The Power of Hope in the Midst of a Pandemic

“What is there to hope for, to look forward to when I am surrounded with so much misery, pain, and suffering?” She asked me, and I, as her psychotherapist had to help her navigate that question.

You may be one of us, who have lost loved ones, or known of people who have lost someone precious to Covid-19, the illness that has ravaged the world, and has India in its vice like grip since the past three weeks and counting. It’s relentless and savage, and is costing us a lot more than we ever imagined. We are experiencing a range of emotions from anger, sadness, anxiety, grief, frustration, helplessness, and yes, hopelessness, in times like these.

From frantic searching for beds in hospitals, to dealing with the acute shortages of life saving medical supplies, to the lack of space, privacy and time to conduct cremations, to dealing with grief as losses hit closer home, with some family members being in different countries who can’t even fly to India to pay their respects one last time. How gut wrenching is this? Really, it is a legitimate question: Is there a silver lining, something to hold on to?

I return to the question asked of me. “What is there to hope for?” A concept I had initially observed, and then researched, and attempted to instil as a rehabilitation psychologist in my sessions with people with spinal cord injuries, and which has been one of the bedrocks of my therapy work till today.

Is hope just another word from the pop psychology realm? A false “feel good” emotion that may not have lasting effects and may bring us crashing down when another rough wave comes?

On the contrary, if you truly see its virtue, hope can be like that lighthouse that brings ships home, even in the most turbulent of seas. When we are surrounded by grim scenarios, grief, suffering, and gloom, hope is that panacea that makes a person balance their present reality, however distressing it may be, with better expectations and outcomes in their days to come, however painstakingly long and evasive it may seem. One persists, and prods and uses hope as a crucial coping mechanism in the face of unrelenting crises, to somehow keep finding the motivation to achieve what is meaningful for them, to salvage a situation, or to keep fighting for a better tomorrow, for themselves and/or their loved ones.

Here are my suggestions on how to bring about hope in your everyday living, as India and the world unite against a deadly virus.

  1. It is a natural response to experience anxiety, panic, confusion, numbness, inability to focus and problem solve when a crisis hits. When your mind gets stuck in this state, it triggers off a chain reaction. Fear and panic start to narrow your field of vision and cloud your attention, and it becomes harder to access your internal resources, to see the bigger picture, and what needs to be done to take charge. Please focus on calming and clearing your mind, on regulating your emotions and centering yourself using whatever means have worked for you previously. Mindfulness meditations, breathing exercises, a time out, exercise or any physical activity, journaling, talking to someone and finding a support system are highly recommended, in addition to any techniques that you may have tried before. To be able to tackle a situation at hand, you need to mobilize yourself towards problem solving mode while simultaneously working on reining your emotions in.

  2. Hope is in reality a motivational state, which involves the interplay between goal directed energy, also known as your sense of personal agency, and the pathways you chalk out to meet those goals. I have known of people who have offered necessary support to their loved ones who are quarantined at home and are living at a distance. From identifying delivery of food and medical supplies as goals, to devising ways and means to accomplish those goals (dropping off at doorsteps, delivery services, identifying doctors to consult etc.), as well as working through obstacles to make sure the said goals are met, people have been working round the clock. Resident Welfare Organizations (RWAs) have stepped in to procure medical supplies and oxygen concentrators for their severely afflicted residents, who are being managed by doctors who live in that neighborhood. People have formed helplines and phone trees to enable quicker access to hospitals. A hope for recovery and survival is what directed their energy and made them spring into action. Identify your goals, energize yourself to meet those goals and find ways to get there, for yourself and your loved ones.

  3. Take charge of some key aspects of your lives as you go through this phase of helping others and reeling under the impact of the pandemic. It will enable you to have some semblance of control, and a feeling of “normalcy”, and autonomy as well. People have struggled to keep up with work, academic, and home routines as they are constantly pulled into several directions of either helping someone, or feeling helpless at the losses they hear about. Cut yourself some slack, be self-compassionate, but take charge wherever you can.  I would highly emphasize kicking in a self-care toolkit that enables you to enhance your sense of well-being across all domains (spiritual, emotional, physical as priority), finding your focus to take charge of work, and also restricting the excessive inflow of news and updates from social media. I am not asking you to avoid facing reality of what’s happening around, but if you are one who is on all possible social media networks, check if it is making you more anxious, depressed, frustrated, and hopeless. And if the answer is yes, then you need to do something about it.

  4. Grieve your losses if you have experienced them directly or indirectly. It’s OK to cry, to express your anger, to make space for your heavy heart and the bereavement you may be experiencing. Everyone has their own way of feeling the impact of grief. Please don’t suppress it or put it on the back burner or resist feeling them. Emotions need to be worked through because sooner or later they may come up in insidious ways and impact you psychologically. And to bounce back, to be resilient, and to enhance your ability to manage things, grief must get its due.

  5. Build your psychological resilience. In challenging times, managing our minds that increases our ability to keep surfing turbulent waves becomes crucial so that we are able to take charge of the crisis at hand. My first question to myself when a crisis hits is: “What can I do to tackle this problem?” It then trickles down to: “Is there something that needs committed action? And if the situation can’t be changed, can I accept what’s beyond my control and take charge of what is?” The struggling medical infrastructure in Delhi especially is beyond anyone’s control at this point. Can I still provide solace and comfort to those who are caught in the grip of it? Can I make space for the grief and helplessness that comes by and let it ease through my mind and body? Can I still bring myself up to providing support as much as I can? All these factors are in my control and I choose to take charge of them.

  6. Extend compassion to others. We are all overstretched, burnt out, and tired. We are unable to meet our loved ones because of lockdowns in place. But see if you can reach out to people more virtually, with the intention of being compassionate. Ask yourself, “How can I help this person to have a better day?” It could just be to share their burdens, to listen empathetically, to stand next to them in solidarity, to just say you care. Now is the time when we need each other the most. Be the beacon of hope for others by being there. People recognize the efforts we make for them even if they don’t have the desired outcome because the situation is beyond our control. You may also find yourself looking for comfort and solace from people who may be overworked, responding to the needs of the pandemic, or taking care of their own crises, and who may not be there for you physically. They could use some empathy and compassion too. They may want to be there, but they also are tied down by limits on their time and psychological & physical resources.

  7. Ask yourself how you are coping with the crises that are affecting you? Maladaptive/ineffective coping looks like this: “Why me?” “Life always treats me badly.” “I have no clue how to deal with this.” “There is nothing I can do.” “The system is to blame.” “I must be strong at all times.”

    Adaptive coping makes you take on responsibility and look for options. You try to take charge of the situation and your emotions as much as possible. It looks like this: “What can I do to make things better?” “What have I learned in the past that will help me get through this?” “How do I want to be in this situation?” What can I do to take care of my own needs in this situation?” “What should I invest my energy in and what should I not?” “If there is nothing I can do, what can I do?”

    We all differ in the ways in which we deal with challenging life events. What stands in front of us today is a common force that we have to contend with. While some of us may give up and experience intense, chronic distress, others persist and face life’s biggest challenges with hope and resilience. The mind expands, our eyes open to what stands in front of us, we acknowledge the crisis, we calm our fears down, and we see possibilities for ourselves and others which may bring us a ray of hope even through the darkest clouds.

    However stormy the skies may be, a rainbow emerges as a prism that disperses iridescent light in several directions. It manages to lift our spirits and makes us marvel at the possibilities that emerge. Hope is the same – our mind’s very own personal rainbow.

    And so, I urge you to choose hope. Every time. Now. And in the future. Despite the odds.

Who is Taking Care of our Mental Health Professionals?

The title of this article caught my eye, “Mental health professionals are the ones taking care of us: Who’s taking care of them?” It somehow struck a chord (a painful one, if I may add) because it rang so true. Even though this is written in the US, I feel it may apply to mental health professionals globally, those of us who have worked through a pandemic, who are now talking about burnout, guilt, and the after effects of working with people who are anxious, depressed, stressed, suicidal, those whose lives have been ravaged by the pandemic.

My life’s work is about understanding, empathizing with and finding ways to improve the quality of life of those with psychological suffering, chronic mental and physical illness, or disability. And then along came the pandemic and changed the course of the conversation, having us talk about the collective ways in which the pandemic affected all of us, and that included me. How I was worried for my octogenarian father, for my loved ones, but of course I had to put my own fears and anxieties aside, roll up my sleeves, and get to work with the people who came with debilitating mental health symptoms which impacted them personally, their relationships, and their work.

It’s one thing that I am helping individuals cope with crises, and I may not have time for anything else besides taking care of them, my immediate family and close friends, my own overall health so that I get to work re-energized the next day and give my clients my best, but when I am subjected to judgments by people close to me, I really began to wonder who has my back.

“You’re not as social/You’ve become so boring because you don’t meet”
“You’re too busy that we’ll need to take an appointment to see you.”
“You don’t return calls/don’t respond to messages, you don’t meet.”
“You’re often online on Whatsapp, but you don’t respond to my messages in real time.”
“What will you do with all that money you are earning?”

And if ever I mention the stress or the compassion burnout which in all likelihood would be the reason for my absence, I clam up when I hear, “But you’re a psychologist, you shouldn’t  be feeling that way.”

It's like saying a cardiologist can never have a heart attack.

And yes, I am human too. I thought, and then thought again, if I should write this piece, but then decided to go ahead with it, because the voices of mental health professionals like me need to be heard. Those like me again, who have a lot on their plate managing work, home, and life in general, and who feel lost, lonely, and burnt out because of their commitment to work, and the constant super human efforts they are expected to summon up every moment by family and friends. Trust me, sometimes just to be our usual selves takes a monumental effort.

So anyway, I can count on one hand the number of messages I get of care and concern.

“Hey Doc, I know you’re busy, but I just wanted to check if you were doing OK, and are taking care of yourself the way you take care of us.”

“Hey, just wanted to send you a big virtual hug. For being the awesome you.”

“Hello Dr. Sahib. Just wanted to tell you that I am doing well and I hope you are too. With immense gratitude…”

And this, from someone I didn’t even know: “Good evening, doc. I have approached you after a reference loaded with appreciation but more than that I am so thankful for your work in your specific field. I understand you must be very busy taking into account the satisfaction you must be spreading, but if you could spare a few minutes for me so that we can figure next steps regarding the issues I want to discuss with you, I would be really grateful.”

And then of course there are kind gestures of handmade goodies being sent my way :)

These messages are from people I work with professionally as you can probably see, and other than my inner circle, I am rarely asked, “Hey, how are you holding up? Is there something I can do for you?” I know we are all so caught up in our own lives, that just reaching out to check on each other seems to become lower on our priority lists.

And on those rare occasions when a friend does call after months and years with that question upfront, it is soon followed up with, “Hey listen, I’m going through this difficulty and I needed your help...” I would of course do what is needed and provide that support, but I can’t help feel that I am back to work again, because this call would have been squeezed in between sessions, in the time where I usually take a breather to get ready for the next person I am going to be working with. And when I haven’t been in touch, it’s perceived as because I may not care, which couldn’t be further away from the truth. I am in a lose-lose situation constantly :)

For the uninitiated, my day starts at 5 AM, and now that summer is fast approaching, my stressbuster—my runs would  start at 5:30 AM, and after getting ready, I am at my workstation by 8 AM and soon after into sessions. The sessions end at 7:30 PM, and then it’s dinner and time with family till 9 PM, following which I will take one last client call in case it’s urgent, before wrapping up for the day at 10 PM.

Therapy is not just the one hour that goes into the session, it is often going over assessments clients have filled out, crafting their treatment plan, going over their journals or voice notes, talking to their loved ones for history taking and/or reassuring them, collaborating with the psychiatrist on calls to discuss progress, working through their reflections and assignments between sessions, and of course documenting the details so that it is a seamless delivery of services. Imagine that a few times over in the day, when I see clients till the evening, six days a week. Not to mention the in-between SOS messages and calls from them, when thoughts of self-harm make them reach out for safety. This is just the clinical side of the work, but when you are a solopreneur like me, the administrative stuff begs attention only to be found time for post sessions and/or on weekends.

Empathy, compassion, being an effective listener, demonstrating patience and understanding, being able to sit with the client through an emotional upheaval, to have them ride the tide, to share perspectives, and create insights, and lead them towards their goals requires a constant, unending supply of energy…energy which ebbs and flows, and often gets depleted to dangerously low levels when we are working tirelessly, constantly, without paying too much attention to our own needs, desires, wants, and most importantly are grappling with time for rest and rejuvenation.

Even an inanimate computer, with its continuously charging electrical circuits when plugged in can get a little too heated up and shut down unexpectedly when overused. The human brain—a far more complex organ with exponentially more circuits and neurons—is prone to the same risk, of overheating (even just physiologically speaking) with overuse and shutting down unexpectedly.

So when I am not able to afford that luxury of paying attention to my own needs of rest and rejuvenation on some days, it often leads to missing out on life outside of work and sometimes guilt imposed by demands that I may not be able to keep, and those lost opportunities to connect on a personal and social level. There used to be a time when the guilt would be strong, but I have accepted it and made space for it, so that I can function better. But the hope remains that people around me would understand what compassion fatigue is all about.

Why does compassion fatigue make its presence felt periodically? Imagine hearing about suffering and pain day in and day out and working through it. Then there are feelings of self-doubt and inadequacy when a client feels stuck and is making no progress in therapy, however much we learn to detach, or feelings of frustration when our time and expertise is not respected but we still have to compassionately deal with the client hoping to reduce their resistance and bring about an openness. I often remind myself to see clients as rainbows and not roadblocks which brings about a needed shift in the lens we view them through so that we continue to work through the challenges, and not around them. It requires persistence and fortitude.

I often take small breaks between sessions to centre myself, to get ready to start with a clean slate with the next person I am working with. Sometimes it takes a few extra minutes to calm down, after a particularly emotionally intense session. But the next person you see would not get a whiff of the turmoil you have just moved on from. Sunday is my day and I am fiercely protective of it, choosing to engage in life based on what needs come up in that moment.

So please understand if I am unable to return social calls when I am coming up for air. If I am online on a chat engine and I am not responding to messages instantly, it’s because I am working with someone on chat too. A lot of people feel safer and less vulnerable when they type their thoughts and feelings out and can eventually speak up when they have built their trust in their therapist. The explanation is as simple as that. I will still commit to working on communicating promptly because I admit that is a lacuna I have found glaring at me.

“What will you do with all that money you are earning?” is another taunt I get. This one bothers me the most.

I chose this line of work. It comes with its challenges and difficulties but it is immensely satisfying when you see people emerge stronger from their struggles and suffering. Every tear I have wiped, to every panic attack that I have sat and stayed with a client through has been worth every bit of my time and effort. And if in taking care of my clients, I also focus on my own well-being so that I can serve them better, that too is my choice. And if I choose my work, my family, my loved ones, and my own self-care over socializing, then that is a choice I am making willingly and am very happy with. I have finite physical, mental, and emotional resources and finite time and I will use that wisely.

The ability to empathize, I also am beginning to question and wonder, has a finiteness to it. I ask myself if therapists lose a bit of themselves in taking such exemplary care of their clients, that they become jaded, and worn out, and their ability to be there with as much spirit and gusto as they demonstrated earlier may begin to falter. But given that empathy and compassion comprise the bedrock of my therapeutic approach, how can I allow those resources to fade away? And so, come hell or high water, I tell myself, I have a standard to maintain, a commitment to fulfil, and a promise to keep.  

It is often an expectation that we therapists would be happy, shining, bouncing, compassionate, Zen, and available for others. ALL. THE. TIME. And when we are not, we are on the receiving end of displeasure, in various ways.

“The world is getting so increasingly selfish and self-centred. We are only watching out for our own best interests.”

This was a  recent client in therapy, his disappointment palpable as his family was caught in the midst of a feud. I could understand where he was coming from.

I falter. I make mistakes. I admit that. I am an introvert. I like my solitude, but I also like the company of close friends and family when I have the bandwidth, like this Sunday, when I hung out with my cousins and friends, because we talked about life outside of pain and suffering, and I found immense healing in their hugs, smiles, and conversations which was so refreshing. I was myself, and was not forced to don the psychotherapist hat. I wonder if most people still see me, as just the ordinary human being as well.

If I am expected to empathize with the world around, wouldn’t it be nice to also be a recipient of it? Where people would step into the other person’s shoes and understand the roller coaster journey they have been on for a year and counting? Where instead of judgments and short fuses based on assumptions, one gets care, compassion, and a bit of understanding? And if all this is too much to ask for, at least let go of the taunts, sarcasm, and judgments. I’m OK with silence. That’s all I ask.

And yet, it will fade as writing in the sand, that Covid-19 hit our home, or that Dad was in the hospital for a cardiac procedure, or that I was doing my best to manage it all, through my own struggles in the midst of a pandemic, managing work, home, friends steeped in difficulties, and myself even through illnesses and injuries. It’s been a lot to juggle, and I would do it over and over again, willingly. 

“Mental health professionals are the ones taking care of us: Who’s taking care of them?”

The answer to that is: Mental health professionals are taking care of themselves. They are struggling, they are doing their best they can to serve a troubled world globally, they are burning out, but they are there. There for the ones who need them. And there for even themselves. Some may even be in therapy of their own.  

Please make their lives a bit easier by extending your empathy, understanding, support, care, concern, and by respecting their needs, and their spaces. It’ll go a long way.