'The greatness of a nation can be judged by how it treats its weakest member."
The Covid-19 pandemic has wreaked havoc on our lives for more than two years. Throughout the pandemic, I have been looking at John Hopkins data to stay abreast of the impact of this tragic outbreak.
Unlike a medical doctor, I have dedicated more time trying to understand the psychological effects instead of the biological ones. For example, it is now well-established that domestic abuse has increased in many countries, child abuse has increased, substance abuse has increased, and the prevalence of psychopathology has increased; yet, during the lockdowns, the media seems more concerned with economic and medical impacts.
Of course, I acknowledge that the biological and economic repercussions are important issues. I also believe we should also focus our attention on the groups of people who are suffering more than most due to social and economic inequality. I further acknowledge that these biological and financial impacts are real. They are traumatic and contribute to the increasingly dire mental health concerns in society today. After all, it's hard to discuss well-being and happiness with someone who is sick, tired and poor. This is particularly relevant to traditionally marginalised groups.
Globally, females, far more than males, are suffering from greater psychological burdens such as stress, anxiety and depression. This is due to several reasons, but we cannot ignore the fact that women and girls are often shouldering the burden of domestic responsibilities to a much greater degree than their male counterparts. This is true of female students, homemakers and employees. Gender inequality leads to social marginalisation and psychological distress. The impact of inequality is particularly apparent for females living in poverty and for those that lack sufficient information on treatment options for abuse, stress, anxiety, fear and depression.
Another group impacted more than most is the hospitality and tourism sector employees. The pandemic disrupted an industry that millions of people rely on for survival. The closure of restaurants, hotels, islands, pubs, theatres, malls and basically all public spaces has dealt a severe blow to the industry, and the employees are left hoping something can be done to repair the damage done. How many readers know someone who, at one point or another over the last year, was trying to get Covid because they needed the insurance payout to cover their expenses?
Another group which struggled more than most is students. Evidence suggests that young schoolchildren are less vulnerable to the biological impact of the pandemic. Yet the psychological effects are real: two years of shutdowns and quarantines, a lack of outdoor activities, disrupted diets and disrupted sleeping patterns, the overall monotony which Covid caused have all had a significant impact on child and adolescent development.
For college- and university-level students, the strict social isolation measures, the school closures, the postponement of special events such as graduation, study abroad and potential for part-time employment or internships have all resulted in increasing struggles with mental health. For many college and university students, the social isolation proved particularly alienating and is detrimental to their psychosocial development. These issues were further exacerbated by the shift in educational delivery to online classes, and we quickly saw how the digital divide affected students already living in poverty, students in remote areas, and those that simply do not have a study space at home or access to laptops or the internet.
I could go on to discuss the elderly, the disabled and the migrant labour populations and the suffering they endured, but I think I've made my point.
We know that the above-mentioned groups are suffering more than the rest of society, so what must be done? I think a good place to begin is to start to conceptualise the pandemic as a multifaceted stressor that has 1) a global impact with no clear end in sight; 2) multiple negative effects on mental health, employment, domestic conflict and increased social marginalisation; 3) has caused a comprehensive sense of loss for many people, a loss that can be felt in terms of a loss of control, a loss of socialisation, a loss of income, a loss in opportunity and, for many, a loss of hope; 4) has caused a greater understanding of, appreciation for and longing to return to the protective elements of modern society, which helped us to cope with our daily struggles before the outbreak.
These protective elements include meeting friends, going to dinner or a movie with loved ones, going to exercise or simply going to work and socialising with colleagues.
To address this multifaceted stressor, a plan is needed. This plan should include support, both psychological and educational for those in need.
We can improve access to psychological literacy through education that focuses on access to services and types of treatment. We can learn to stop stigmatising the marginalised through media campaigns. The relatively affordable and accessible medical treatments available in Thailand should be expanded to include the psychological burdens people are dealing with.
We can develop more Thai language-based mental health questionnaires that can be completed anonymously online. Also ensure that the psychiatric facilities can promote the services necessary for the alleviation of disorders and move from a psychopharmacological treatment focus to include talk therapy, which focuses on developing coping skills and resiliency.
Pills treat symptoms, which is important, particularly for severe conditions such as schizophrenia and bipolar disorders, but therapy is also an effective method to nurture growth, healing and self-acceptance.
The education system should ensure that our schools have counsellors and clinics which do more than call parents or recommend medications. The social marginalisation of those suffering from mental health concerns is real, and society would benefit from beginning to have this difficult discussion. Perhaps then we can decide what should be done to help those suffering the most.
Assoc Prof Douglas Rhein, PhD, is the Principal Investigator at Psychology Research Cluster, Mahidol University International College.
