The pandemic and the consequent fear
One of the initial impacts reported by iCALL callers was related to the fear of the pandemic. The disease itself created a sense of panic and anxiety (including death anxiety) in people’s minds. Low levels of awareness about the disease, its changing symptomatology and its novel nature, caused further anxiety among public; especially during the initial stages. Callers reported experiencing worry towards possible signs and symptoms of COVID-19 in themselves and their loved ones. They approached iCALL with several queries related to signs and symptoms of the disease, and prevention measures to be undertaken.
The media plays a significant role during emergencies and epidemics by informing people about the situation and keeping them updated on measures taken by governments to contain the spread of the virus (IOM 2020). Research findings show that too much of media exposure can be harmful to mental health; with social media escalating anxiety more than the traditional media (Weir 2020). Strong sets of emotions stirred up by the media, may lead people to judge risk by these emotions rather than facts and data (Weir 2020). Similar trends were seen among iCALL callers. Those who had access to audio-visual, digital and social media were bombarded with information, which often relayed ill-founded and contradictory messages. Constant exposure to reports of rising number of cases and deaths, affected people’s psyches, creating an atmosphere of terror and threat. Individuals were worried not only about their own safety, but also of their loved ones.
Disappointment with the health system
Adequate and credible health system can play an important role in addressing and alleviating some of these anxieties faced by the general public. These include measures such as raising awareness and providing reliable information about risk and potential health consequences of the virus as well as progression of a pandemic, and prevention and intervention measures; ensuring adequacy of testing and medical facilities; making available health personnel and protection equipment; enacting steps to reduce the spread of the virus in the community and in health-care facilities; setting up of tele outreach programmes to address queries and to provide telehealth consultation; protect and support health-care workers during a pandemic etc. (WHO 2009).
However, during the COVID-19 pandemic in India (barring a few noteworthy examples), the health system did not perform adequately to address the pandemic effectively and inspire confidence in people (Chatterjee 2020). iCALL callers shared painful, disappointing and anxiety provoking experiences of dearth of testing facilities and of credible health services, delayed reports, and negligence (and at times exploitation) at the hands of the health system. iCALL callers expressed their frustrations over lack of availability of beds and health facilities. Some also complained about being overcharged for medical facilities, tests and hospital stay. The public health system in India, is known to be riddled with several inadequacies including those related to poor financing, dearth of accessible and affordable health care services, inadequate human resources and poor accountability (Kasthuri 2018). The pandemic further burdened the struggling health system, resulting in diversion of its resources to the treatment and prevention of COVID-19, and in making regular health services inaccessible to common public. Changes such as mobility restrictions and lack of transportation leading to compromised access to healthcare, inadequate supplies of medicines, shift to telemedicine and online practices, further added to the plight of the individuals.
Economic and professional worries, practical concerns, and disruption of life plans
Due to the lockdown and restrictions on mobility, callers approached iCALL to seek assistance for practical concerns related to food, medicines, transportation, and health and essential services. Callers also approached iCALL with several concerns related to livelihood and employment. They reported anxiety and uncertainty about an actual or possible job loss, pay cut, pending bills, inability to buy food, inability to pay EMIs etc.
The disease and subsequent lockdown disrupted life plans that were taken for granted by many individuals; especially by students, employers, employees etc. The sudden changes in school and college schedules and particularly in exam timetables, created an extreme sense of uncertainty and panic among students (John 2020). Those who were planning for future careers, had to change or forgo their life plans. There were many others who had planned important life events such as marriage, job transfers, buying a new house, travel, surgeries etc.; all of which had to be significantly altered. This created a huge sense of disruption and a loss of control.
Employees working in organised sector reported having to bring their offices into their homes. Initially, ‘work from home’ appeared as a positive prospect, especially to those who lived in metro cities, as it provided the necessary respite from long commute and hectic work hours. Employees looked at this as an opportunity for increased productivity. However, as the lockdown got extended, individuals reported contrary experiences of low productivity and lack of motivation. They started complaining about fatigue caused by prolonged screen interface, lack of differentiation between personal and professional lives, dearth of human interactions with colleagues, lengthy communication loops to get simple tasks done etc. Those individuals who considered their professional lives (and performance related to the same) as central to their identities, found it most difficult to accept possible losses, uncertainties and failures. Women were doubly affected as they lost their own jobs and/or those of their partners who were the primary bread winners. Competing home and work demands exposed women to further risks of pay-cuts or lay-offs.
Psychological and emotional distress
Callers approaching iCALL reported myriad of negative emotions such as feeling anxious, sad, bored, lonely, a sense of loss and grief, anger, frustration etc. Many also reported a feeling of numbness and a disconnect from every day reality. Some complained about the fear of losing every day life skills during the lockdown. Despite the talk of the ‘new normal’, the reality of the normal remained dynamic and illusive, leaving many with a sense of loss of control over their own lives. Callers complained about their depleting internal and external coping resources as the lockdown got repeatedly extended. The older ways of coping with distress, which were often linked with participation in the outside world (e.g. talking to friends or neighbours, visiting religious places, going for a walk, going for a movie, shopping etc.) were inaccessible due the lockdown. While some quickly adapted to, and developed newer ways of coping with the changed reality, others struggled to do so. For some, this also led to existentialist questioning about the meaning of life and death.
Family dynamics and increased conflicts
One of the significant themes for which callers repeatedly sought help from iCALL, pertained to relationship conflicts and their psycho-social impact. These conflicts were reported by individuals across different age groups and in several kinds of relationships including (but not limited to) parent–child, intimate, married, long distance, peer relationships etc.
Indian families, often described and boasted for their collectivistic nature, when forced to stay together for extended periods, found it difficult to navigate through this enforced togetherness. The lockdown disrupted everyday rhythms of family functioning, and robbed people of the much-needed distraction provided by work, schools and outside life. The lockdown brought ‘hierarchical and unequal nature’ of the family systems in India, to the forefront. Adolescents and young people found it restricting and frustrating to be monitored by their parents and elders, and to be sermonized on issues pertaining to screen time, digital dependence and household chores. Parents on the other hand reached out to iCALL to seek tips for keeping their children engaged at home, and for managing anger outbursts and conflicts in their teenagers.
Literature shows that the multifaceted effects of the pandemic have been exacerbated for women and girls (Mathews 2020). Given the traditional gender role expectations of caregiving from women, and unavailability of house help during the lockdown, women felt completely unsupported by the family members as they conducted the household responsibilities. Women complained about the exponential increase in unpaid care work with school closures and heightened care needs of family members at home. They also expressed their frustration and anger about the unequal and unfair division of labour at homes.
Literature also shows that measures such as social distancing may have grave consequences for the mental health of the elderly, leaving many in a state of isolation and depression (2020) and contributing to a possible increase in elderly suicides during the pandemic in India (Rana 2020). iCALL too was approached by some older adults who were separated from their children and loved ones, and needed practical as well as emotional support. On the contrary, there were a few others, who were forced to live with their children during the pandemic, and found it difficult to accept their increased dependence on their younger children and the resultant loss of freedom and dignity. iCALL also received calls from adult children of the elderly who played care-giving roles for their older parents. These individuals reported worry for the health of the elderly, and burn-out and exhaustion due to the constant caregiving burden. Some also called for psychiatric referrals to address relapse of mental illnesses in their elderly parents.
Murray Bowen’s family systems theory is one of first comprehensive theories of family systems functioning which proposes that families attempt to balance two life forces—family togetherness and individual autonomy-, that one of the known sources of conflicts in intimate relationships is lack of balance between togetherness and separateness (Bowen 1978). This core conflict reflected in the calls that surrounded issues of intimate relationships, woven around both ends: ‘frustration due to forced togetherness’ and ‘isolation due to separation from the loved ones’.
iCALL was approached by many who were stranded in the same household with their partners for months together without an escape; making the experience frustrating and distressing. Many reported that the old conflicts, which were supposedly buried under the carpet, re-emerged during the lockdown; a phenomenon described as the ‘return of the repressed’ (Veliyannoor 2020). The usual household decisions around food, routine, work, expenditure, habits etc. became grounds for contestation. Individuals also reported newer triggers for conflicts surrounding issues such as quarantine, preventive measures, testing, stepping out of the house, travelling or inviting visitors at home. Callers complained that their earlier strategies of conflict resolution in intimate relationships, failed in these circumstances, often leaving them hurt, frustrated and sad. While some reported forced sharing and intimacy as a source of conflicts, others also reported that isolation and social distancing from partners and family members, created negative consequences for their mental well-being.