Tips on Managing Anxiety in the Crisis


Salman Akhtar, MD., a well-regarded psychoanalyst and author, wrote a piece on managing anxiety during this crisis. I thought it might be useful for others to read. 


Earlier this week, a group of conservative Hindus in New Delhi took part in a communal ceremony where everyone drank a glass full of cow’s urine. Their hope was that this would serve as a prophylactic against the corona virus infection. In Istanbul, a Muslim cleric declared that he held a detailed conversation with the virus during which he prohibited it to enter Turkey. Lest these outlandish gestures be seen as restricted to exotic locales, one needs be reminded that many people in our own nation hold the belief that the viral pandemic is essentially a biological warfare unleashed upon the world by the government of China.

The emergence and mindless acceptance of such childish fantasies should, however, not be surprising. We are all frightened and vulnerable to magical thinking as we face an invisible, life-threatening enemy. The human mind, under such circumstances, desperately tries to avoid feeling helpless, seeks a ‘rationale’ for what is happening, and wants instant remedies to reverse the course of events.

It seems much healthier, even though difficult, to bear the anxiety aroused by the current threat, and resist the temptations of blaming others (‘they are responsible for it’), self-pity (‘first I lost my parents during childhood and now I have to go through this’), foolhardy denial of fear (‘I am young and healthy and will not get infected’) , or worse, sadistic glee (‘good that people are dying – maybe they deserve it’). But the question is how to avoid these morbid pathways? How to stay balanced in such scary times?

My 50 years of experience in the practice of psychiatry and psychoanalysis, has led me to conclude that the following measures might be of considerable help in staying calm under these trying circumstances.

• DEPLOY all possible preventive measures against this infection that are suggested by scientific organizations and Federal and State governments. This will not only enhance the chances of avoiding the infection but also will mobilize a sense of group loyalty, something that invariably makes us stronger in difficult times.

• DISTILL the quantity and quality of information you expose yourself to during any given day. It is good to be informed but undesirable to allow oneself to be overwhelmed. Thus, it is preferable to read the websites of CDC (the highly respected Center for Disease Control) or the National Institute for the Study of Infectious diseases, or the Johns Hopkins Medical School than to roam over the internet and collect ‘data’ from random and obscure websites.

• DE-PATHOLOGIZE your concerns. The emotional distress you might be feeling these days is not a psychiatric disorder. It is what Freud called ‘automatic anxiety’ or an uncomfortable feeling that follows from too much frightening stimulation. Your fears are not phobias. In fact, the absence of fear is more likely to be problematic. And, this might sound like an outrageous irony but I do suggest that you relax and let yourself be anxious!

• DISTINGUISH ‘physical distancing’ from ‘social distancing’. I am thankful to my daughter who underscored the necessity of making this distinction. She astutely put her finger on a crucial issue here: yes, we need to avoid too much proximity and close physical contact with others to diminish the chances of catching or spreading the infection. But this must not be mistaken for ‘social distancing’ which would leave us isolated and prone to disturbing fantasies. Thankfully the availability of social media make it possible to retain all but physical contact with loved others. And, even when such ‘Neo-instruments’ of living are not handy, there is always the good old telephone.

• DIRECT some of your attention to matters other than the current public health crisis. Work from home. Take care of the clutter around you. If you live with others, play with them, cook with them, dance with them. This will restore vitality, enrich family bonds, and bring joy to all. If, for one or the other reason, you live alone, make phone calls, watch television, and sing to yourself. The psychoanalyst, Gilbert Rose, points out that singing divides us into two people: the singer and the listener. And this dramatically reduces the sense of loneliness.

Salman Akhtar, MD Professor of Psychiatry, Thomas Jefferson University

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