These uncertain times are testing our resilience
There’s evidence that shows when you treat someone as old, they start to feel and act old, writes
NOBODY saw this coming. Well, maybe Bill Gates did. Talk about the butterfly effect. An imperceptible happening in the ground-zero Wuhan market unleashed a tornado that has torn through the way we live, leaving a trail of premature deaths in its wake. Governments were caught on the hop, forced to rely on administrative systems that were not prepared for this. To borrow a phrase that was once used about the social partnership process, they are building the ship at sea. So we need to extend some forgiveness here. Still, there are mystifying gaps in our response .
Take the National Public Health Emergency Team (Nphet), the body which advises the Government on the response to the coronavirus, chaired by Dr Tony Holohan. The great majority of this 16-strong team are eminent medical experts, the rest come from nursing, HSE or patient representative groups. This exclusive focus on medical and hospital expertise was understandable at the beginning of the outbreak when everybody was scrambling to orchestrate an immediate response. But managing the coronavirus outbreak was never just a medical issue. It always carried huge economic, psychological and social implications. The Government has ready access to economists. But there is not one psychologist on the Nphet team — someone with expertise on mental health, who could advise on the likely psychological and social effects on people of living with the constant low-level anxiety of infection, and the long-term effects of living under lockdown. This must surely be part of the national response.
We are not just physical bodies or potential coronavirus patients. We have minds and hearts. And our psychological wellbeing is not some optional accessory in all this. Splitting body and mind, as if one is unrelated to the other, flies in the face of all the evidence from the social sciences that say otherwise. Psychological wellbeing, physical health, and even mortality are tightly linked. Last week, the World Health Organisation warned of a looming mental health crisis. So managing uncertainty, isolation, loneliness, stress, anxiety, boredom, and depression has to be part of the national response.
Well, you’d never guess this if you relied on the advice coming from the Department of Health where the old medical model appears to hold sway. Maybe this accounts for the strategy of ‘cocooning’ older people — a term that is usually used in relation to babies. Add to that the relentless negative narrative about age, which has now embedded a clang association between being old and…? Being vulnerable. Being old and..? Being frail.
Does the risk of contracting coronavirus increase with age? It does. But if you are obese, or male, you are also at higher risk. Yet, there was no messaging about the ‘frail male’ or the ‘vulnerable obese’. So is this just a matter of a few ruffled elderly feathers? Hardly. Being treated as old, frail and vulnerable has real and adverse effects on your general physical and cognitive functioning, including your memory, your balance, gait, hearing, and speed of movement. There’s a large body of evidence that shows when you treat someone as old, they start to feel and act old.
How old you feel is not a trivial matter — there is a strong link between how old you feel and your physical and psychological health, and the older you get the stronger that link becomes. In fact, how young or old you feel is a more powerful predictor of health and mortality than your chronological age. That is why a hyper-focus on age drives home the message that it’s age itself which determines your health and wellbeing, and when you come to believe that, it has measurable and adverse effects on your functioning.
Let me count the ways. When you believe your chronological age determines your health and how you live, you see your health, and any illness you may develop, as less preventable, and less treatable, so you are less motivated to actively manage any health problems you may have. All of this decreases your sense of control over your life, and can create a downward spiral that deepens your feeling of vulnerability and helplessness, and increases the risk of depression and inertia. Worse, it doubles your risk of mortality in a two-year period.
Every time you are exposed to messages of frailty, however well intentioned, it has a direct impact on your physiological functioning and autonomic nervous system, a branch of the central nervous system that responds to environmental stress. You show a heightened cardiovascular response to stress. Repeated elevations of cardiovascular stress response heighten your susceptibility to heart problems. As a result, you are twice as likely to suffer a heart attack or stroke after age 60, and if you do, your recovery may be compromised. So, too, with recovery from injuries and other illness. You are more susceptible to cognitive decline and feel much less satisfied with your life. Hardly surprising then that all this increases your risk of dying prematurely.
Nphet could have taken a different approach. The message to older people could have been: ‘Take active charge of your life’ — an appeal to the experience and wisdom of older people, to their continuing ability to actively and pro-actively manage their health and their lives, rather than go into avoidance mode. They could have been encouraged to stay as fit as possible in constrained circumstances; to preserve their autonomy, and to live as independently as possible.
There is a bigger challenge ahead. As the summer rolls on, there is an increasing risk of lockdown fatigue. The novelty has worn off. The first frenzy of spring cleaning has turned into a grind as a houseful of people, off work and off school, have to be fed three meals a day. Trying to bake sourdough bread is losing its allure
The lockdown is stressful but at last the rules are simple. Managing the easing of lockdown will be a lot harder. Inevitably there will be more ambiguity, and the burden of decision-making will increasingly pass to the individual. They will fret more. Have I the right information to determine what’s safe, or what might be a risk worth taking? Am I reacting the right way? And how are other people going to react? As desire and fear fight it out, good intentions can get derailed and sidetracked. This creates a lot of psychological unease, and the more ambiguous the situation, the greater the unease. Helping people manage this more complex, dynamic context is going to move centre stage.
Irish people have shown remarkable resilience in how they have responded to this crisis. But prolonged uncertainty wears down resilience when there is no end in sight.
Nobody knows when this crisis will end. The issue now is just how to keep going. Nphet and the Department of Health can’t be expected to provide certainty, but they can and should provide leadership — not just a rulebook. They need to partner with the public. So let’s hear about the surveys of public opinion that you commission, so that we can each individually calibrate our beliefs and feelings with the general public mood. Let’s hear how you plan to deal with the psychological issues ahead, with the potential fallout on mental health. Tell us how we can help you. Up to now, we have willingly put our trust in you. But as time moves on, that trust will have to be earned.
‘Psychological wellbeing is not an optional accessory’