You are living through a sticky, complex time. As such, whatever your response to the latest changes from your government – from the opening of clubs in England to the latest easing in Scotland – it's likely true that, at some stage, you need to process what the past 16 months, and whatever happens next, meant for you.
Of course, we're all unique, and different people will have been impacted in different ways. But it's vital not to underestimate how this collective stress could play out, in some people. Experts are speaking to this reality. The World Health Organisation’s (WHO) Director-General, Tedros Adhanom Ghebreyesus, issued a warning on Saturday 6th March, declaring that the world must prepare for mass mental trauma for years to come following the pandemic.
One mental health professional who is keen to talk about this issue is Owen O’Kane, a leading UK Psychotherapist, a former NHS Mental Health Clinical Lead and the author of Ten Times Happier, He has been campaigning for the recognition of a potential new mental health complication, which he has coined Post Pandemic Stress Disorder (PPSD).
What is Post Pandemic Stress Disorder (PPSD)?
Similar in many ways to PTSD (Post Traumatic Stress Disorder), PPSD is a hypothesis that predicts that in the months after we come out of the pandemic in the UK, there will be some people experiencing a trauma reaction. This could look similar to how PTSD develops in the months and years after a traumatic event.
So what are the signs and symptoms we should be looking out for, and how can we help someone we suspect to be affected?
And what is Post Traumatic Stress Disorder?
For context, Post Traumatic Stress Disorder happens when a person has been through a traumatic life event. You have either seen, witnessed or experienced a traumatic event, and then months or years later, exhibit symptoms which could include anything from anxiety and depression to flashbacks.
So, how does this link into what has happened, and will continue to happen, during the pandemic years? 'A lot of people have experienced some degree of trauma this past year. This is where PPSD (Post Pandemic Stress Disorder) can come into play. From the uncertainty around the pandemic, the unexpected nature of it all, having been locked away for a year, the horrific headlines every day, the losses of life, the financial difficulties, the conflict with governments — it has been a relentless bad news story that hasn't let up, and I think that’s impacted on many people in different ways,' explains O'Kane.
It's important to emphasise that PPSD is not an official medical diagnosis. 'I'm talking about this at the moment, hypothetically, as something that might play out similarly to PTSD,' O'Kane says. 'It's really a warning to be looking out for this because like everything in life, you need to look beyond the surface.
'Often anxiety, depression, anger, fear and panic, are symptomatic of something else going on. I think a lot of these symptoms maybe directly linked to what's been going on over the past year – and it's important that we don't dilute that.'
What are the symptoms of PPSD?
'I think PPSD will present a bit like PTSD, in that there will be key symptoms that you're looking out for, but not everyone will have all of them,' O'Kane notes. Here are some symptoms that he would anticipate.
Increased anxiety levels or panic
Ruminating about a specific moment
Avoidance of seeing people
Developing dependency issues
O'Kane stresses that, in the case of PPSD, it would be vital to get to the root cause of these symptoms, rather than trying to tackle a symptom such as anxiety, in and of itself. 'Of course, we have to tackle that anxiety, but if there’s trauma underlying the anxiety, you've also got to tackle the trauma, because if you don't the symptoms will just keep coming back over and over until you address what it is they may be struggling with.'
How might we recognise PPSD?
'It really depends on the context of what's been going on in people's lives,' says O'Kane.
There are certain hardships specific to this time, for instance, that need addressing. 'If you take somebody who has lost a loved one and not been able to say goodbye to them, then that might have been traumatising.
'My concern is that if we try to go back to normal, somebody who has been really struggling might then go and see their GP be treated for depression. But if you don't address the trauma that's been inflicted during this period, and you don't treat that specifically, then something really significant gets missed. This is what I'm seeing in clinical practice every day.'
Who is most at risk of developing PPSD?
'I think there's an assumption that people who pre-existing mental health issues might struggle the most. But I don't think it's going to be as clear-cut as that. If you look at some of the statistics around younger people, they went through an especailly tough time and suffered with a lot of anxiety and depression,' says O'Kane.
'In "normal times," we have outlets to help us manage our own mental wellbeing. Over the last year, many resources were taken away. So when you take away the ability to connect, the ability to see people, the ability to socialise, the ability to go to the gym, of course, their mental health is going to decline.
'I grew up in Northern Ireland, and if you look at things like the 1998 Omagh bombing, most of the PTSD that happened wasn't spotted until four to six months afterwards, sometimes a year or two, before people started to present with symptoms.
'So when we talk about post pandemic stress disorder, we've got to be quite broad in the sense that we have to expect that we're going to see lots of very different presentations that might start to manifest themselves quite strongly at that point when people have to reemerge back into normal life.'
What does trauma look like and why does it take time to present itself?
'The brain works in a very protective way. During a time of trauma, or highly intense difficulty, the brain mechanics go into functioning mode, where it's trying to literally just "get through" the event of the time.
'So then when the threat is taken away, if the trauma hasn't been dealt with or processed, the brain will still be in threat mode. That's why six months later, someone might still feel anxious and hyper-vigilant, and not want to go out of the house, because they feel as frightened now, six months on, as they did at the time of trauma.'
What can be done to help people cope with Post Pandemic Stress Disorder?
'It depends on the individual. For somebody who has been suffering severely, it might be medication that helps them to rebalance. For others, it could be talking therapies, and for some people — as long as they're engaging socially and connecting with people, that might be enough to get them back on board.
'I'm not saying that everyone is going to need professional help. But it's important to not minimise the past year and not say "oh well, it’s all done now and that’s fine." '
We need to encourage people to talk about things that have maybe bothered them or really distressed them. It's about helping people to adjust at a pace that’s comfortable for them.
How to know if someone close to you is dealing with PPSD
'It's important to recognise that the occasional bad day for anyone is normal, that’s part of being human. But I think if you're having more challenging days than good days, and things are not shifting or are getting worse, it's time to address it.
'I think it's about approaching the conversation with openness. Just simply being able to normalise the conversation can be a useful way to start talking about it. For some people, even the acknowledgment of realising that someone's spotted they’re struggling can help. Make it clear to them that you're there for them and are willing and ready to listen.'
How to help yourself if you think you might be struggling with PPSD
'I think the first initial step would be to choose one person that you trust and just have a conversation with them.'
As well as tapping into your personal support system, though, O'Kane wants you there is help out there. 'The NHS have a system called IAPT which offers psychological therapy services throughout the UK. They offer brilliant treatment programmes. A skilled clinician with good experience under their belt would be able to differentiate the difference between someone who's just having mainstream panic disorder measured against someone who's got panic symptoms or anxiety symptoms, but who’s also been significantly traumatised by the events of the past year.
As for his final word, it's one of hope. 'These things are treatable— people do get better, and people do manage to deal with trauma and recover and regain their life again. But, sometimes, they might need some help.'
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