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By Suzanne M. Anderson, DPST

Westerners have often oversimplified the Chinese symbol for "crisis" to mean danger and opportunity, when in fact, it means "danger at an incipient moment" (Zimmer, 2007). Linguists argue whether "the moment" is neutral or has a positive inflection in its original language. A crisis is an incipient moment--a moment when change begins and has the potential for harm and growth. Part I addressed the danger, the emotional and social impact of the Covid-19 and can be found here. Part II discusses the opportunity for building resilience while coping with the effects of Covid-19.

How is stress like carrying a glass of water?
A psychologist walked around a room while teaching stress management to an audience. As she raised a glass of water, everyone expected they'd be asked the "half empty or half full" question. Instead, with a smile on her face, she inquired: "How heavy is this glass of water?" Answers called out ranged from 8 oz. to 20 oz. She replied, "The absolute weight doesn't matter. It depends on how long I hold it. If I hold it for a minute, it's not a problem. If I hold it for an hour, I'll have an ache in my arm. If I hold it for a day, my arm will feel numb and paralyzed. In each case, the weight of the glass doesn't change, but the longer I hold it, the heavier it becomes." She continued, "The stresses and worries in life are like that glass of water. Think about them for a while, and nothing happens. Think about them a bit longer and they begin to hurt. And if you think about them all day long, you will feel paralyzed – incapable of doing anything." It's important to remember to let go of your stresses. As early in the evening as you can, put all your burdens down. Don't carry them through the evening and into the night. Remember to put the glass down! (Source unknown)

What is resilience?
Resilience is the ability to bounce back when things get tough. When a crisis happens, we often talk about being the victim of the event. Resilience is moving from victim to survivor to thriver. When a crisis happens, we will not return to pre-crisis normal; we will need to create a new normal. Our goal must be to grow in response to the trauma. It doesn't mean we would have chosen to go through the crisis event. It means that having had no choice, we come through it and like who we are better than who we were before the incident. Perhaps our priorities are redefined. Perhaps we realize we have a new sensitivity and understanding of what others go through that gives us a greater sense of connection. Maybe we clarify our values and realign how we live in line with our values. 

As with anything that challenges us, we have the opportunity to learn more about ourselves and even to develop ourselves. The reality is that many of the things we can do to strengthen our resilience we already know. However, when crisis arises--especially protracted ones--we can spend so much time coping with the effects of the crisis, that we forget to take care of ourselves in some of the most basic ways. 

Resilience is not a characteristic that we have or don't have. It is a capacity we can choose to foster and develop. Resilience can become a lifestyle. 

Social support
We are hardwired for connection. Scientist Matthew Lieberman argues that our need to connect is as essential as our need for food and water (Cook, 2013). We connect better when we are face-to-face in the same room with each other. For educators in countries that have closed schools, there is limited opportunity for face-to-face connection. Educators in China have shared a feeling of withdrawal, a sense of sensory deprivation. 

While we are socially distant from our wider circles, we often face separate challenges from the social “support” of being cooped up with family members 24/7 day-after-day with little opportunity to get out. In this case, it may be that we have to find ways to structure some autonomy and independence. Perhaps an overnight in a guest bedroom for children who share a room, or even spouses. Perhaps creating an agreed-upon do-not-disturb time frame in which we can think our own thoughts and do our own things, knowing that we will be undisturbed. 

There are several ways to address our needs for social support. Find time to be with people who bring you a feeling of joy. Plan what you are going to do with family and friends when you can get out and travel again. Remember that anticipation is a significant part of the fun. Talk with friends or a counselor to reduce isolation, clarify thinking, get feedback, or hear some new ideas or perspectives that may be helpful. Ask for help. We often say we don't want to burden others by asking them to do something for us, but the fact is we are depriving others of a "helper's high" when we don't ask. 

Share vulnerabilities. We tend to isolate ourselves when we are not feeling emotionally well. We hide how we are feeling, and think that we are the only person feeling the strong emotions or struggling in the way that we are. So, we keep them to ourselves and may become shrouded in a feeling of shame and be isolated. Brené Brown (2017) has taught us that the antidote to shame is vulnerability. And that empathy (not sympathy) drives our connection. Find people to talk to who can be with you empathetically. 

And, as the people around you open up with their vulnerabilities and needs, support them. Give help when asked.

Physical/health abilities
Physical health is put under significant strain when our body is more stressed and exhausted from dealing with all the change, and sometimes accompanying fear that comes with crisis. We know that stress and exhaustion lower our immunity. Think about how our immunity is affected by how we take care of ourselves. 

There are no surprises here. Remember to eat well (avoid sugar); drink water; get good rest; move and exercise (but don't over-train); take time to breathe deeply; practice progressive muscle relaxation (a favorite recording is by Beth Salcedo); and set an alarm or timer to take short rest breaks to move from sitting and give our eyes a rest from the computer screen. There are a great variety of routines on the Internet that can be followed in your home (a favorite is https://darebee.com with 1,300 workouts).
 
Emotional capacities
Part 1 of this article provided a review of the emotional reactions that are commonly experienced in crisis. It is essential that we don't stuff our feelings. That is like trying to hold a beach ball under the water with one hand. When we get distracted, our emotions, like the beachball, are going to come popping out. Find ways to express your feelings:  talking, writing, or physical activity. Identify and name your feelings. That simple step can move us from reacting from the emotional center of our brain to responding from the cognitive center, allowing us to connect with more resources for analyzing and problem-solving. 

Laughing and crying both exercise our muscles, bring more oxygen into the body, and provide a release of emotions. Like exhaling takes unwanted gases out of our body, tears carry away chemicals that build up in our body in times of stress. Give yourself an excuse to cry by watching a good tear-jerker movie or creating an "angst playlist" that will help you release those tears when you want to. Laughter can reduce stress and thus help strengthen our immunity. There are many ways to find an excuse to laugh, such as good comedy videos or, if you dare, do an Internet or social media search on "Covid-19 Memes." 

Fear can be a significant and natural part of our reaction to Covid-19. We can use this as an opportunity for growth, to expand our capacity to cope with fear. Doing something outside our comfort zone every day (while being physically and emotionally safe), reduces the number of things that create fear in us, and puts us in touch with how bold, brave, and capable we can be. 

Anxiety and panic are significant features of the unseen threat of the virus. For some of us, it can feel like nervous energy, with limited ability to move around to discharge it. Find ways to soothe yourself with calm music, a warm bath, mindfulness, or a moderate exercise routine. 

Use worry and angry properly. When we use our emotions well, they serve a purpose. They get us what we need by moving us to action or getting others to move to action for us. When we worry or get angry, they are responses -- something has happened that has hurt us, or we think that something in the future could hurt us. Figure out what that dangerous thing is. And if you can do something about it, take action. If it is something outside of your control, let it go. Sometimes we might need our social support, our family and friends, or maybe a counselor, to get clarity on the problem, to sort out our power, what we can change and what we can let go. 

Can you channel your emotions into creativity? Can you create art? Write music, short stories, poetry, novels?  When we are out of our regular routine, we might have new eyes for seeing ourselves. Instagramer Amber Rae recommends journaling about what is coming up for you as an excellent way to channel this potential for learning and growing. 
 
Spirituality
David Elkins, Ph.D. in a Psychology Today article, tells us that "The word spirituality comes from the Latin root spiritus, which means 'breath'--referring to the breath of life." Susan Santucci, in Pathways to the Spirit, shares that people in every country and language search for the unquantifiable spirit that nourishes the most profound part within us and brings joy into even some of the life's darkest moments. Trauma victims and survivors teach us that for our search for the spirit to be nourishing; we need to find what speaks to us individually, not what others tell us. One person's imposition of their spiritual practice on another can often be unhelpful or harmful. 
 
For some, spirituality can mean a religious practice. However, during this time, many houses of worship have been closed or are harder to access. For others, it may be making a practice of gratitude by keeping a journal, compiling an A to Z list of gratitude, reading inspirational writings, spending time in prayer, mindfulness or meditation, or spending time in nature. During this time of being indoors in the winter, it may seem hard to find nature. "Forest bathing’ expert Dr. Qing Li describes a sixth sense that he says connects us with the world beyond ourselves. He suggests that we can bring the forest indoors with indoor plants, by bringing the essential smells of the outdoors in with aromatic oils, and bringing the sounds of nature indoors. He shares how essentials oils have been used in Taiwan to reduce the stress of primary-school teachers.
 
Cognitive abilities
The hallmark of crisis is chaos. Chaos means that we lose our routines, the usual, predictable pace and cadence of our days, our weeks, and in the case of Covid-19 it seems months. For many educators, that has meant learning how to teach class on-line and learning how to use each of the tools needed to do that. Not only are educators engaged in teaching each day (an already exhausting task), but they have to do it in new ways. 

Each time we step out of routine, we have to create new patterns that require new decisions. These multiple changes can lead to decision fatigue, which is not as easily as recognizable as physical fatigue. Making decisions about things that were otherwise mundane that we have not encountered before can require a lot of energy, and can sap us of the capacity we have previously allotted for the things that are most important to us. 

While it might seem trite to say "our thoughts become our reality," it is fair to say that "our thoughts become our perception of reality." This is based in our biology. The thoughts we think the most, will cement themselves as neuropathways in our brain that fire faster and more often. Limit our media to the barrage of news and social media about this crisis so panic and fear don't become seared into our brains. Pick a couple of good sources and let the rest fall to the side. 

Some of us who are staying indoors day-after-day may feel like the days begin to bleed together. Find a way to mark the days, to distinguish one from another:  literally mark the days off of the calendar, have a different routine for weekdays and weekends, schedule specific things on certain days of the week. 
 
We also want to normalize and create new habits around socially responsible behaviors. Create new routines around washing hands when coming into the home, when touching buttons out in the community, before touching our face. Pick a new greeting to replace the handshake. Our new greeting may be an elbow bump, the tapping of feet (affectionately called the Wuhan Shake), or a greeting with palms together in front of our chest and a smile as the Hindus greet each other. 
 
Education/experience
The cliché "information is power" has been used by many survivors of crisis and trauma. Crisis and trauma--by their very essence of being sudden, random, and arbitrary--take away our control and leave us with a feeling of helplessness. For some, learning as much about the situation they are in serves to lessen feelings of helplessness. If we follow the path we teach our students, and find reliable sources, there is much to learn about this epidemic--people's reactions to them, the impact of confinement, the effect of internet communication on the effectiveness of mirroring neurons, the sequencing of genomes, how seasonal temperatures might affect the spread of the virus, the list is endless. 

What have you learned about yourself and others? How has this situation changed you? How has it changed your values or priorities? Has this crisis helped you to clarify your perspectives on where you live, your employment, friends, and family? Is there anything that you have learned from teaching classes on-line that will inform the work you do when you return to the classroom? Will you return to the classroom?
 
Self-esteem
Self-esteem is about valuing ourselves and what we can do. We can engage in activities that increase our sense of value and worth, either because we have made ourselves a priority or because we have something that is of importance to others.

For many, in the busyness of work-life we have given up things we like to do or are for which we are skilled. Now is the time to find some time to return to those things. Perhaps you can do them for a few minutes while you are taking the mini-breaks recommended in the Physical/Health Abilities section. The confinement of having to stay at home may mean we are not able to get out to do some of the things we enjoy. Still, we can make plans about what we would like to do in the future, or we can enjoy the memories of past adventures through photos or videos, or create a vivid memory to relive the enjoyment you have had doing those things in the past using all of our senses. 

As you work on maintaining your social support network, described earlier, don't forget to spend time with people who admire you--the people who when you leave them, leave you feeling stronger, more capable, more creative, and knowing that you have a lot to offer the world. 
 
Value yourself enough to make time for fun and to celebrate your successes and life events such as birthdays and anniversaries. Perhaps every night becomes "Friday night" until you can return to your routine. Maybe you find a place where you can go outside and play a game without a mask for a short time. Have a camp out under sheets in the living room. As expatriates, we so often live for the magic of travel, but in these times, we may need to find a way to create magic at home! And remember, we are living through times and situations we never thought we would have to. We are still working, caring for our children, caring for ourselves. Our coping and surviving are worth celebrating.
 
Personality
The goal of this discussion was to provide a buffet of options for developing and strengthening our resilience. Some items in this article may even be in contradiction with each other. What we need, what works, is different for each of us. What helps us to feel rejuvenated? What brings us joy? What reduces our stress? What helps us to be the best version of ourselves? We need to listen to ourselves and do, unapologetically, what is best for our own coping and resiliency development. 
 
Developing a resiliency plan
Having read through this list, I hope that you have recognized things that you are already doing (Well done!), things you have done in the past (and will easily be reinstated), and some things that are new that you think might be helpful. Don't try to take on too much. Remember, change -- even good change – is stressful. Done too fast and our “slow-changing, stable brains” will resist (Guise, 2013). Aim for "Progress, not Perfection."

Psychiatrist and neurologist Vicktor Frankl, who survived three concentration camps in World War II reminds us "Everything can be taken from a man but one thing: the last of the human freedoms—to choose one's attitude in any given set of circumstances, to choose one's own way." I hope these ideas help you to find a resilient way through these difficult times. 

The framework for this article is based on the concepts of resilience outlined in the Community Crisis Response Team Training Manual (NOVA, 2019). The content is a compilation of ideas generated by members Singapore-based crisis response team that the educators of the Jakarta Intercultural School in September 2014 found useful and ideas of educators currently based in central and eastern China. Thank you to long-time friend Pam Schuur for once again performing her editing wizardry.
 
Reference 

• Brown, B. (2017, 20 November). Daring Greatly. 
• Cook, G. (2013, 22 October). Why we are wired to connect. Scientific American.
• Dossey, L. (2018) The Helper's High. Explore November/December 2018; 14:393-399.
• Guise, S. (2013). Mini habits: Smaller habits, bigger results. 
• NOVA. (2009). The community crisis response team training manual: Edition 4.0. Washington, DC: National Organization for Victim Assistance.

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This article is written by Claire Holmes who is Head of Counselling at Tanglin Trust School and a Certified Mindfulness teacher.

This article explores the helpfulness of being ‘purposely present’ to avoid getting swept along with the collective anxiety as Covid-19 becomes increasingly global. It comes from a place of acknowledgement that we can’t control the news or other people’s reactions; we only have control over ourselves and how we respond.

Where is your mind?
Most of us have probably noticed ourselves more future orientated than usual, getting caught up in the ‘What-ifs,’ weaving a story about what might happen and perhaps feeling more anxious over the last few weeks. This is normal with what’s happening in the world around us and of course, future planning and thinking about precautions is useful but it’s the rumination in times of uncertainty that is troublesome for us. Being ‘purposely present’ means intentionally bringing yourself back to this moment rather than getting caught up in unhelpful thinking patterns. When we are worrying about the future, we are operating from the part of our nervous system which causes a state of hyper-arousal. It’s from this place that we tend to react rather than respond, things feel more overwhelming and out of our control. When we are more present focused, we slow things down for ourselves, we move into the part of our nervous system that helps us relax and we make much better choices. 

Taking Notice
Awareness is key. When you notice that you are caught up in worrying or catastrophising, your body will often give you signs that help you recognise this. Your heart may beat a little faster, you may feel breathless, sweaty, fidgety or have that ‘butterflies in the tummy’ feeling. This is your anxiety signature, it’s different for everyone and it’s helpful to get to know yours so that you can make a choice to be ‘here.’

Purposely present techniques 
You might like to tune into your breath from time to time or drop into your body by breathing into places of tension and inviting these areas to relax. Tuning into ‘the soundscape’ – being aware of the sounds around you is another way of being present. Be aware that when you practice these things your mind will wander as all minds do, the skill is to notice where it went and gently bring your focus back to where you want to place your attention, over and over. You might like to try this for a short period of time during the day, sometimes setting a timer can help you to mind the time.
​
It might be helpful to bring yourself back to the present by simply noticing your feet in contact with the ground. Naming the emotion (s) that are here in any given moment helps us to not get wrapped up in its story and stay present too. Acknowledging what you are thankful for, connecting fully with others, offering random acts of kindness are other things that you can try to connect with the present.  Engaging your senses also helps you to be in the moment as this helps you to focus on your interaction with your environment, savouring your food, even just for one mouthful is a good way to do this. Adopting a ‘one-pointed focus’ on anything that you are doing in the now helps you move from indulging the ‘What-ifs’ to connecting with the ‘What-is,’ helping you to feel more in control.

Take a Breathing Space
As a meditation teacher I share with my class, a ‘mini – meditation’ called a Breathing Space. This technique helps us to press reset, it’s like taking an internal selfie to ‘check in’ with ourselves. It combines some of the ideas above into one exercise. Punctuating your day with this strategy can be an interesting experiment. To do this, make a choice to pause, take a breath, connect with an attitude of acceptance and non-judgement and then:
   
∞  Notice where you feel the breath most obviously and let your attention settle there. Notice the inbreath and the outbreath. 
∞  Dropping your attention into the body, notice any body sensations.
∞  Turn your awareness to your thoughts – what are you telling yourself right now? Registering not reacting.
∞  Name the emotion/s that are here.
∞  Tuning into the senses: what do you notice in your visual field? What is here to be physically felt right now (touch of your clothes on your skin, feet in contact with the floor etc….), what can you hear, smell and taste?
∞  Now making a choice to carry on with your day

​Fitness for the mind
All this is a bit like taking your mind to the gym. As with physical fitness you’ll need to practice. At first try your ‘purposely present’ strategies when you are not feeling overwhelmed. You’ll literally begin to re-train your mind, carve out new neural networks in your brain and the more that you do this the stronger these skills become. This makes the possibility of creating a pause, to respond rather than to react more available to you in times of overwhelm.

Meditating regularly helps to cement these neurological adaptations.  There are many apps to help with establishing this, they have recordings and courses available on them; Insight Timer, Headspace and Calm to name a few. 

A Gift?
Perhaps choosing to be present on purpose is indeed a ‘present’ or kind gift to ourselves in these difficult times. Cultivating being ‘purposely present’ may become a life-skill that helps you to find more stability and spaciousness in your day to day life even after this period of uncertainty has passed. If you are up for it, experiment with the strategies shared here that feel useful and fit with you, choosing to bring yourself into the present whenever you need to and explore your experience with curiosity. 
You might even like to try a Breathing Space right now before you continue with your day.

Download PDF here. 
Also published on TherapyRoute.

By Suzanne M. Anderson, DPST
 
Singapore has been my home for 20 years. It has been 17 years since I lived through SARS with three kids under 6 years of age. My strongest memory was grabbing the newspaper each morning and taking in the numbers found in the center column of the front page. Were they going up or down? Had we hit the low point (the worst it will get) or was that still to come? I was trying to answer an essential question, “Are we safe? Are we not safe?” And then to decide what my children and I could safely do that day.
 
This time my “go to” for monitoring the numbers are Singapore’s MOH reports and the WHO Situation Reports. Asking the same essential question, “Safe? Unsafe?”  
 
Carrying the news of an increase in alert levels and news stories of emptying grocery store shelves into the darkness of night can make us worry what the world will be like when we wake in eight short hours.
 
And yet when we wake, checking the numbers is not our only way of centering ourselves.  We can also look outside and see that the sun has once again risen to a day of sunshine, birds chirping, and connections with loved ones and neighbors.
 
It is a rollercoaster of emotion to manage from sun-up to sun-down, regulating ourselves, even when we see the dysregulation of others.
 
A friend of mine, a measured, thoughtful, and non-reactive friend shared with me the story of heading to Cold Storage to pick up some fruit for breakfast the next day and seeing the number of people, the lines at the cashiers, the emptying shelves and later reflected, “I am normally calm, but seeing people going crazy, made me react.” Strong, a sociologist says, “…the subjective experience of the first social impact of such epidemics has a compelling, highly dramatic quality (Rosenburg 1989 in Strong 1990, 249).”
 
What is your first memory of the Coronavirus? When did it first become a real concern or threat? That is where your story begins. It will be different for each of us, and yet there will be some commonalities. How we think and what we do matters. It matters to your own well-being and it matters to the well-being of each person who looks at you – who reads your face and interacts with you throughout your day.
 
I knew I needed to “make patterns out of the chaos of events” so that my actions wouldn’t be bouncing on inevitable waves of disaster chaos, contributing to it. Ideally, I would engage with measured, thoughtful understanding of the larger narrative. More simply put, I didn’t want to feed on fear or put out fear for others to feed on.
 
As a mental health provider watching the Coronavirus unfold, I began looking for words to codify and communicate internal and social experiences into thought and language. And as I always do, I started to read. 
 
A Google search elicits only six to a dozen articles. Some of the articles were quite dated. My “go-to” trauma resource pages focus much more attention on coping with bush fires, mass shootings, but not coping with an epidemic. The trauma literature is skewed to the Western world, even as the numbers of those affected by disease in the Eastern world surpasses many of the apparently higher priority crises. I was surprised that I was surprised. It is a dilemma known to survivors of and responders to crises—the confusing inequalities of the world’s attention. 
 
The search surfaced an insightful discussion of “epidemic psychology” (Strong, 1990, 251). Philip Strong coined the term as he sought to identify a model for understanding people and societies reactions in the wake of the AIDS/HIV crisis. He described epidemic psychology as consisting of parallel epidemics. Not only is the epidemic biological. There is also the potential for a psychological epidemic of fear. In the process of Strong’s proposed model after fear comes explanation and moralization and then the implementation of solutions or proposed solutions to the disease itself or the social and individual impact. These are concepts that affect both individuals and communities.
 
The following discussion looks at the epidemic psychology of Coronavirus and the role of the media. The article finishes with some recommendations for coping or finding a middle path through the almost predictable over-sized fears that can result in the midst of a disease outbreak.
 
Fear, suspicion, panic & irrationality 
When we are rattled by the question, “Am I safe?” describing the feeling as fear does not quite encapsulate it. For many, when the danger is invisible or incalculable – when one cannot see the enemy or the threat, but only the results – the fear may become more intense: an uncomfortable feeling of terror or dread. The feeling of having the “veil of immortality” (NOVA, 2009) torn away when thoughts, “Could I die?, Will I die? Will others I know and care about die?” come. Humans have a natural tendency to catastrophize, an evolutionary survival orientation—a primal skill of survival designed to help us survive the worst. It is natural for us to start to view, every cough, sneeze, breath, communally-touched item (railings, doorknobs, elevator buttons), with fear, terror, and dread.  
 
Suspicion and its underlying belief that that danger could be nearby, but can’t readily be verified, informs our behavior. We may suspect other people may have the disease. We may suspect medical practitioners are not doing enough to effectively respond to the medical threat. We may suspect governments are not releasing true and accurate information. We may suspect the media is releasing inaccurate or sensational fearing-inducing stories. We may suspect neighbors are stocking up on or getting the needed medical or daily living supplies and that there will not be enough left for ourselves when we need it. In a kiasu/kiasi (translated scared to lose, scared to die) culture that is scared to lose out it seems this fear of others getting what we might need could be amplified in this crisis. 
 
For some, fear and suspicion can rise to the level of irrationality. In some cases individuals can believe they have the disease or illness when there are no facts to support it. This irrationality may be fueled in some parts of the world by the worldview that accepts magic and the unexplainable to be as legitimate as the empirical. 
 
Explanation: stigma & moral judgment
On our way to action, we try to find an explanation or manufacture a rationalization. Unfortunately, our natural efforts at trying to understand what is happening and keep ourselves safe can at times lead society to respond with “avoidance, segregation and abuse” (Strong, 1990, 253). This can be in found in the form of shunning the doctors and nurses who treat the virus patients. It can be found sadly in explanations made by some that the virus is God’s judgment. It can be found in judgments of others ways of living. 
 
The more quickly we can move through this phase, the more quickly we can get to a phase of interacting with the problem in a meaningful way and the less likely we are to harm relationships within our communities.
 
Action & solutions
Strong (1990, 254) describes the intellectual confusion at the start of a disease in which “People may be unable to decide whether a new disease or a new outbreak is trivial or whether it is really something enormously important.” There comes a time when someone becomes convinced in the proportions of a religious conversion of the danger of the disease and sets about to warn and educate people (Strong, 1990). In the present response to the Coronavirus I think many would be the Dr. Le Wenliang, who was among the first to warn about the virus outbreak and was subsequently silenced.
 
As the first responder “converts” learn and begin to educate, others begin their own journeys. They experience shock, denial, disbelief. And for a health disaster that spreads like Coronavirus, it seems natural to take longer for reality to settle in and propel one from the state of confusion to the full action of warning and educating others. 
 
Like SARS and MERS before it, Coronavirus is yet another reminder that the actions and solutions of prior epidemics have affected, perhaps unrealistically, our expectations of current epidemics. When my grandmother was growing up in the 1920’s she lost two of her siblings before they were five years old. Her parents had two children die before they did. It was not uncommon at that time. The invention of antibiotics and childhood immunizations have lulled us into forgetting that life is often messy. Engineering, science, and medicine truly accomplished amazing things, but they cannot control all of nature.  What was a common occurrence during the years that my grandmother was growing up has now been deemed unnatural. I am not suggesting that we want to go back to that time. I am suggesting that we need to acknowledge the frailty of life while we aim live life more fully and meaningfully, with hope for our future in all its messiness, supporting our scientists as they work to fight these diseases, as we take positive steps for our own mental health.
 
Effect of disease on social systems
Our daily lives are ordered by innumerable behaviours and actions that happen on auto-pilot (Strong, 1990, 258). Many of these auto-pilot behaviours are related to social interactions and hygiene. In Singapore these are made visible with the initiatives such as the National Courtesy Campaign and are closely related to generating a belief in the good will or positive intentions of friends and neighbors to live in harmony. When disease arrives, the essential positive assumptions are replaced with the parallel epidemic of fear and suspicion.  From a sociological perspective, we humans then have the capacity to share those fears and suspicions through language to others. This phenomenon is heightened in the era of globalization; social media makes it easier and faster, and harder to contain. It is interesting to note that Facebook and other media platforms were not a part of the response to SARS. 
 
Medical and mental health professionals have long known the foundational positive impact of social support in difficult times. It presents a unique challenge in the case of disease, where the very person who needs your connection and support may also be the person that is the carrier of the looming catastrophe. 
 
Impact of media on mental health
Yotam Ophir from the University of Buffalo has studied the content of news information during the outbreaks of infectious disease. He concluded that the media does not generally provide the kinds of information that is most helpful. He identified three types of information found in the reporting of disease: scientific information, social stories, and pandemic themes—issues related to preventing the spread. Often the news is focused on the human-interest stories—and often the extreme behaviours (Lu, 2015), but is lacking in the information needed for the public to make fact informed decisions. Ophir finds that during the course of an outbreak such as Coronavirus, the public needs simple and clear information about the risks and healthy ways to cope. On average, however, in his study, only one in five articles included coping information. Unfortunately, information about diseases without coping information can result in an increase emotional distress and a feeling of not being able to take steps to protect oneself (Ophir, 2015).
 
Suggestions for coping & finding a middle path
A clearer understanding of how we as individuals and societies are affected by a disease crisis can lead us to a better understanding of how to take care of ourselves, and prevent a biological epidemic from becoming a mental health epidemic. The following, though not exhaustive, provide some ideas for effectively coping. 
 
Recognize that the tasks of daily living take more energy when it takes place against the backdrop of an epidemic. Figure out what you can let go or postpone some things and spend more time in self-care.
 
Identify what can be controlled and implement measures to control them. Identify things that can’t be controlled and let those things go. 
 
Recognize when our thinking is leaning towards a natural tendency to catastrophize and find a measured response the acknowledges the facts. For example, “It is possible I could get the virus, but it is not probable.”
 
Assert control where it will be useful such as routinizing new social patterns of washing hands, keeping hands from touching our faces and keeping a measured distance from others.
 
Engage in activities that develop our equanimity (calmness and composure, especially in a difficult situation (Oxford)), such as yoga, mindfulness, and meditation.
 
Turn off screens for several hours a day to engage in exercise, reading or other pleasurable hobbies.
 
Increase your connection with loved ones by spending time together and expressing affection.
 
Find support with a mentor, wise friend, medical or mental health practitioner if you find that concerns about the virus are interfering with your ability to engage in the responsibilities of daily life.
 
Look for opportunities to engage in “random acts of kindness” that will increase our own positive feelings as well as strengthen the social fabric that binds us together as community in Singapore. 
 
Be clear about the type of media reports you are consuming. Media reports without clear messages about how to protect yourself will increase anxiety. 
 
Listen to information provided by friends and family and share information with others discerningly. Is it fact? What is the source? Is it helpful or anxiety provoking?
 
When spending time getting informed about the Coronavirus be sure to spend more time on official sites that provide reliable information about risk and guidance on coping. Singapore’s MOH site or the Gov.sg WhatsApp Subscription are a reliable ones.

A special thank you to long-time friend Pam Schuur who graciously edited this piece and helped the content and flow come together. 

References
 
Dingwall, R. (2020, January 29). We should deescalate the war on the Coronavirus. Retrieved from https://www.wired.com/story/opinion-we-should-deescalate-the-war-on-the-coronavirus/
 
Lu, S. (2015). An epidemic of fear: Psychologists’ research is guiding governments and health leaders in their efforts to communicate with the public during disease outbreaks. Monitor on Psychology, 46(3), 46. Retrieved from https://www.apa.org/monitor/2015/03/fear
 
Ophir, Y. (2018, August 15). How media coverage of epidemics helps raise anxiety and reduce trust. Retreived from https://www.niemanlab.org/2018/08/how-media-coverage-of-epidemics-helps-raise-anxiety-and-reduce-trust/
 
Strong, P. (1990). Epidemic psychology: A model. Sociology of Health & Illness, 12(3), 249-259.
 
Young, M. (2009). The community crisis response team training manual:  4th edition. Washington, DC: National Organization for Victim Assistance.

Photos: Bernard Spragg (Tree lined avenue). Flickr Public Domain Dedication (CC0).