“As a journal and poetry therapist, I highly recommend therapeutic writing as a way to manage emotions”

Anjana Deshpande, a licensed clinical social worker based in the US, tells Swati Subhedar in an interview how we can use our rich tradition of art, storytelling, and poetry to heal from the collective trauma that we are experiencing presently because of the coronavirus pandemic and elaborates on how, as per a study, people who wrote for at least 15 minutes a day about a painful moment are better equipped to deal with painful circumstances

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The pandemic has affected each one of us in some way or the other. Most importantly, it has drained us emotionally. What long-term impact will this have on our society per se given the fact that many countries may not even have enough counselors and therapists to deal with this unprecedented situation?

The world is currently in chaos. Masks have become the new normal, and we are “touching elbows” instead of shaking hands. While the virus snakes unrelentingly through our lives, we are constantly devising ways to manage it. Even though this struggle is emotionally draining, it is also forcing us to grow, adapt, and change. The theory of Post Traumatic Growth, propounded by Richard Tedeschi and Lawrence Calhoun in the early 1990s, posits that humans demonstrate the capacity to evolve after distressing events.

“It is the realization that old meanings no longer apply, and the subsequent search for new ones that result in the psychological shift known as post-traumatic growth. The struggle to find new meaning in the aftermath of trauma is crucial to positive psychological growth, as well as the acceptance that personal distress and growth can co-exist and often do while these new meanings are crafted —“Tedeshi, 2004.

This theory also identifies the concept of “expert companion”. This companion is able to provide support to those who are suffering, without getting overwhelmed themselves. While a counselor/therapist would be an ideal expert companion, at this time, we can cast our net wider. We are facing “collective trauma”, collective helplessness, collective grief, and I believe that healing can also be collective.

We can make meaning out of this experience by asking ourselves what have we learned, how will we change, how did we cope? To do this, we will need a safe space, and creating that safe space becomes our next task. We have a rich tradition of art, storytelling, poetry and other modalities to hold the space for this. I already see the Durga puja pandals telling the story of the pandemic. Our healing lies in this retelling of the story, in making meaning of this experience.  

Post Traumatic Growth is said to occur in five domains:

  • Appreciation of life
  • Relationships with others
  • New possibilities in life
  • Personal strength
  • Spiritual change

If you look around today, you might notice changes already happening in these domains. We are not taking anything for granted, have survived almost nine months of this pandemic, have adapted by working from home, and are using technology in innovative ways.

A Durga idol wearing a mask. Image credit: Director, producer and author Ram Kamal’s Twitter account

The brouhaha around the pandemic may have subsided, but the virus is still lurking around. People are feeling more anxious than ever. Thoughts like “what if it’s me”, “What if it affects my parents/children/partner?” must have crossed everyone’s mind. How should people deal with such extreme emotions?

I have tested myself for COVID multiple times during the past year for the usual reasons … “What if it’s me? What if it affects my family?”. At this time, we can do two things — engage in what is known as “reality testing” and identifying what is in our control.

I have not done enough research on this, but the Spanish Flu of 1918 was considered to be the deadliest epidemic faced by humans. A strain of that virus survives till today and is known as the “common flu”. We get vaccinated for it every year, but the vaccination varies according to the predominant strain that year. Today we are more medically advanced than we were in 1918, and pharmaceutical companies around the world are working round the clock to identify treatments for COVID. Thoughts like these, which are reality-based, and challenge the narrative of fear, are called “reality testing”.

Other reassuring and believable thoughts could be “I have done well till now. I take proper precautions” etc. If we start thinking about things that we cannot control or predict, we slide deeper into helplessness and terror. Establishing routines that protect us and using safety to create structure is also a way that we can manage our emotional reactivity and increase distress tolerance.

When COVID claims someone, their family is not even allowed to go near them, for fear of contamination. There is no time for proper goodbyes. This in itself is traumatic. Photo by CDC on Pexels.com

There have been too many casualties around the world.  All of us have seen images of mass graves and overflowing burial grounds. At least one person known to us may have succumbed to the virus. This is affecting the mental health of people. How should one deal with the fear of death?  

This is not the first time that humankind has come face to face with death in such a catastrophic way. In the past, we have coped with it by finding our strength and our compassion in the face of extreme events. What events like these churn up are values that we choose to uphold, and a decision of “how am I going to uphold that value in these times?” For some people, the value may be family, for some it may be spirituality or service to the community. For some, it may be survival. So, in this chaos, there is also an opportunity for growth.

We cannot minimize the pain of grief and loss that people have experienced. When COVID claims someone, their family is not even allowed to go near them, for fear of contamination. There is no time for proper goodbyes. This in itself is traumatic. What helps is again, expressing our feelings through various platforms and making meaning out of this loss. Coming together as a community and having pain acknowledged and shared by others will have a huge impact on the mental health of people.

The global media coverage is a double-edged sword. While pictures of death have been distributed swiftly, there have also been messages of hope. Again, we have control over what we see, and what meaning we choose to make out of it. Our brain has an inherent “negativity bias”, which means that we “velcro” onto negative facts, while the positive facts slip away. It takes effort to cling to the positive, and that is the effort we have to put in.

Children, the elderly, and those who live alone — irrespective of the circumstances and age group — are the most vulnerable right now. How to help children and the elderly sail through this phase? How much should we tell our children? How to be there for the elderly, emotionally, especially those who live away from their families. 

Yes, this is a real issue now, as these two populations are vulnerable and feel helpless. While there is no right answer here, open lines of communication and increased connectivity is key.

Children are constantly learning from adults. How we speak about this crisis and how we respond to it will impact how the children will deal with it. If a child is fearful, it is important to address these fears honestly, and in an age-appropriate way. While it is important to tell them the truth, how we word it is equally important. Sharing information gives children a sense of control and respect, and that seeps into their day to day lives, making them more resilient and confident.

The elderly are indeed suffering, and are in need of connection. For instance, the UK has lifted the ban on the elderly staying indoors, identifying that for this population, loneliness is perhaps worse than the pandemic. The connectivity is especially important for this group. There are many ways of contactless connections through deliveries of food, comfort packets, letters etc, which allow the elderly to feel as if they are cared for. The difference between being alone and being lonely is that of neglect. When we are lonely, we feel the absence of care, and eventually, stop caring for ourselves. This loneliness can be eased by providing care through the ways mentioned above.

Journaling/expressive writing is a proven way to manage our emotions. This is different from “normal” writing and is done with the intention of moving towards recovery. Photo by Julia M Cameron on Pexels.com

It may not be feasible for all to visit counselors/therapists as there might be other pressing issues to deal with; like a job loss or loss of business or loss of a loved one. What should people do to keep their emotions in check if therapy or medication is not the immediate option?

As a journal and poetry therapist, I highly recommend therapeutic writing as a way to manage emotions. Dr James Pennebaker, a pioneer of expressive writing, conducted a study about 30 years ago. The study proved that people who wrote for at least 15 minutes a day about a painful moment, reported improvement in the mental state and coped better with painful circumstances. The expressive writing model that he created has the following steps:

  • Write 15-20 minutes/day for four consecutive days
  • Write about something that is difficult to talk about
  • Write both about what happened and how it felt
  • Participants showed physiological improvement at the end of four days

In another experiment conducted among 63 recently unemployed professionals, those assigned to write about the thoughts and emotions surrounding their job loss were reemployed more quickly than those who wrote about non-traumatic topics or who did not write at all. Expressive writing appeared to influence individuals’ attitudes about their old jobs and about finding new employment, rather than their motivation to seek employment.

Therefore journaling/expressive writing is a proven way to manage our emotions. This is different from “normal” writing and is done with the intention of moving towards recovery. Reading Just One Thing by Rick Hanson, which is about mindfulness, could help you. 

Writing in a journal provides a safe release of emotions and aids in self-regulation. Photo by Negative Space on Pexels.com

What is poetry therapy? How does this medium help in managing bottled up emotions?

The use of poems to promote well-being, healing and recovery is known as poetry therapy. To find out more, you can visit https://www.goodtherapy.org/learn-about-therapy/types/poetry-therapy and ifbpt.org.

Poems are uniquely positioned to become containers to examine and express emotions that may be confusing, overwhelming, or shameful. By its very nature, poetry is open to interpretation, and as such is good at hiding the secrets of the writer. Poetry is precise, layered, and delivers several experiences in a condensed form. The role of poetry therapy is not to “stir” emotions, but to “integrate” them and hold space for conflicting emotions. Poet Gray Snyder says … “poetry has an interesting function. It helps people be where they are”. Poetry also allows you to slip back and forth in time and space, and helps create a coherent narrative. 

I had written the poem below when I was new to the US and missing India terribly. In India, I was able to point out trees and would know their names. In the US, I was lost. Everything that I had known about myself had come crumbling down, and I was doing unfamiliar things such as waving to my Pakistani neighbour! The poem moves between India, Pakistan and the US (across timelines, continents and seasons) and helps me place conflicting experiences on the same page. Each word that has been chosen reflects my reality at that time. 

If I had chosen to write in prose about my experience, I would have spent a lot of time trying to capture what I felt, and would have probably felt more agitated. The poem allowed me to move in and out of my experience very quickly and helped me make meaning out of my experience. Here’s the poem:

Pakistani neighbour

The tree is heavy with dew,
drips and drips
What tree is this?
I don't know.
A foreign tree,
a foreign sky.
I sit at my window,
stare at my neighbour.
At home, it is spring,
our countries
are at war
Here, we wave across
an empty parking lot.

Doodling/sketching/drawing comics can also help in keeping your emotions in check. How? Read Tanika story.  

This conversation is a part of our series on mental health and illness, as we talk to people whose voices have brought to life, with empathy and without judgement, what is it to live with a mental illness or to care for someone who does.

Related interviews: Jerry PintoAmandeep SandhuKarishma Upadhyay Shyam Mithiya and Shampa Sengupta 

“A person never commits suicide. He/she dies by suicide”

Shyam Mithiya is a Mumbai-based psychiatrist and sexologist. In this interview, he talks about how the recent death of a Bollywood actor and what followed after that was an opportunity lost, in terms of starting an honest and open conversation on mental health

Was the recent death of a Bollywood actor and what followed after that an opportunity lost, in terms of starting an honest and open conversation on mental health?

Yes. We could have done so much in terms of spreading awareness and educating people. Many people got interested in his case because he was a well-known Bollywood actor. If you try to educate people about mental health issues without any context, it might not interest them. But if a mental health issue is associated with a celebrity, they would be interested in knowing more. In an ideal situation, therapists, counsellors, psychologists, psychiatrists, and mental health professionals should have been invited to various forums, they should have had a nuanced and detailed discussion about mental health issues and busted various myths associated with these illnesses. But what followed after his death in the name of TRP (television rating point) was shocking and shameful. People were already going through a lot because of the pandemic and the lockdown. The media should have been a little empathetic and sensitive. There was no need to cash in on someone’s tragedy during such an emotionally draining phase.

His photos were circulated soon after his demise, which was such an unethical thing to do. Imagine the kind of impact it must have had on emotionally fragile minds. The headlines read “he committed suicide”, which is a wrong way of putting it. A person never commits suicide. He/she dies by suicide. By saying a person committed suicide, it, in a way, glorifies suicide. It may give people the impression that if such a successful, famous and financially stable person could commit suicide then, maybe, that’s the way to end your miseries. By focusing on this case in an unreasonable manner, and without balance and empathy, we are worsening the situation.

Image credit: Ministry of Health Twitter account

When a celebrity opens up about battling depression, people say “how can he/she be depressed?” People often associate depression with extreme sadness. What should be done to bust various myths related to depression?

We tend to use the word depression very casually. Say, if India loses a match, people say, “Oh, we are so depressed that India lost”. People tend to get confused between sadness and depression. Depression is a clinical disorder wherein a person feels extremely sad, with or without a trigger, for 14 days or more. That’s the starting point. Then there are different types of depressions like unipolar, bipolar, mild, moderate, or severe depression.

A person who has everything going for him personally, professionally, financially, and socially, and his/her life is 100% perfect, even this person could be depressed. It is a biological condition wherein there is an imbalance in the neurotransmitters, and it can be treated with medication and by making changes in the lifestyle. However, we must also understand that by making lifestyle changes or by only doing yoga and exercising, or by developing a hobby one can’t beat depression. Yes, these are additional factors that help significantly, but you need to see a counsellor or a therapist and take medication if need be. People around a person who is dealing with depression should not give him/her lame advice like “watch a motivational video” or “listen to music” or “think positively”. These things will suffocate a person with depression even more. Instead, encourage him/her to see a therapist.

Please understand, a depressed person goes through a lot. People going through depression can’t help feeling sad and or crying non-stop. They know the ill-effects of eating junk food, yet they binge. They can’t sleep. They feel like going out, meeting friends, and living a regular life, but they are just not able to pull themselves out of their beds. Also, a depressed person need not necessarily be suicidal and those with mild or moderate depression can still function as normal human beings.

Mental health helpline numbers. (Right) Dr Shyam Mithiya

Often, people categorize those suffering from complicated mental health issues like mental disorder, bipolar disorder, or schizophrenia as “paagal” (mad). How should we address this issue? 

Unfortunately, all mental health disorders like depression, anxiety, obsessive-compulsive disorder, phobia, panic disorder, social anxiety, dyslexia, learning disability, attention deficit disorder, hyperactivity disorder, mental disorder, schizophrenia, or bipolar disorder are categorized as “pagalpan”. People say things like “arey ye to paglo ke doctor ke paas jata hai”. People having schizophrenia or bipolar disorder are often termed as “possessed”, are ill-treated, chained, burnt with match sticks, or taken to faith healers. When nothing works, their families bring them to us. When the families see a considerable improvement in the patients after we prescribe medicines to them, they feel guilty, especially so when they realize that these illnesses are treatable. There are many such misconceptions. We need to spread awareness at the ground level or at the school level. Only then the next generations will be more aware, more accepting, and ready to seek medical help.  

A large section of society has access to the internet. People often google their symptoms and arrive at a conclusion, rather than visiting a therapist. They read about the side effects of medicines and either stop taking the prescribed pills or don’t start the treatment at all. What should be done to change this?

It is dangerous. Let me tell you why. If you Google “headache”, the third option is tumour! Now, imagine a person having anxiety googling his/her symptoms, reading about the medicines and the side effects. That person will get petrified and not even come to a therapist. This worsens the situation. Visit a therapist, talk to him/her, understand your situation, take medication, if need be. That’s the proper way. Don’t try to be a doctor. You are not an expert.

Video credit: Ministry of Health Twitter account

Mental health is still a taboo in Indian society. Even educated families are not willing to accept that their children could be having mental health issues. Very few are open enough to take their children to a therapist. Casual reactions like “oh, it’s nothing” or “it’s all in your head” can do a lot of damage.

Yes. If someone is having a heart problem then we don’t tell that person “heart se nikal do”. So, why tell someone having anxiety or depression that “dimaag se nikal do”. I feel people who recover from mental illnesses should share their success stories on social media so that more and more people read about their experiences. This will help others. This way, those dealing with mental health issues will not feel awkward about their situation. This will give them the courage to open up and discuss their options with their families or friends. But, it’s a vicious cycle. People don’t share their stories because they fear that others will brand them as “pagal”.

The pandemic is having an adverse impact on the mental health of people. What should be done to be mentally and emotionally fit during such difficult times?

As per the statistics, one in seven people in India is dealing with some mental health issue or the other. That comes to 15-20 crore Indians and this means almost every family has one person who is dealing with a mental health issue. We never had enough psychiatrists, psychologists, or mental health professionals. Now, the pandemic has added to this burden. There is too much anxiety. Today, a family visited me for therapy. I asked their nine-year-old son to wait outside while I spoke to the parents. Fearing coronavirus, he kept standing for 15 minutes and didn’t sit on the sofa. That is a reflection of how anxious people are. Yes, there is too much coronavirus-related grim news floating around, but if you are a parent, remember, your kids are watching you and they are going to replicate your actions, so react to a situation in an appropriate manner.

These are the seven things you must do to keep your mental health in check during the pandemic.

(1) Sleep for at least eight hours a day
(2) Eat healthy and balanced meals
(3) Exercise … meditate for sure, yoga rebalances the nervous system
(4) Don’t live in a bubble … communicate (5) Don’t suppress any kind of emotions
(6) Develop a hobby
(7) Do something for someone or society. There’s nothing more satisfying than that

As told to Swati Subhedar

This conversation is a part of our series on mental health and illness, as we talk to people whose voices have brought to life, with empathy and without judgement, what is it to live with a mental illness or to care for someone who does.

Related interviews: Jerry Pinto, Amandeep Sandhu, Karishma Upadhyay, Anjana Deshpande, Tanika Godbole and Shampa Sengupta