Life in lockdown: Psychiatrist’s survival guide for ‘new bizarre, crazy world’

Are you tired of virtual chat and find yourself guzzling snacks and alcohol while fixating on grim death tolls?

You are not alone in this “new bizarre, crazy world” where primitive instincts can ride roughshod over reason, says consultant psychiatrist Mark Salter.

Mr Salter, from Hackney, east London, shares some survival tips in a BlueJeans online chat with lawyer Jill Greenfield, from Fieldfisher.

He said: “First of all you have to start with the fact we are looking at human beings who have brains, who have lives, who have minds.

“The brain or the mind is something that, by and large, likes stability and predictability.

“So, for most of us, when things are going well, our lives are predictable and vaguely manageable and that means we are switching to a relaxed frame of mind where we can measure, deliberate and take our time.”

But in periods of rapid change, such as in a viral pandemic, anxiety begins to rack up, he said.

Mr Salter said: “Anxiety is the mother of all mental illness – the mother of all unhappiness as well.

“Fear freezes our ability to reason. And that means we fall back on the more primitive, more frightening part of our brain, which is the bit that has been with us ever since we evolved from apes, which teaches us to look after Number One.

“That involves withdrawal, flight, isolation and also a lack of abstract thinking about solutions.”

The biological effect can disrupt normal sleep patterns and people turn to snacking over meals.

Mr Salter said: “We will reach for richer, sweeter foods. We will find ourselves nipping off to the fridge a bit more frequently – comfort-snacking.

“The very important thing that goes with the sleep cycle is the one or two meals a day cycle.

“We retreat to our favourite tranquiliser – usually alcohol.”

As “sociable creatures” the crisis has also meant withdrawing from the world and relying on electronic devices to communicate.

Remote working from home has forced those from different walks of life to rely on video conferencing over face-to-face chat.

On the challenges of speaking to vulnerable clients from afar, Mr Salter said: “It’s very, very hard to reach out to establish and maintain an empathic, understanding, caring, even some may say loving, link with someone at the other end when you are not in the room.

“Those squeaks of the chair, those quiet sighs, those breaks of vision, those silent moments.

“Notice how silence seems so long on Skype, Blue Jeans, Zoom or whatever.

“It’s hard to read the meaning of silence because the silence is devoid of its context and that is a very unconscious, subtle manifestation of this creeping unfamiliarity which has already got us on edge as it is.”

He suggested sitting as close to the screen as possible, ensuring videos are well lit, and discussing the strange artificiality from the start.

He said: “Let silence take effect. Normally we interrupt prematurely.

“A good therapist will understand the importance of letting silence sink in.”

Using video conferencing is like speaking a foreign language, he said.

“As you will know when you are in a country for the first time and you are using your schoolgirl French – it’s exhausting.

“You can minimise that exhaustion, but it takes a lot of patience.”

He said the whole process requires more cognitive effort, meaning the brain burns more glucose.

“The act of trying to seem as if you are familiar with a situation in which you are relatively unfamiliar burns energy. It’s exhausting.

“That’s a reason why you have to look after your body.

“Watch what comes out of your mouth and what goes into it.”

He said maintaining a normal sleep cycle, having “down time”, keeping up with friends and getting out of the house are all important.

As humans in crisis, we look out for anything that is a threat or risk and become “sensitised” to events.

Mr Salter warned against developing an unhealthy fixation with negative news.

People are drawn to “trigger words” like Covid, death, disaster, ventilators, and PPE, which resonate in the “new bizarre, crazy world”, he said.

“There is an old line in the media: ‘If it bleeds, it leads’. In this case it’s ‘If it coughs, wheezes and dies, it leads’.

“So what we are doing is looking out for Covid-positive items.

“That is at the expense of looking out for things we probably would have looked out for elsewhere when we were more relaxed.

“If we are not careful, we can get into this terrible ‘pas de deux’ with the media.

“Psychologists call it an availability cascade. You are frightened; journalists know they can get your attention by giving you things that are frightening that will resonate with you.”

Mr Salter advises using trusted websites, stretching the brain and trying not to “soak up more of the same because of fearful fixity on a single subject”.

And just when we get used to the new normal, a fresh fear approaches – what will the world look like when we open our doors again?

Mr Salter supports clients who have been physically and psychologically injured following terror attacks, sexual abuse and road crashes.

Ms Greenfield said: “It’s vital that support doesn’t go away during lockdown. My team, Mark and other therapists like him offer invaluable contact via online platforms to keep people going.”