefits can be found in this experience. More time indoors provides an opportunity to incorporate self-care practices into our daily routine. Grounding, optimism, and mindfulness are evidence-based techniques with proven therapeutic value.18 Identifying positive exceptions within a problematic experience can lead us away from stressful emotions and negative thinking patterns.19 Other positive activities include reconnecting relationships, creating useful meaning in solitude, remaining optimistic, and fostering feelings of gratitude.6,10,13

The lockdown provides a chance to reconnect relationships which have grown distant. A study on families in the pandemic has found that themes of family improvement and partner reconnection exceed that of relationship deterioration13 The pandemic may serve to bring people together in times of hardship. Strategies for maintaining positive relationships in quarantine include open communication, emotional expressiveness, and balance between individual and shared needs.13

People living alone can benefit from solitude, a now scarce opportunity.20 Some benefits of solitude include:

  1. Creating a comfortable home environment
  2. Detaching from social media
  3. Reflecting on life circumstance
  4. Constructive planning for the future
  5. Starting a new project, hobby, or learning endeavour

There are reasons to stay optimistic. The pandemic presents a window of opportunity for improving systems in society. On October 27th, the Government of Canada launched a $1-billion-dollar program to improve shelters and develop new affordable housing.21 The Canadian Emergency Relief Benefit has given an indication for the viability of universal basic income, helping millions throughout the country with the financial strain of lockdown.22 With more people remaining close to home, there has been a statistical decrease in crime and pollution.23 Furthermore, the disruption of global supply chains has forced corporations to improve efficiency, reducing global levels of waste and pollution in the process.24

As we wait for a return to normalcy, there is time to foster gratitude for things often taken for granted. Life in Canada provides many privileges. Diverse multicultural communities allow the experience of unique foods, traditions, and peoples. Robust infrastructure provides the enjoyment of parks, social gathering spots, and recreational services. Although these facilities remain closed, they give us something to look forward to. Despite the challenges, we are going through this experience together.

Quick Tips for Surviving Quarantine

  1. Stay informed.
  2. Manage expectations.
  3. Maintain a regular routine.
  4. Keep in contact with social supports.
  5. Plan time for physical activity.
  6. Separate productivity and self-worth.
  7. Create healthy habits and practice mindfulness.
  8. Make time for self-care, hobbies, and recreation.

Edited by Emma Syron & Curtis D'Hollander

References

  1.  Colette S-G. Oeuvres complètes en seize volumes. Flammarion. (1974). 
  2. 'Stay home, stay informed': Ontario reports 1st COVID-19-related death as province declares state of emergency. (CBC News, 2020).
  3. Fajzullin B. How the coronavirus pandemic is turning into a mental health crisis. (DW News, 2020).
  4. Marmarosh, C.L., et al. The psychology of the COVID-19 pandemic: A group-level perspective. Group Dynamics: Theory, Research, and Practice. 24, 122–38. (2020).
  5. Banerjee, D. & Rai, M. Social isolation in Covid-19: The impact of loneliness. International Journal of Social Psychiatry. 66, 525–7. (2020) 
  6. Brooks, S.K., et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet.395, 912–20. (2020).
  7. Bergland C. The Neuroscience of Social Pain. (Psychology Today, 2014).
  8. Barlow, D.H., et al. Abnormal psychology: an integrative approach. Nelson Education. (2015).
  9. Li, Y., et al. Psychological distress among health professional students during the COVID-19 outbreak. Psychological Medicine. 1–3. (2020).
  10. Yang D., et al. The effect of the 2019 novel coronavirus pandemic on college students in Wuhan. Psychological Trauma: Theory, Research, Practice, and Policy. 12(S1). (2020)
  11. Mallet, J., et al. Addictions in the COVID-19 era: Current evidence, future perspectives a comprehensive review. Progress in Neuro-Psychopharmacology and Biological Psychiatry. (2020).
  12. Columb, D., et al. Addiction psychiatry and COVID-19: impact on patients and service provision. Irish Journal of Psychological Medicine. 37, 164–8. (2020).
  13. Günther‐Bel, C., et al. A Mixed‐method Study of Individual, Couple, and Parental Functioning During the State‐regulated COVID‐19 Lockdown in Spain. Family Process. 59, 1060–79. (2020).
  14. Cui, L.B., et al. Challenges of facing coronavirus disease 2019: Psychiatric services for patients with mental disorders. Psychiatry and Clinical Neurosciences. 74, 371–2. (2020).
  15. Theidon, K., et al. On Marginalized Populations and the Impact of COVID-19. The Fletcher School. (2020).
  16. DeClerq, K. More than one million jobs lost in Ontario since pandemic was declared. (CTV News, 2020).
  17. Layton, J. Jack Layton's last letter to Canadians. (CBC News, 2011).
  18. Geller, S.M. & Greenberg, L.S. Therapeutic Presence: a Mindful Approach to Effective Therapy. American Psychological Association. (2015).
  19. Corey, G. Theory and practice of counseling and psychotherapy. Cengage. (2013).
  20. Einzelgänger. The Benefits of Social Isolation [video file]. 2020 Mar 26 [cited 2020Nov14]. Available from: https://youtu.be/nxQe9bPDW5E
  21. Curry, B. el al. Toronto to get $203M, Vancouver and Montreal to split about $108M more under city-specific housing plan. in The Globe and Mail. (2020).
  22. Premila, D. As CERB winds down, calls for universal basic income intensify. in Canada’s National Observer (2020).
  23. Nelson, B. The positive effects of covid-19. in The BMJ. (2020).
  24. Dente, S. & Hashimoto, S. COVID-19: A pandemic with positive and negative outcomes on resources and waste flows and stocks. Resources, Conservation and Recycling. 161, 1049679. (2020).
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