….. and the timeliness of Mental Health Awareness Week (18-24 May 2020)
During this last week (which has been Mental Health Awareness Week) the theme, aptly, has been ‘Kindness’; the kindness experienced by many people over recent weeks – the kindness offered by others and to others - but also the need to be kind to ourselves. Self-compassion. It’s OK to feel sad, anxious or angry – these are normal human emotions, especially during times of crisis or difficulty. We can’t always be at the ‘top of our game’. Sometimes you need to give yourself the compassion you might normally reserve for others. To be kind to yourself; to give yourself a metaphorical (or even actual) hug! That can seem difficult, feeling perhaps as if we don’t deserve it. But how helpful is it to beat ourselves up for not coping; for not being ‘perfect’? (Tip: there is no such thing as ‘perfect’).
And now, as we begin to emerge from Covid-19 lock-down we may be discovering a whole new suite of emotions. The temporary certainty and sense of safety afforded by lock-down is now being replaced – again – by a new uncertainty and a sense of fear. Governments created fear among the population (perhaps justifiably given the rising the numbers of deaths) to ensure they abided by lock-down rules. And it worked. Incredibly well, here in the UK and in many other countries. So much so that many people are now fearful to emerge from lock-down, to send their children back to school, to get on a bus or train.
In my previous Coronavirus blog early on in the pandemic (in March 2020, Coronavirus – taking one day at a time…) I explained how anxiety works, typically how we over-estimate the likelihood and the severity of a threat and under-estimate our ability to cope. As lock-down is gradually loosened it may, perhaps, be helpful to begin to evaluate the relative risks we face: how the risks from Covid-19 compare with other risks we take every day without even thinking about them - crossing the road, using the car. Let alone risks we choose to take because of the rewards we get (the thrill, exhilaration, one might get from more extreme sports like climbing, hang-gliding, a parachute jump, skiing etc). I am reminded, more than ever, of how the model of anxiety relates so closely to a risk assessment model, where risk is a function of likelihood x severity of harm. And that risk is enhanced by your vulnerability.
Risk Thermostat model Source: John Adams (1999), Risk Freedom and Responsibility
John Adams (Emeritus Professor, University College London) - a long-time critic of much of the risk management industry, published his book ‘Risk’ in 1995 as an important contribution to the whole debate about risk perception and risk management. John created his ‘risk thermostat’ model that he used to explain how people make judgements all the time about their relative risks, including how people compensate through their behaviour for reduced risks, e.g. some people drive more recklessly because of safety improvement in cars – seat-belts, air bags etc. So, if their perception of danger is reduced some people may take more risks, because of the rewards they get from taking those risks compared to the risk of danger. And how people interpret threat or harm and rewards depends also on cultural and perceptual filters (societal and individual).
During lock-down we have been bombarded with relentless news stories of how dangerous and deadly Coronavirus is. That’s not to say is isn’t deadly - clearly, and sadly, it can be, and some of us may be grieving for lost loved-ones. Yet – as I said in March – the risk of a fatal outcome from Covid-19 is still a relatively small one for MOST people. Not for the most vulnerable – and we now know much more about who is most vulnerable - for whom special protection is necessary. But for those who are very young, relatively young and fit, and with no underlying conditions, the chance of a bad outcome is small. And it is becoming apparent that in London, for example, the infection rate is now the lowest in the country. London was the place in the UK where infection rates were greatest early on in the pandemic because of its ‘World City’ status and density of population. But now early antibody surveillance surveys by Public Health England suggest at least 17% of Londoners may have already been exposed to the virus and survived, having had no or mild symptoms, or even if moderate symptoms having recovered, most (c.90%) without ever going to hospital. The survey results suggest a death rate of c. 0.6% of those infected in London, which seems likely to go down with further testing and as more people have been exposed.
So, Covid-19 still appears to be a relatively low risk, despite the headlines and the large number of deaths around the world and in specific countries. Our perception is influenced by our own experience, but also by people around us and the media – the daily news briefings of numbers of deaths, 24-hour news and constant social media chatter. It is easy to lose sight of the relative risk, and so our anxiety - naturally - is enhanced. Added to this, if you have been indoors for weeks or months on end, it naturally feels scary to go outside and potentially be around other people. Indoors, you may feel in control. Outside - amid all that space - you may not, except that there are still many things you do have control over. How and where you travel, how and where you shop, wearing a face covering in places where you can’t socially distance, simple hand washing, and so on. And even the UK social/physical distance measure (currently 2 metres) would seem to be a more risk averse distance than in many countries and compared to the 1 metre recommended by the World Health Organisation (WHO).
There is, of course, no such thing as no risk – or ‘completely safe’. Intuitively we know this and adjust our behaviour all the time (often unconsciously) to balance risks and rewards. But having been confronted with such a dramatic and – yes – devastating pandemic – we can easily lose sight of the fact that the risk now may not be the same as it was, and it will change again, reducing even further, hopefully (or it may increase again). We will have to live with this virus (and uncertainty) – we cannot lock-down permanently and wait indefinitely until a vaccine or effective drugs come along, since neither may happen in a reasonable time frame, if at all. There are real risks also from lock-down itself - physical and mental health, livelihoods, social and economic. Maybe, if we can reflect on and apply some rational and informed perspective on relative risks we can, perhaps, be a little less prone to catastrophise about the worst possible (but low probability) outcomes. And, we can feel more empowered to act to reduce or mitigate the risks where we have agency, for everyone, and especially if we or our loved ones are more vulnerable.
Which brings me back to where we started – kindness and self-compassion. The simplest act of self-compassion is to allow yourself to be in the present – to be mindful - in the here and now, connecting to your surroundings, the environment and other people (even if you still have to ‘socially distance’). To be present, and have awareness of now and the world around you enables you to observe, create distance from, and get out of, your thoughts and the churning worry about what might or might not happen. To let go of thoughts.
Easy to say, but here’s the simplest of techniques (and one of the most powerful) to help you do it. It’s called ‘Five Things’:
Looking around you now, name silently to yourself five things you can see;
And then name five things you can hear (close your eyes if it helps);
And then five sensations you can feel against the surface of the skin.
When you do ‘five things’ you engage your senses, and when you engage your senses you are in the present (the only reality) – and so not in your thoughts (in the past or future).
Do it several times in quick succession and lots of times a day – in the street, in the house, your room, the garden, on public transport, anywhere and everywhere. Just get used to using it to bring yourself into the present and experience what is going on around you. And as you become more aware of the present, and connected to your surroundings (instead of focused in on yourself, your thoughts and feelings), so you can begin to find more calmness and relaxation.
Try it - be kind to yourself!
Bill Sheate, 23 May 2020