COVID-19 PANDEMIC: CHALLENGES AND RESPONSES OF PSYCHOLOGISTS FROM INDIA [First ed.] 9798663053372

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COVID-19 PANDEMIC: CHALLENGES AND RESPONSES OF PSYCHOLOGISTS FROM INDIA

L. S. S. Manickam EDITOR

COVID-19 PANDEMIC: CHALLENGES AND RESPONSES OF PSYCHOLOGISTS FROM INDIA

LEISTER SAM SUDHEER MANICKAM EDITOR

Copyright © L. S. S. Manickam, Editor First Published in 2020 Each chapter to be cited as Author/s Last Name, Initial(s). (2020). Title of the chapter. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.xx-xx). Thiruvananthapuram: The Editor. Independently published by Leister Sam Sudheer Manickam [email protected] Centre for Applied Psychological Studies Thiruvananthapuram - 695 133, India. Cover photo: Helen Joy ISBN: 9798663053372

DEDICATION To all psychologists from India and their families responding to COVID-19 wherever they are.

CONTENTS Acknowledgments Contributing Authors Preface

i iv xv

1

Psychologists from India Responding to the COVID-19 Pandemic: An Overview L. S. S. Manickam, Dr. Annie John, M. A. Debora, Dr. Preethi Krishnan and Dr. J. Jasseer

1

2

Refining Psychological Services and Strategies in India in the wake of COVID-19 S. N. Anindya, M. A. Debora and L. S. S. Manickam

8

3

Responding to COVID-19 Pandemic: Challenges of Indian Psychologists Kalpna and Dr. NovRattan Sharma

23

4

Socio-Emotional Responses Within and Outside Family Boundaries During COVID-19 Dr. Anagha Lavalekar

38

5

COVID-19 and Migrant Workers: Clinical Psychologists’ Viewpoints Asima Mishra and Dr. Neha Sayeed

43

6

Supporting Students and the Community During a Pandemic Dr. Annie John

School

56

7

Promoting Well-Being and Resilience of Young People During COVID-19: An Initiative with Schools Dr. Chetna Duggal and Lamia Bagasrawala

63

8

COVID-19 the Pandemic and People with Intellectual and Developmental Disabilities Dr. S. Venkatesan

76

9

Outbreak of Corona: Gifted Response Dr. Sujala Watve

90

10

Psychologist’s Mind on Missing Beats of an Expatriate Life Reena Thomas

101

11

Locked or Unlocked: Two Sides of the Coin Aarzoo

105

12

‘The Return of the Repressed’ in COVID-19: The Need for Intervention at Socio-Cultural Inscape Dr. Paulson V. Veliyannoor

108

13

Tomato or Tennis Ball? Tips for Coping with Corona 130 Resiliently and Helping Others Psychologically Dr. B.J. Prashantham

14

Self-Talk to Change Your Perceived Reality Dr. Manju Agrawal

135

15

Role of Psychologists in Dealing with Triple Disaster Situation During COVID-19 Pandemic Dr. Prasanta Kumar Roy

141

16

Psychological Response to COVID-19 Pandemic: Views of an Indian born Australian Counsellor Sunita Jitendra Gaud

149

17

Reclaiming New Horizons: Therapist of 2020 Pandemic Era Dr. Prerna Sharma

155

18

Contributions and Challenges of Psychologists in Private Practice in India and their Responses to COVID-19 Dr. Dherandra Kumar

166

19

Telepsychotherapy: The Bridge to Continuity in Care and Mental Health Services in COVID-19 and Post Covid Era Smriti Joshi

170

20

An Experiment with Online Group Counseling during COVID-19 D. S. L. Amulya

182

21

Indian Academy of Applied Psychology (IAAP): Vocal Voice on Local to Global Perspectives of Psychological Services Dr. NovRattan Sharma

198

22

Tamil Nadu Association of Clinical Psychologists (TNACP) Responding to COVID-19 Pandemic Dr. N. Suresh Kumar, Srinivasan Jayaraman and Dr. K. Rangaswamy

204

23

A Paradigm Shift: Changes, Challenges and Way Forward S. Divyaprabha, N. Ganesh, S. Kalpana, R. Nandini, S. Bhaskar, R. Suryakumar and Dr. T. R. Uma

209

24

COVID -19 Pandemic: A Time for Prudent and Ethical Action L. S. S. Manickam

218

ACKNOWLEDGMENTS The journey of bringing out this book has been very short. It was conceived and realized within a span of a few weeks, thanks to the generosity of the authors and editorial team members who put in extra effort to bring it out, realizing the urgency of the topic. We got several psychologists and students of psychology to respond to the call to write their reflections and reports on how they had responded to the COVID-19 pandemic. I wish to acknowledge my sincere thanks to all the authors who had responded to my invitation and gave their contributions on time, irrespective of their professional engagements in responding to the pandemic. Amidst personal losses, inconvenience during lockdown days and struggle to meet personal demands, each of them took time to write, by sharing their reflections. Thanks are to Aarzoo, Dr. Anagha Lavalekar, Dr. Annie John, Dr. Chetna Duggal, Ms. Debora Myrtle Anish, Dr. Dherandra Kumar, Ms. Lamia Bagasrawala, Dr. Manju Agrawal, Dr. Paulson V. Veliyannoor, Dr. Prasanta Kumar Roy, Dr. B.J. Prashantham, Ms. Reena Thomas, Ms. Smriti Joshi, Dr. Sujala Watve, Mrs. Sunita Jitendra Gaud and Dr. S. Venkatesan who had authored various chapters. Thanks to Ms. D.S.L. Amulya, Ms. Asima Mishra, Ms. T. Kalpna, Dr. Neha Sayeed, Dr. NovRattan Sharma and Dr. Prerna Sharma for submitting articles in response to the announcement made through different social media and indiacaps.in. I also wish to express my thanks to all the others who had responded but could not be accommodated in this book. Various national, state and regional level psychology associations were contacted and thanks to Dr. NovRattan Sharma, General Secretary, IAAP; Dr. K. Rangaswamy, Dr. Suresh Kumar and Srinivasan Jayaraman of TNACP and Ms. Saras Bhaskar and colleagues Ms. S. Divyaprabha, Mr. Ganesh Nerur, Ms. Kalpana ii

Suryakumar, Nandini Raman, R. Suryakumar and Dr. T.R. Uma of CCF who gave their perspectives, record of activities and future plans of their respective associations in responding to the pandemic. Special thanks to the Editorial team members Dr. Annie John, Ms. M. A. Debora, Dr. Preethi Krishnan and Dr. J. Jasseer for sparing their time and energy to give a better shape to this work as it appears now and for associating to present an overview of this book. Thanks to Ms. Aarzoo, Ms. M. A. Debora, Dr. Emilda Judy, Dr. Lena Robinson, Dr. Neena David, Dr. Nitha Thomas, and Dr. Preethi Krishnan, for helping me with the review of the articles. Finally, my sincere thanks to my wife, Helen Joy, daughter Neha and son-in-law Navin. Thanks to Milan, four year old grandson, for letting me to work in his ‘toy room’ during the lockdown days, though occasionally he complained about me not playing with him and ‘advised me’ to take rest instead of ‘working all the time’. Leister Sam Sudheer Manickam (L. S. S. Manickam)

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CONTRIBUTING AUTHORS Aarzoo holds Masters in Psychology from Panjab University, Chandigarh and M. Phil. Clinical Psychology from Chennai and is working as Assistant Professor in Clinical Psychology at the Department of Psychiatry, Government Medical College & Hospital, Chandigarh. She has been working in the clinical setting since 2007 and is interested in areas of adult psychiatry; children having an intellectual disability, autism, ADHD, and behavioural problems. She has been supervising and teaching trainees of M.Phil. Clinical Psychology since 2012. Manju Agrawal is a Psychotherapist, Hypnotherapist, Family Constellation Therapist, a Social Entrepreneur and an Educationist with 38 years of experience. She is the former Director of Mahila Samakhya, UP. She is currently the Professor of Psychology and Dean Student Welfare, Amity University, Lucknow Campus. She is the Chief Architect of the Women’s Policy for UP. She has also conducted more than 125 training programs for more than 4,000 hours in India and abroad. She has partnered in the launch of a platform for psychologists and alternative therapists for holistic healing committed to Mission Mental Health with YouTube Channel by the name of MindSpa. [email protected], [email protected] D. S. L. Amulya is a practicing Counseling Psychologist, an alumnus of Montfort College, Bengaluru. She has experience in working with adults of different age groups, through face-to-face as well as online counseling. She is a freelancer at present and her work interests include psychological counseling and building awareness about mental health through workshops/webinars. [email protected]. S. N. Anindya holds Masters in Psychology from Amity University, Lucknow, and currently in training as a transpersonal therapist from EKAA foundation. She believes in aligning with the inner nature to create harmony within and around by giving expression to all the aspects of the self through art, science and iv

spirituality, to reach full potential of human life. She is enthusiastic about bringing psychology in the lives of common people through workshops, and is currently preparing to connect with doctors and school teachers to create a collaboration in Rourkela, Odisha. [email protected] Lamia Bagasrawala is a practicing psychotherapist and queer affirmative counsellor. She is the Project Coordinator for School Initiative for Mental Health Advocacy (SIMHA). She is a visiting faculty member at the Department of Psychology at SNDT University, Mumbai and Jyoti Dalal School of Liberal Arts at NMIMS University, Mumbai. She is also on the Board of Studies (Psychology) at Jai Hind College, Mumbai and NMIMS University, Mumbai. She has completed her M.A. in Clinical Psychology from TISS, Mumbai. Saras Bhaskar is a Counseling Psychologist and Coach. She has more than 30 years of campus, corporate and NGO experience. She practices at Bloom Healthcare in Velachery. She is the co-founder of Chennai Counselors’ Foundation. She has submitted her Doctoral thesis at the University of Madras. She has a Master degree in Counseling and Applied Psychology from St. Edwards University, Austin, Texas and from SIET College, Chennai. Myrtle Anish Debora, works as an Assistant Professor of Psychology and Clinical Psychologist at the Government Stanley Medical College and Hospital, Chennai. She completed her graduate and post graduate study in Psychology from Women’s Christian College, Chennai, and was awarded her M.Phil. in Psychology from Sri Ramachandra Medical College, Chennai. She works predominantly in the area of Intellectual Disability and also enjoys teaching post graduates at Stanley Medical College. She was actively involved with the Trauma Counselling team in the aftermath of the 2004 Tsunami response. She is actively involved with the Tamil Nadu Association of Clinical Psychologists in providing tele-counselling services for the COVID-19 Pandemic response. [email protected] S Divyaprabha is a Counseling Psychologist with a Masters degree in Counseling Psychology and has more than a decade of v

experience as a School Psychologist. She is a Certified Professional Supervisor. She has submitted her doctoral thesis in psychology and is the Research Wing Coordinator of Chennai Counselors Foundation (CCF). Chetna Duggal is an Associate Professor in the School of Human Ecology, Tata Institute of Social Sciences, Mumbai. She has completed her M.Phil. in Clinical Psychology from NIMHANS, Bangalore and her Ph.D. from TISS, Mumbai. She is the Project Director and heads the School Initiative for Mental Health Advocacy (SIMHA). She is a practicing psychotherapist and through her initiative RAHBAR she works for training, supervision and professional development of mental health practitioners and supervisors. She is a trustee of Apnishala, an organisation working towards making social-emotional learning accessible to children from underprivileged contexts, and is on the advisory board of Project Mumbai for the mental health initiative. [email protected] Sunita Jitendra Gaud, Master of Clinical Psychology from Pune, India in the year 2006 is now a member of Australian Counselling Association. She worked in the position of Sports Psychologist for 5 years at the Army Sports Institute and helped the sportspersons to use their full mental potential in achieving their participation in the World Championships and Olympics. She has been working for the Department of Communities, Australia as a Child Protection Officer for the last 7 years and specialised in a range of fields including Trauma, Relationship Counselling, Family Counselling and Risk Assessment. [email protected] J Jasseer is the Associate professor and Head, Department of Psychology, University of Kerala and he did his Masters and PhD. Published 21 research articles and co-author of one book titled ‘Basics of Counselling’. He is the Honorary Director, Center for Geriatric Studies and Psychology Consultancy cell attached to the Department of Psychology, University of Kerala. He had supervised 8 doctoral students, developed and standardized 12 psychological tests. He is registered with the Rehabilitation Council of India as a rehabilitation psychologist. He is also the President of the Kerala Manasasthra Parishath. [email protected] vi

Srinivasan Jayaraman, is M.Phil. in Clinical Psychology and is Assistant Professor in Clinical Psychology, SRM University, Chennai. He is Executive Committee Member, Indian Association of Clinical Psychologists and Treasurer, Tamil Nadu Association of Clinical Psychologists. [email protected] Annie John is Head, Counselling Services, Mallya Aditi International School, Bangalore, India. She did her Masters in Psychology from University of Kerala, M.Phil. and Ph.D. in clinical psychology from NIMHANS, Bangalore. She was instrumental in developing the systematic assessment tool of learning disability, which was later modified as the NIMHANS battery of Learning Disability. She was the lead in developing IACP Practice guidelines for Learning Disability. She practices as a School Psychologist. [email protected] Smriti Joshi is a clinical psychologist and certified advanced telemental health professional, with 18 years of experience. She currently leads designing psycho therapeutic interventions for the world’s first mental health chatbot - Wysa and played a key role in developing a text based supportive therapy delivery platform for Wysa users. She was also instrumental in setting up of one of the first online therapy platforms in India and has been on the advisory board of some others. She is a life member of International Society of Mental Health Online (ISMHO), Telemedicine Society of India (TSI) and IACP. [email protected] T Kalpna has done her Masters in Psychology and M.Phil. from Himachal Pradesh University and is currently pursuing her Ph.D. in the area of Cognition and Personality from Maharishi Dayanand University, Rohtak, Haryana. She is a member of Indian Academy of Applied Psychology (IAAP). Her areas of research interest are personality, cognitive psychology, industrial psychology, school psychology, gender psychology and criminal [email protected] Dherandra Kumar is the founder and director of Psyindia (multidisciplinary intervention centre) and LRS World College (RCI Recognized). He is a consultant with Apollo Hospital, Noida, President-Elect of Indian Association of Clinical vii

Psychologists and Chairperson of Committee on Tele-counselling Practice Guidelines. He was instrumental in setting up the mental health support helpline in the wake of COVID 19 pandemic. He is consulted as an expert by different media organizations such as NDTV, Zee News, India TV, Time, Times of India, Hindustan Times, Indian Express, Femina, Vanita, Child, India Today, Radio Mirchi, Red FM, Radio City and other media [email protected] www.psyindia.com N Suresh Kumar did his Masters in Psychology from Bharathiar University, Coimbatore, M.Phil. in Clinical Psychology from Sri Ramachandra Medical College, Chennai and Ph.D. from Bharathiar University. He is currently working as Asst. Prof cum Clinical Psychologist, Department of Psychiatry, Madurai Medical College, Tamil Nadu. He is the Secretary of the Tamil Nadu Association of Clinical Psychologists and Executive Committee member, Indian Association of Clinical Psychologists. He had published several research papers in various National and International journals. [email protected] Preethi Krishnan works as a clinical Psychologist/Counsellor in Srishti Institute of Art Design and Technology, Bengaluru, a visiting Professor at Sweekar Academy in Hyderabad, a part-time faculty at Montfort and is also a private practitioner. She was formerly a Professor and Head of the Department of Clinical Psychology, SRM Medical College, Chennai and Sri Ramachandra University, Chennai. She did her M.Phil. in Clinical Psychology from NIMHANS and has a Doctorate in Counselling Psychology from Swinburne University, Australia. She had worked with the people who were affected by the Gujarat Earthquake and Tsunami and was also involved in research related to the disasters. She is also a Professional Life Member of the Indian Association of Clinical Psychologists. [email protected] Anagha Lavalekar is a passionate traveler in the field of psychology. She has a Masters in Clinical Psychology, and a Doctorate in Social-Educational Psychology aiming at fusion of Eastern and Western viewpoints on quality of life. As a Director at Jnana Prabodhini's Institute of Psychology, Pune, India she is viii

pursuing the path of positive mental health through different initiatives in profession, and has contributed to the field of research and academics over the last 25 years. She has published more than 30 articles in national and international referenced journals, written books on psychology, edited books on compilation of research and is also a National level awardee for Research in Psychology. [email protected] Leister Sam Sudheer Manickam received his Masters in Psychology from University of Kerala, Clinical Psychology training (M.Phil.) from the National Institute of Mental Health And Neuro Sciences, Bengaluru and Ph.D. from C P University, USA. He is the Professor of Clinical Psychology and Hon. Founder Director of Centre for Applied Psychological Studies, Thiruvananthapuram, India and serves as Director of Training and Research, Mhat, Calicut, India. He also serves in the research committee of the Association for the Advancement of Gestalt Therapy. [email protected] Asima Mishra is currently working as a Clinical Psychologist in Central Institute of Psychiatry, Ranchi. She is pursuing Ph.D. in Clinical Psychology from CIP under Ranchi University. Her areas of interest include working with children, Adult psychiatry and psychotherapy. Ganesh Nerur has an M.Sc. in Applied Psychology from Annamalai University. He is a non-practitioner. He is a member of the Advisory Committee and active member of the Chennai Counselors Foundation (CCF). He is a retired IT Professional, having managed and mentored large teams across cadres. He is an avid blogger and studying human behaviour is his passion. B J Prashantham is Professor of Counselling Psychology and Director, Institute of Human Relations, Counselling and Psychotherapy, Christian Counselling Centre, Vellore, India, Distinguished Prof. of Coaching Psychology, CFI Graduate School of Coaching, USA and is a world renowned Psychologist with 50 years of professional experience as a trainer and supervisor of many counsellors. He has versatile competencies in areas like corporate coaching, counselling, clinical work, cross-cultural ix

psychology, trauma counselling and psycho-neuroimmunology. He is the President of Association for Psychological Counselling (APC), India and author of best-seller book ‘Indian Case Studies in Therapeutic Counselling which was translated into Tamil, Burmese, and Korean languages. [email protected] Nandini Raman, is a consultant counselor, a corporate trainer, and a columnist with The Hindu. She did B.A in Psychology and Education from Sophia College, University of Mumbai and did M.Sc. Psychology from University of Madras. She consults at Venkateshwara Hospital, Nandanam and at Saraswathi Vidyalaya and Sri Sankara Vidyashram, Chennai. K Rangaswamy, President, Tamil Nadu Association of Clinical Psychologists, Retired and Visiting Professor at Institute of Mental Health, Chennai. Former Dean and Head of the Department of Clinical Psychology, SARS, Secunderabad. He is a Fellow of Indian Association of Clinical Psychologists. He was formerly editor of Indian Journal of Clinical Psychology and currently the editor of Journal of Psychological Researches. Prasanta Kumar Roy has done M.Phil. in Medical and Social Psychology from Central Institute of Psychiatry, Ranchi and Ph.D. from University of Calcutta and is working with Department of Clinical Psychology, Institute of Psychiatry, COE, Kolkata. He is having training in Disaster Mental Health, Clinical Hypnosis, Verbal Behavior Therapy, Interpersonal Therapy and Social Role Valorization. His areas of interest include the Comprehensive System of Rorschach, Mindfulness based intervention, Hypnotherapy, Psychological Trauma Management, Disaster Psychology. He has volunteered in many natural and man-made disasters in India to provide psychological support and training. He is currently a Member of Disaster Mental Health Task Force, Indian Association of Clinical Psychologists. [email protected] Neha Sayeed is an Associate Professor; Head, Department of Clinical Psychology, Central Institute of Psychiatry, Ranchi, x

Jharkhand, India. She is the chief coordinator of suicide prevention helpline which renders help to suicidal individuals round the clock. She has been a gold medalist in Social science and an achiever in her university. Her area of research includes Neuro-Cognitive Psychology, Suicide Prevention, CBT, Adult Psychiatry, Sex Therapy. [email protected] NovRattan Sharma is a Professor at Maharishi Dayanand University, Rohtak. Currently, serving as the Secretary of Indian Academy of Applied Psychology (IAAP) and the editor of the Journal of Indian Health Psychology. With the experience of 36 years in teaching and research, he has contributed extensively to the psychology discipline by publishing 12 books and approximately 196 papers in national and international Journals. His areas of interest are Personality, Applied positive health, and Counseling [email protected] Prerna Sharma has done her M.Phil. in clinical psychology and Ph.D. She has drawn her work experience working with institutes like TISS, Mumbai; Medanta, Sangath, Goa; GMCH, Chandigarh and Dr. RML Hospital New Delhi. She is passionate about broadening horizons of mental health for every person. She believes that the future of psychology lies in moving out of the closed spaces of clinics and hospitals and having meaningful collaboration and dialogue with experts from other fields as well as laypersons. She is currently working as a clinical psychologist in the center of excellence in mental health, Dr. RML Hospital, New Delhi. [email protected] R Suryakumar is a Counseling Psychologist and Founder of MANAS Counseling Services, Chennai. He is a Research Scholar, pursuing his PhD from Bharathiar University, Research and Development Centre, Coimbatore. He is the President of TA Study Circle (Madras) and also the Honorary Correspondent of Chinmaya Vidyalaya Anna Nagar, Chennai. Kalpana Suryakumar is a practicing Counseling Psychologist with a Master’s degree in Guidance & Counseling. She is the Co-Founder of MANAS Counseling Services and the current President of Chennai Counselors’ Foundation. She has specialised in Marital xi

and Family Counseling and has given several interviews on mental health issues in print and visual media. Reena Thomas hails from Thrissur, Kerala, India. She did her M. A. and M.Phil. in Psychology from University of Kerala. After M. Phil. in Clinical Psychology from KMC, Manipal in 2002, she started her career as Clinical Psychologist at NIMHANS, Bengaluru and moved to the Department of Clinical Psychology, KMC and served as a faculty member until 2008. Since the last 12 years, she has been part of various health care sectors catering to the mental health needs of people from all over UAE and had multicultural exposure. For the past 3 years, she has been associated with Medeor, Burdubai, Dubai, UAE. a unit of VPS healthcare group. [email protected] T R Uma is a counselling psychologist and completed her M. Phil in Psychology from the Presidency College, Chennai. She holds her Ph.D. in Neuropsychology (Executive Functions of Children with ADHD) from the University of Madras. She is a visiting consultant in Bloom health care hospital, Velachery and in ‘Be well Hospital’ Chennai. Paulson V Veliyannoor, CMF, a catholic priest, holds a doctorate in clinical psychology and currently serves as faculty at the Forge Center for Claretian Renewal at Madrid, Spain. He has previously served as assistant professor of psychology at Christ College (now, University), Bengaluru, and founding principal of Saint Claret College, Ziro (Arunachal Pradesh). He is also the founding editor of Artha: Journal of Social Sciences (CU, Bengaluru) and InterViews: An Interdisciplinary Journal in Social Sciences (SCC, Ziro). He may be contacted at: [email protected] Srinivasan Venkatesan is Professor & Head, Department of Clinical Psychology, All India Institute of Speech and Hearing, Mysore, Karnataka. He has authored 27 books, published 150 research articles, and conducted over 300 workshops for various audiences on topics related to children with special needs. A recipient of several awards and accolades including a Gold Medal by a former President of India in 1994, his publications have xii

received Google Scholar H-Index of 17, i10-Index of 38 with 19000 views on Academia.edu, ResearchGate Score of 22.49 and 85000 reads. [email protected] Sujala Watve is Former Secretary of Jnana Prabodhini Samshodhan Sanstha, Pune, India, National Supervisory Psychologist of Mensa India and Advising Psychologist. She initiated and coordinated a one-year ‘Post Graduate Diploma course in Education for the gifted: methods and strategies’, affiliated to Savitribai Phule Pune University under UGC Innovative. [email protected]

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PREFACE The impact of the COVID-19 pandemic on mother earth and every life it supports has highlighted the role and significance of psychology. Urging the public to learn to comply with physical distancing, helping people to cope with their distress during isolation, and the stigma towards those who are identified as positive are some of the challenges faced. After the initial shock of the pandemic, people are slowly getting into a different phase of realization. What emerges next is not known. Preparedness can help to cope with what may come up. The Centre for Applied Psychological Studies (CAPS), Thiruvananthapuram sent out an invitation to the psychology community through the e-groups of psychologists and through social media requesting articles on the major theme, ‘Responding to the COVID-19 Pandemic: Challenges of Indian Psychologists’ on May 15, 2020. To motivate the students and professionals, prizes to the top 3 entries were also offered. The option to write on 14 subthemes was given. CAPS sought any Indian Citizen, living in India or abroad and a psychologist or student of psychology or who has studied psychology to respond. CAPS received 29 submissions and selected 5 of them for publication. In addition, 4 reports of action programs of different national psychological associations in India, Indian Academy of Applied Psychology, Indian Association of Clinical Psychologists, and regional associations Tamil Nadu Association of Clinical Psychologists and Chennai Counselors Forum are also included. CAPS also invited professionals and experts from different areas of specializations to write on their perspectives in relation to COVID-19 pandemic and 16 responded. Though diverse, one can find an ‘invisible blend’ of thoughts. Some of the work executed by psychologists in India and their perspectives are made available in the public domain as a document of reference for the upcoming psychologists. I hope that this volume would help those who are researching psychological responses to COVID-19 to get a glimpse of the perspectives.

Leister Sam Sudheer Manickam (L. S. S. Manickam) xiv

COVID-19: Challenges and Responses of Psychologists from India

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1 PSYCHOLOGISTS FROM INDIA RESPONDING TO THE COVID-19 PANDEMIC: AN OVERVIEW This book is the edited work of original articles and views of psychologists and psychological associations in India who have responded to challenges that arose from the COVID-19 pandemic. The book gives an overview of the concerns of professional psychologists in India and their responses, from their individual and organizational capacity, to meet the mental health challenges of different sections of society. It also gives their reflections and aspirations on how the profession of psychology needs to move forward in addressing issues that have emerged during this pandemic and to make sustainable and strategic plans to mitigate them. S. N. Anindya, M. A. Debora, Dr. L. S. S. Manickam, in their article ‘Refining Psychological Services and Strategies in India in The Wake of COVID-19,’ present national strategies that psychologists of our country need to use while responding to the pandemic directly and what the profession needs to do in the next 5 years. In their wish regarding what psychological associations in India need to do in the next 5 years, they call for role clarity, rethinking on the training of psychologists, streamlining organization from within, standardization and inter collaboration of associations in responding to disasters and calls for a paradigm shift, to align with the values of our cultural context. In the chapter responding to COVID-19 Pandemic: Challenges of Indian Psychologists, Kalpna and Dr. NovRattan Sharma review the psychological and mental health problems faced during the COVID-19 pandemic and earlier virus related epidemics that have been reported from other countries as well as from India. They discuss the mental health consequences of lockdown, quarantine and post quarantine situations and warn of challenges that arise. 1

Dr. Anagha Lavalekar through her writing on ‘Socio-emotional responses within and outside family boundaries during COVID-19’ takes one to the realities of the COVID-19 that are happening across the different sections of society in India, and highlights the importance of ‘dialogue’ to overcome the fear that sets in. Asima Mishra and Dr. Neha Sayeed in their article review the existing literature on psychological disturbance relevant to the COVID-19 pandemic along with a review of various articles highlighting the plight of the migrant workers. The articles which were reviewed focused on the psychosocial issues of migrant workers and provide steps that are essential to manage the distress of the people who had to travel long distances to get back to their home states. Dr. Annie John in her article ‘Supporting Students and the School Community During a Pandemic’ highlights the particular stresses that arise during a pandemic in a school community of students, teachers and parents. School psychologists have a responsibility and are in a unique position to support the community with sessions aimed at improving mental health, advice regarding learning and formulating policies that can be put in place to alleviate the effects of stress. In the chapter ‘Promoting Well-Being and Resilience of Young People During COVID-19: An Initiative with Schools’, Dr. Chetna Duggal and Lamia Bagasrawala present some of the activities carried out through the School Initiative for Mental Health Advocacy (SIMHA), an initiative of the School of Human Ecology, Tata Institute of Social Sciences, over a period of two months. The initiative was meant to support and promote children and young people’s mental health and well-being, in collaboration with the school community of school leaders, teachers and counsellors. Webinar series for counsellors working with children and adolescents, web-series for teachers, experiential workshops on self-care and support for counsellors during the pandemic were initiated to achieve the objectives of developing communities of care to build resilience that provide an enriching experience.

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COVID-19: Challenges and Responses of Psychologists from India

! Dr. S. Venkatesan, in the article ‘COVID-19: The Pandemic and People with Intellectual and Developmental Disabilities’ highlights the unique challenges in addressing the acute and long-term needs of People with Intellectual and Developmental Disabilities (PWIDD) in the context of the ongoing pandemic. Beginning as a personal narrative, critical psychosocial issues related to COVID-19 etiquette, lockdown-quarantine, risks-vulnerabilities, economic and occupational fallouts, and research are highlighted. He has provided a recommended outline for public education on COVID19 and PWIDD, which is a valuable guideline. Dr. Sujala Watve, in the article, ‘Outbreak of Corona: Gifted Response, writes about tele-education for the Gifted, where the educational needs of gifted children are met during the lockdown, in the comfort of their homes. In addition, a report of initiative of students and the alumni of the school of Jnana Prabodhini who were engaged in service to the needy during this lockdown is also provided. Reena Thomas, in the article, Psychologist’s Mind on Missing Beats of an Expatriate Life’ writes from her heart on how a psychologist from India, living in a foreign land feels and cares about the ‘motherland’. The realization that one cannot take home all who are living abroad, forcing many to remain wherever they are, gives a feeling of being ‘stranded’. Living in a developed country, she shares the double pain of ‘struggles to balance the economy and contain COVID-19’, amidst several uncertainties which move people into a ‘collective agony and a state of worry’. Aarzoo, in her article ‘Locked or Unlocked: Two Sides of the Coin’ sees another side of the lockdown and writes about people who wish for an extension of it to spend time with their loved ones. Overcoming the initial barriers of pent-up emotions, suppressed interests, mechanical lifestyles and other unhealthy behaviours she feels that many have started investing and utilizing their time to do things which they wished. The lockdown ‘paused a fast-pacing life uniformly’, on the positive side, it permitted certain segments of people in our country ‘to pause, rethink, rediscover, rejuvenate and repair’ leading to a liberated people. 3

In the chapter, ‘The Return of The Repressed’ in COVID-19: The Need for Intervention at Socio-Cultural Inscape’ Dr. Paulson V. Veliyannoor, currently living in Spain, amidst people who have initially struggled to contain the pandemic uses a case study of a client who sought psychospiritual help during the pandemic times as symbolic of what may unfold at the macro levels. He brings forth to the conscious level some of the ‘forgotten’ concepts in psychology to understand the current scenario. The ‘Interdividual’ living in a collective society with the prohibition of touch, adapting to virtual reality has to be understood from the critical vulnerability of our context. The current state can stir up within an unbiased psychology professional, several repressed thoughts. The author analyses the possibilities of the return of the repressed in the Indian society and calls for an active and concerted intervention by psychologists and other behavioral scientists at the socio-cultural inscape. Dr. B. J. Prasantham in his article titled ‘Tomato or Tennis Ball’ Tips for Coping with Corona Resiliently and Helping Others Psychologically, provides his findings of a survey conducted following the pandemic and gives tips for resilience and suggestions for Psychologists to respond to in the current situation. He gives useful tips for those who are worried about the COVID19 and to those professionals who are providing support. His practical 5 R’s can be adapted easily by those who are in the frontline and others alike. Following the tips even partially, he hopes would help people to “bounce like a tennis ball rather than splash, and disintegrate like a tomato on impact of the fall”, On a positive note, Dr. Manju Agrawal in the chapter ‘Self-Talk to Change Your Perceived Reality’ observes that people living in a happy and positive family environment with good domestic harmony have made constructive use of the available time and seized the multiple advantages and opportunities from the current situation. She suggests a technique of ‘self-talk’, which is basically positive pronouncement or constructive proclamation to the self and narrates the experience of releasing a podcast online which many of her clients found very soothing and calming. 4

COVID-19: Challenges and Responses of Psychologists from India

! In the chapter, ‘Role of Psychologists in Dealing with Triple Disaster Situation During COVID-19 Pandemic’ Dr. Prasanta Kumar Roy describes that the usual pattern of dealing with disasters by psychologists in India, of providing psychological support days after the disaster, needs to be replaced by active involvement and that it has taken place during the current pandemic. He goes on to state that in some parts of the country, mental health professionals are challenged by ‘triple disasters’ at the same time; including socio-economic disruptions due to the loss of livelihood in all socio-economic strata leading to an increase in mental health issues. When multiple disasters which demand conflicting response measures strike simultaneously, it compounds the challenges mental health professionals face calling for a review and total revamping of conventional methods employed in disaster management. As a counsellor who has experienced the Indian and Australian scenario, Sunita Jitendra Gaud in the chapter ‘Psychological Response To COVID-19 Pandemic: Views of an Indian Born Australian Counsellor’ suggests measures that can be used to address the challenges that arise. She proposes that we establish support services, emphasise communication about accessing day to day needs and services, and help people rate their personal distress in order to access psychological services. She cautions not to ignore providing recreation activities, taking into consideration the culture that one lives in. Dr. Prerna Sharma, in her article, ‘Reclaiming New Horizons: Therapist of 2020 Pandemic Era’ gives a personal account of transforming herself from working as a clinical psychologist in hospital set-ups to the role of a therapist at the various quarantine centres of COVID-19 across Delhi. Not many clinical psychologists across the country had to wear Personal Protection Equipment (PPE) and meet their clients while responding to this pandemic. Prerna working in high risk situations narrates the professionally enriching and challenging experiences that led to discovering ‘new realities’ in the wake of the current pandemic. She feels that 5

responding to extraordinary situations requires new ways of relating to clients and is a great challenge. Dr. Dherandra Kumar in the article ‘Contributions and Challenges of Psychologists in Private Practice in India and their Responses to COVID-19’, writes that mental health professionals in private practice were the first in responding to psychological distress caused by the spread of the virus and the lockdown. Apart from informing their patients that they are reachable over phone, they used social media and addressed the public through free helplines. Mental health professionals, who predominantly engage in inperson client sessions, are now challenged to use technology as a means of reaching out to those in need. Smriti Joshi suggests using tele-psychotherapy as a means of providing service for the issues posed by the COVID-19 pandemic, and also as a preventive measure to instil resilience for what the future holds. In this regard, she goes on to stress the need for guidelines for tele-psychotherapy and to make training in telepsychotherapy essential for postgraduate students of psychology. Amulya D S L initiated online group counselling during the lockdown period based on perspectives gathered from interviews of professionals running online groups for mental healthcare. The 8 sessions experiment was meant to create a safe and supportive space for clients to work together on self-care goals. She records observations and relevant inferences drawn regarding the potential of creating such therapeutic groups online. Dr. NovRattan Sharma, in his report ‘Indian Academy of Applied Psychology (IAAP): Vocal Voice on Local to Global Perspectives of Psychological Services’, describes the functioning of the IAAP and how the association has responded to the pandemic. He also narrates the programs that the association wishes to implement in the immediate future. Dr. Suresh Kumar, Srinivasan Jayaraman, Dr. K. Rangaswamy in their article titled ‘Tamil Nadu Association Of Clinical Psychologists (TNACP): Responding To Covid-19 Pandemic,’ 6

COVID-19: Challenges and Responses of Psychologists from India

! report how the association initiated telecounselling for psychological issues and the response from the public. The TNACP launched a series of webinars for continuing professional development, benefitting both students and professionals during the lockdown. S. Divyaprabha, N. Ganesh, S. Kalpana, R. Nandini, S. Bhaskar, R. Suryakumar and Dr. T. R. Uma in their article on ‘A Paradigm Shift: Changes, Challenges and Way Forward’ describe how COVID-19 has impacted people and calls for a paradigm shift and ease into the ‘new normal’ way of living. It also gives a description of how the Chennai Counselors Foundation (CCF), based in Chennai, Tamil Nadu, functions and describes their initiatives bringing out a brochure on wellness tips, a Parenting Manual for COVID-19 free e book and “Let’s talk”, a free tele counseling pan India initiative. Evaluating the ‘worlds biggest psychological experiment’, Dr. L. S. S. Manickam in his article ‘COVID -19 Pandemic: A Time for Prudent and Ethical Action’ calls for developing national strategies by the psychological associations that can help individual psychologists be heard by policy makers of our country. In the absence of ethical guidelines developed for the psychologists of the country, based on ethical guidelines developed by American Psychological Association, the article calls for psychologists to take steps that are ethical while creatively adjusting to the new normal situation that is emerging. The articles that are presented in this volume, will help the reader get a perspective on how psychologists in India have responded individually and collectively to the COVID-19 pandemic. We hope that it provides encouragement to the fraternity, and direction to guide them while formulating action plans in the future. L.S.S. Manickam, Annie John, M. A. Debora, Preethi Krishnan, J. Jasseer Editorial Team 7

2 REFINING PSYCHOLOGICAL SERVICES AND STRATEGIES IN INDIA IN THE WAKE OF COVID-19 ANINDYA S. NAG, M.A. DEBORA, L. S.S. MANICKAM Introduction COVID-19, as it is known all over the world has taken a great toll on humanity and continues its unrelenting spree. The corona virus (2019-nCoV), that originated in Wuhan, China, was reported to the World Health Organization (WHO, 2020) as a variant of influenza on December, 31, 2019. Observing the alarming rate with which it spread and the high mortality rate, what was initially recognized as a flu-like disease was soon declared a public health emergency of international concern by WHO on January 31, 2020. In India, the first case was reported in Kerala, in January, 2020 (India Today, 2020). As the spread of the virus continued at an alarming rate, the Government of India and the state governments got into action and kick started measures to contain its spread. The lockdown that was declared on March 24, 2020 has great implications on the behavior of all the people in every walk of life in our country. While it has forced a majority to face the harsh realities of life, it has brought out the creative side of many others. In this article we present the national strategies that psychologists of our country need to take in responding to the pandemic. It also focuses on how the psychology associations can play a proactive role and make use of the opportunity to help the people at large and strengthen the psychology community in India to take on the challenges, in dialogue with the policy makers. NATIONAL STRATEGIES OF PSYCHOLOGISTS IN RESPONDING TO COVID-19 The WHO provided guidelines for health workers, team leaders and psychologists for contingency plans along with aids for psychological support in its article published on 18th March 2020 (WHO, 2020). Each member country has already enforced and put 8

COVID-19: Challenges and Responses of Psychologists from India

! in place the National Action Plans which has implications at the national, sub- national and international levels, but there are still baseline priorities that need active focus. Coordinated systems and contingency planning While adapting to COVID-19 changes, the management of psychological health, public health and emergency demands structured plans that are coherent at the local, state and national levels. This in turn demands the national level psychological associations to establish connections globally and respond locally. Internally the associations have to work in coordination with government departments of Home Affairs, Human Resource, Education, Finance, Industry, Travel, Environment, Social Justice, Health and Family Welfare, National Disaster Management Authority (NDMA) and Defence. The national level psychology associations in India and regional level associations (Divyaprabha et al., 2020; Kumar, 2020) have taken steps to coordinate with government initiatives. Psychologists and mental health professionals working with institutions or independently can be encouraged to deliver their services and employed in different frontline capabilities of our country once they are trained in COVID-19 contingency strategies. Undoubtedly, it is of prime importance to work closely with the Government of India and the state governments, parliamentarians and policy makers in order to bring this elaborate idea into fruition. DISASTER MANAGEMENT Our country has experienced several natural and man made disasters in the past. During the past two decades we had several major natural disasters that led our country to establish a National Disaster Management Authority, as per the Disaster Management Act (2005). However, our profession does not seem to have taken it seriously and has not made attempts to develop a strategy for national level preparedness by training the people at large in Psychological First Aid (PFA), which psychologists only can take a lead. Disaster psychology or Disaster Management or Trauma Psychology as a specialization is not offered for undergraduate students of psychology. The need for introducing disaster psychology in our psychology training is a necessary take away this 9

pandemic has highlighted (Roy, 2020). The National Policy of Disaster Management (2009) has prompted NCERT to include Disaster Management as a subject to be adapted and adopted by state level and secondary boards from classes VIII–IX. Disaster management was included as a part of the CBSE and ICSE school syllabus and other courses, but not yet as a specialization in psychology. Practice drills in combating disaster can be grouped together with sports events or Social Awareness Program (SAP project) making it a compulsory component of the syllabus and a certificate of competency can be issued on successful acquisition of mandatory skills. Volunteer organizations and volunteers who actively participate in rescue operations, can be trained in PFA to work in coordination with a mental health professional while responding to disasters of any nature. ROLE OF PSYCHOLOGICAL SCIENCE IN RESPONDING TO COVID-19 PANDEMIC. The current pandemic has thrust millions of people to a territory seeming to be home, but is a place of anxiety, disrupted lifestyle, uncertainty of future and financial instability, with social distancing aggravating and provoking the suppressed emotions. The social and work-life which used to be coping strategies are no more available to fulfill one’s esteem needs. Therefore, loneliness, anxiety, fear, abuse and other psychological issues that previously remained dormant in family systems and individuals, are now rearing their ugly heads (Veliyannoor, 2020). The temporary disconnect from nature can also affect the mind and general health of the public. Using community resources to support Pro-social and Pro-health plans can be activated within much deeper layers of segmented populations by using the available community resources. Psychological associations can connect with clubs, societies, fraternities and various other NonGovernmental Organizations (NGO) and cater to alleviation measures like enforcement, creating awareness drives, working out creative methods of community engagement, helping stabilize the unrest in communities and counter-balancing the stigma associated with COVID-19 affected individuals and risk communication. This also helps to monitor, identify, and stabilize the subclinical and 10

COVID-19: Challenges and Responses of Psychologists from India

! home quarantined individuals by providing Psychological First Aid (PFA). Functional support groups for target populations like the active health care professionals, parents, teachers, caregivers and quarantined individuals are active in some places. It is important to engage migrants, villagers and farmers who are below the poverty line(BPL) who do not have access to such groups with culture specific and context based innovative approaches. Traditional forms of art that can bring psychological relief and were found to be helpful in dealing with anxiety, pain, fear and hopelessness may turn out to be effective (Sajani, 2017). Research Research on pandemic afflicted aspects of human life which will help to make mitigation processes effective and friction-free is essential (Singh et al., 2020). Along with alleviation of psychological distress due to Covid-19, the psychology fraternity needs to plan and implement systematic and large scale research through the course of the pandemic. This can help in evaluation and refinement of the current assessment and therapeutic methods, to aid better policy planning, implementation and service delivery. Positive psychology is a blooming field with life-skills teaching methods, that can transmute the gloom of the pandemic and urge the affected minds to appreciate life with positive thinking. Research in the past had shown that several positive psychology concepts including gratitude can aid in reducing anxiety, help the recovery of persons with Post Traumatic Stress Disorder (PTSD) and relieve many from other disorders (Chen, 2017; Lies, 2014; Vieselmeyer, Holguin & Mezulis, 2017). Positive mindset may help counter the psychological issues that humanity is facing right now and research is needed to establish how these can help some people to ‘harness the stress during a pandemic for positive growth’ (Van Bavel, 2020). University of Kerala, Thiruvananthapuram had already called for innovative research proposals from different departments including the department of psychology on various aspects of the pandemic meant for different sections of people including children.

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CHALLENGES TO OUR PSYCHOLOGISTS - MAJOR SHIFTS LIKELY TO OCCUR IN 6-12 MONTHS, 5 YEARS. Psychologists today are left to face the consequences of once ignored factors that cannot afford to stay neglected anymore. Furthermore, the current challenges are perfect opportunities to reevaluate our priorities, reset our inner resources and re-engage plans put on hold, channeling the creative mind to anchor an ideology or a philosophy deep into ground reality. The alarming number of calls to the helplines reporting domestic violence and child abuse should not come as a surprise, as these lay under wraps and were coped with ineffectively until now. Students, adolescents and a large section of the society including the working class are now seeking professional help, which is desirable for maintaining mental health of the people (Health and Social Justice Department, 2020). However, the sudden increase in demand has become a challenge. Therefore, psychologists from India across the nation and worldwide, must now pool in their inner resources and their knowledge on human psychological processes, behavior and life skills to come up with a standardized procedure for care and support. Making the general public aware of the services that psychologists can provide is the first and foremost step that can be taken. Besides planning and organizing within psychological associations, it is time to connect with all active mental health professionals and start programs for community outreach. Coalescing with other health professionals, especially the physical health care professionals and educationists who are invested in ground level work can be of great help. Awareness drives through media and mass communication channels regarding the services and knowledge that psychological science has to offer can help streamline the crisis support amidst the pandemic. Connecting all service providing psychologists with the active health workers in their respective geographical locations within these 6-12 months, can be challenging. However, in the upcoming years, building our own channels and networks can equip us to handle various disasters. This needs to focus on establishing sustainable helplines, assistance and support groups, legal and paralegal teams, rescue teams, shelters and supporting/reviewing legal policy groups regarding violence and 12

COVID-19: Challenges and Responses of Psychologists from India

! abuse cases. Individuals with disability consistently need clinical assistance which needs to be maintained despite disaster or pandemic (Amatya & Khan, 2020; Venkatesan, 2020). Prioritizing our goals It is evident that the general public lack life skills to deal with uncertainty and maintain home- work-life balance. It was easier to adopt divergent coping techniques till the real setback in the form of a pandemic struck, to reveal the deeper void of human consciousness. So it is time to focus on making life skills the basic knowledge criteria, rather than relying on temporary solutions. Using psychology to promote self-reliance, community connection, social responsibility, group consciousness and kinship within and among various groups can act as strong anchors in the face of challenges. Psychological assessment and Online platform With the shift of counselling and psychotherapy being conducted through online media (Amulya, 2020; Joshi, 2020) data management and securing the data collected under the confidentiality clause is a big challenge. Along with learning necessary digital handling of data skills, there is a necessity to adapt therapeutic online communication skills to make it worthy. With online sessions, the outreach is now global. However, administration of psychological tests which require face to face contact demands thoughtful review. It is time to seek alternative methods of administration of projective tests and develop norms to interpret the tests that can be taken online (Jellins, 2015). Formulation of methods to supervise the online administration, revising the assessment protocols in online assessment, privacy and security of the data gathered are of prime importance. At the same time, unauthorized use of the tests has to be kept under check by the regulatory body that keeps a check on the development and distribution of the tests. Experiments, testing and policy making One of the key components of training in psychology is the experiments which took psychology from the arts domain to science. Basic and conventional time based tests like the ‘reaction 13

time’ and similar tests probably can be better administered and recorded using the online platform (Anwyl-Irvine et al., 2020). Teaching departments of psychology have to collectively think of transforming more assessment tools to online platforms, and validate the tools. Our tests for experimental psychology are distributed by private companies who are independent of the psychology organizations. Therefore, the quality of the tests for experiments goes unchecked. Many psychologists have developed tools to be administered online even during this period (Amulya, 2020). These projects and experiments need to be indexed, categorized and compiled and the data base should be made available for researchers across the country. OUR WISH: WHAT PSYCHOLOGICAL ASSOCIATIONS IN INDIA NEED TO DO IN THE NEXT 5 YEARS To eradicate, mitigate or control any layer of human life wherever it is contributing, psychology can do wonders to manage the resource we currently have at our hands. Though India has more than 100,000 trained psychologists, (Manickam, 2016 b) many have not taken membership with the mainstream national psychology associations. The psychological associations in India, need to work collectively in facilitating growth in the society with the support of its members. We are highlighting some points that we expect from the psychology associations in our inner resources that come naturally to us as Indians and psychologically inclined to act as peacemakers. Role clarity Our psychological associations need to acknowledge and state clearly what are the roles of each psychologist with specific specialization. When it comes to the general public, people are still conflicted as to what kind of ‘mental health professional’ one can visit for what type and kind of issues. There is no clear assignment of counsellor roles and job duties and it is also denigrating to see job sites showcasing ‘counsellor’ as front-desk managers. Even among the psychology professionals, there is a constant displeasure and mistrust between psychologists with different specializations and those delivering different services, like the academicians and the professional service providers in different settings and the researchers. Either the associations collectively decide on precise 14

COVID-19: Challenges and Responses of Psychologists from India

! role descriptions, or each association should come forward and state what each member can do and cannot do. But that does not deter one from being a member of different associations provided one has acquired the competencies required for the specific role, like a trained counseling psychologist becoming a school psychologist, after getting trained in the skills to be a school psychologist. Lack of regulation by the associations allows many unqualified people to fill up the vacuum created by the needs of the society. Once the professionals are clear about the roles, awareness drives through newspapers, media and various channels of communication can bridge this information gap to make the public access our services, for whom the psychologists are meant to be. Training in Psychology In the next 5 years, if psychology stakes its due claim in nation building, it will be a much sought after career. However, there are several roadblocks which need to be cleared at the earliest, some of which are already mentioned above. Unless the academics, practitioners and research psychologists come together and arrive at a consensus, it will be difficult to achieve. The tenure of courses in psychology has to relook at the number of years of training. Students giving 7 years of their life in order to earn a commendable career in a subject that is considered as an art rather than science, creates a lot of financial stress. Psychological science needs to be standardized and grounded in more skill based training in the master level itself. The current Master in Science is more of an academic qualification in comparison to Masters in Arts of Psychology. The weightage disparity between Psy.D. and M.Phil. in clinical psychology courses that are intended for similar areas of work, varying in focus and expertise, needs serious review (Manickam,2016). There is a need to establish psychology courses as two separate streams: academic based and practice based at the graduate level, so that psychology graduates have clarity in choosing what they intend to do and choose their career accordingly. A selection process must be formulated to select students for both academic and practice based professions at the 15

entry level itself, which can be done by a panel of career counsellors and supervisors in respective fields. Encouraging the general public to study psychological concepts by introducing it as a common subject just like history or mathematics in the school curriculum will help dissolve the stigma and accept the science of psychology until they opt for it as a clinical or specialized subject to make a profession out of it, at the graduate level. Streamlining organization from within. It is heartening to learn that Indian Association of Clinical Psychologists, Indian Academy of Applied Psychology (Sharma, 2020), Tamil Nadu Association of Clinical Psychologists (Kumar, Jayaraman and Rangaswamy, 2020) and Chennai Counselors Forum (Divyaprabha et al., 2020) have initiated several programs in response to the pandemic. However, there does not appear to be any coordination among them or any collaboration with other associations like National Academy Of Psychology, Indian Association of School Psychologists, Indian Association of Community Psychology or Indian Association of Health Psychology. Several initiatives were reported in social media on regional psychology associations and private psychology groups in our country responding to the pandemic. The responses seem to be disjointed, discreetly placed and lack networking. In responding to pandemic like this, a stand alone approach will not help and what is needed is a well coordinated and collaborative effort so that we can utilize our maximum potential to help the people in need. Since there is no strong association in India that one can lean on for support, there is a tendency among graduates, postgraduates, researchers and service providers to work independently to address the grave need of the community without being affiliated to any psychology association or even with the institute to which one belongs. Re-evaluating the values and priorities of the profession and self- reflection are of paramount importance as it can help the psychology community in India to move forward by picking up the pieces left behind. Psychology needs to be re-invented beyond its established identity as a commercial subject, or an elite subject where skills and its applicability are shoved under piles of certificates. This is the time to encourage and mentor psychology students to affiliate 16

COVID-19: Challenges and Responses of Psychologists from India

! themselves with various associations to help bring their talents together, to impart the skills to collectively respond to the challenges that are in front of us. Standardization and Collaboration In our country, where most sectors are interdependent, professionals like us need to be connected in more ways than one. Our psychology associations as non governmental organizations (NGO) need to make conscious effort to collaborate with other NGOs, and those in the private sector at an association level to achieve our common goals. Affiliating with schools (Duggal & Bagarswala, 2020), community clubs, Community Social Responsibility (CSR) of corporates and other organizations should be given priority to cater to the pandemic mitigation plans that WHO and the Ministry of Health and Family Affairs of our government have proposed. The Paradigm shift: Aligning with the values of our cultural context India is a country with unique values, diverse systems and groups. Post-independent India has seen the youth from metropolitan cities gravitating towards individualistic values. Our education system is directed towards goals pertaining to employment, which is an individualistic approach and psychological sciences followed suit. However, seeking professional help for psychological problems is still a stigma. We need to keep the profession grounded in our values and in the Indian reality (Manickam,2016b). Mindfulness based techniques, self-help techniques like chanting and different yogic asanas including pranayama based on Indian philosophical psychology that had shown significant improvement in psychological wellbeing, melatonin secretions, and cardio respiratory response (Harinath et al.,2004) can be explored in the current context and may require collaborative research with other health professionals. The COVID-19 pandemic has not only reined in the erratic pace of the world, but has also thrown all forms of normalcy off track with its strike, widening the outlook of the global population to a renewed perspective of life and a resolve to press on ahead of 17

changing times. Psychology, as a science and community, now stands at the crossroads of a journey into wider opportunities and endless possibilities. It is time for us to seize the opportunity and unite as a collective body that plays an active role in the mental health of our society. We seem to lack a collective Indian connect while addressing ‘emotional aspects’ of human life. Hostility is a natural consequence of lack of shared connection. Integrating psychological concepts from the Indian philosophical psychological framework of operation will help to connect with more people in stigmatized sections of our country. Conclusion A paradigm shift in priorities has taken place amidst this unfortunate pandemic. Normalizing the conditions in purview of creating a ‘new norm of living’ has gained prime importance (Tugade, 2020). The psychological distress has taken centre stage and it is of paramount importance to highlight that it is a consequence of earlier neglected or disorganized plans of the psychology community to which we belong. Lack of community outreach, lack of connectivity within and scarcity of skilled professionals had caused enormous damage to the profession. Keeping the past aside, it is a perfect opportunity to establish a firm foundation, as psychological science is an integral part of human life and growth. It requires conscious, concerted and collaborative efforts in reviewing what we have done to the profession of psychology during its existence in India for more than a century and what is yet to come. References Amatya, B., & Khan, F. (2020). Rehabilitation response in pandemics. American Journal of Physical Medicine & Rehabilitation. 2020;10.1097/PHM.0000000000001477. doi:10.1097/PHM.0000000000001477 Amulya, D. S. L. (2020). An experiment with online group counseling during COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp. 182-197). Thiruvananthapuram: The Editor. 18

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! Anwyl-Irvine, A. L., Massonnié, J., Flitton, A., Kirkham, N., & Evershed, J. K. (2020). Gorilla in our midst: An online behavioral experiment builder. Behavior research methods, 52(1), 388-407 Chen, G. (2017). Does gratitude promote recovery from substance misuse, Addiction Research and Theory, 25, 1–8. Disaster Management Act, (2005). https://www.ndmindia.nic.in/images/The%20Disaster%20M anagement%20Act,%202005.pdf Duggal, C., & Bagarswala, L. (2020). Promoting well-being and resilience of young people during COVID-19: An initiative with schools. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.63-75). Thiruvananthapuram: The Editor. Divyaprabha, S., Nerur, G., Suryakumar, K., Raman, N., Bhaskar, S., Suryakumar, R., & Uma, T.R. (2020). A paradigm shift: Changes, challenges and way forward. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.209-217). Thiruvananthapuram: The Editor. Harinath, K., Malhotra, A. S., Pal, K., Prasad, R., Kumar, R., Kain, T. C., & Sawhney, R. C. (2004). Effects of hatha yoga and omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. The Journal of Alternative & Complementary Medicine, 10(2), 261-268. Health and Social Justice Department. (2020, May 4). Press Release retrieved From https://prd.kerala.gov.in/pressrelease Jellins, L. (2015). Assessment in the digital age: An overview of online tools and considerations for school psychologists and school counsellors. Journal of psychologists and counsellors in schools, 25(1), 116-125. 19

Joshi, S. (2020). Telepsychotherapy: The bridge to continuity in care and mental health services in COVID-19 and post Covid era. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.170-181). Thiruvananthapuram: The Editor. Kumar, D. (2020). Contributions and challenges of psychologists in private practice in India and their responses to COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.166-169). Thiruvananthapuram: The Editor. Kumar, N. S., Jayaraman, S., & Rangaswamy, K. (2020). Tamil Nadu Association of Clinical Psychologists (TNACP) responding to COVID-19 pandemic. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.204-208). Thiruvananthapuram: The Editor. Lies, J. (2014). Gratitude and personal functioning among earthquake survivors in Indonesia, Journal of Positive Psychology, 9, 295–305. Manickam, L. S. S. (2016a). Challenges of professionalizing psychology in India: Where do we go from here? Indian Journal of Psychology, Centennial issue. 243-252. Manickam, L. S. S. (2016b). Towards formation of Indian Federation of Psychology Associations: Let us wake up for our causes. Journal of the Indian Academy of Applied Psychology, 42, (1), 40-52. National Policy of Disaster Management (2009) https://ndma.gov.in/images/guidelines/national-dmpolicy2009.pdf Roy, P. K. (2020). Role of psychologists in dealing with triple disaster situation during COVID-19 pandemic. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.141-148). Thiruvananthapuram: The Editor. 20

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! Sajani, V. (2017). Integrative Art Therapy for Adolescents with Depression. Doctoral dissertation submitted to University of Kerala. Thiruvananthapuram Sharma, N. R. (2020). Indian Academy of Applied Psychology (IAAP): Vocal voice on local to global perspectives of psychological services. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.198-203). Thiruvananthapuram: The Editor. Singh, N.K., Gopalan, S.V., Ahabibie, I., Rahardjo, D., & Girdhar, S.(2020), World’s First COVID-19 Business readiness and impact assessment tools launched by Indian-Indonesian Venture,[Press release], 5 May 2020, Retrieved from: https://www.thetruthone.com/press-release/worlds-firstcovid-19-business-readiness-and-impact-assessment-toollaunched-by-indian-indonesian-venture/ Tugade, M.M. (2020, April 1). Positive psychology strategies for keeping stress at bay through the ongoing COVID-19 crisis: Let's stay resilient together during this time. Thriving in the New Normal. https://thriveglobal.com/stories/positivepsychology-strategies-stress-coronavirus-crisis/ Van Bavel, J. J., Baicker, K., Boggio, P. S., Capraro, V., Cichocka, A., Cikara, M., ... & Drury, J. (2020). Using social and behavioural science to support COVID-19 pandemic response. Nature Human Behaviour, 1-12. Veliyannoor, P.V. (2020). ‘The Return of the Repressed’. In COVID19: The need for intervention at socio-cultural inscape. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp. 108-129). Thiruvananthapuram: The Editor.

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Venkatesan, S. (2020). COVID-19: The pandemic and people with intellectual and developmental disabilities. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.76-89). Thiruvananthapuram: The Editor. Vieselmeyer, J., Holguin, J., & Mezulis, A. (2017). The role of resilience and gratitude in posttraumatic stress and growth following a campus shooting. Psychological Trauma: Theory, Research, Practice, and Policy, 9(1), 62-69. WHO. (2020, March 18). Mental health and psycho-social consideration during COVID-19 outbreak from https://www.who.int/docs/defaultsource/coronaviruse/mental-health-considerations.pdf

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3 RESPONDING TO THE COVID-19 PANDEMIC: CHALLENGES OF INDIAN PSYCHOLOGISTS KALPNA, DR. NOVRATTAN SHARMA Maharishi Dayanand University, Rohtak, Haryana

Introduction COVID-19 (Corona Virus Disease 2019) is a highly infectious disease caused by SarsCov-2 (Wang et al., 2019, WHO, 2020). With its outbreak in China in December 2019 (Wang, 2020) it is now globally affecting the health and wellbeing and has therefore been declared as a world public health emergency by the World Health Organization in January 2020 (WHO, 2020). Physical health and psychological problems have been reported by researchers (Wang et al., 2019; Rajkumar, 2020). People around the world are worried about their safety. The associated uncertainty and spread of SarsCov-2 pose threat to psychological well being, particularly emotional and cognitive wellbeing. There are research findings that are consistent with Behavioural Immune System (BIS) theory which says that people experience anxiety, depression (negative emotions) and negative cognitive assessments for protecting themselves. (Schaller et al., 2015). They tend to develop extreme avoidant behaviours while trying to follow physical distancing. Uncertainty about future situations causes cognitive dissonance that results in mental discomfort. Social risk assessment has been reported to be higher and lower life satisfaction after COVID-19 outbreak (Holmes et al., 2020; Nicola et al., 2020). Lack of cure and treatment and adverse socio-economic outcomes because of the lockdown measures are projected as the reason for mental health problems among people (Holmes et al, 2020, Nicola et al, 2020). The current article focuses on understanding the psychological problems faced by people at large during the COVID-19 pandemic and the mental health issues that were reported from other countries as well as India. 23

Extent of the Problems There are other studies that have reported mental health issues among general population in the community during previous exposure of Corona Virus like SARS and MERS (Taylor et al., 2008, Sprang & Silman, 2013) as well as current pandemic of COVID-19 (Goyal et al., 2020, Lei et al., 2020; Kang et al., 2020). Mowbray (2020) in his study reported Post-Traumatic Stress Disorder (PTSD) to be ranging from 4-41% in the population and Major Depression was observed in 7% of the population in Beijing after the outbreak. The same study also highlighted that factors like low Socio Economic Status (SES), interpersonal conflict, excess use of social media, lack of social support increased the risk of such conditions. The above mentioned factors may also increase the occurrence of anxiety, substance abuse, loneliness, domestic violence and child abuse. For example, Li et al., (2020) reported prevalence of anxiety and depression to be 8.3% and 14.6% respectively among the general population in the community. This percentage increased to 12.9% and 22.4% for anxiety and depression respectively if a person in close contact has been quarantined. The same authors reported that in China 40% of the general population in the community have mental health problems. Another study by Zhou et al., (2020) reported that China’s adolescents experienced symptoms of depression (43.7%), anxiety (37.4%), and a combination of both during the current pandemic (31.3%). Therefore, the increase in mental health related issues is a new reality that we should not overlook. Lockdown, social distancing and quarantine measures taken by our government have been able to contain the spread of the virus. Lockdown has also restricted the sale of alcohol, marijuana, heroin and other addictive substances which on the one hand might be good because easy availability is one of the reasons for heavy use of the substances. On the other hand, those who are drug dependent faced several psychological problems ranging from withdrawal symptoms to increase in domestic violence, which impacted the psychological well-being of themselves and also their family members. This is an important aspect which both the professionals and the policy makers should take into 24

COVID-19: Challenges and Responses of Psychologists from India

! consideration while implementing measures to contain the virus. There are some groups of people who are stuck like the migrant workers due to lockdown and unable to get back to their home state and hence face problems like anxiety, stress, loneliness, depression, fear and other adverse emotional reactions (Mishra & Sayeed, 2020). Previous studies have reported that there are indications of distress, lower reported rates of physical and mental health and life satisfaction during lock down, (Taylor et al. 2008). In Australia where due to the outbreak of highly infectious equine influenza lockdown was imposed, they reported that adults in lockdown had feelings of distress, lower physical and mental health and lower life satisfaction. Due to lockdown socio-economic activity has been hampered and people from the low SES (daily wage earners, migrant workers and people from similar strata) are facing financial strain which can lead to stress, conflict, anxiety, and affect the cognitive development of children due to lack of nutritious food. In India, researchers from different disciplines have opined about the impact that the COVID-19 pandemic can have on the general population. In a review article, Rajkumar (2020) concluded that anxiety, depression, disturbed sleep and stress can be the most common responses to COVID-19. Moreover, migrant people getting back to their homes and staying with family may lead to felt lack of space (crowding) which may also lead to psychological problems. There is evidence suggesting that increased use of the internet during lockdown has restricted physical activity and this has associated effects on physical health and psychological well being. Excess use of internet/ gaming/social media can lead to more serious problems such as cyber bullying and excess dependence on the internet. (Thakur et al., 2020). Quarantine Related Psychological Problems Quarantine is defined as, ‘separating and restricting people’s movement who have had potential exposure to a contagious disease to ensure if they get sick, so as to reduce the chances of them infecting others’ (Brooks et.al.,2020). They observed that this often 25

resulted in unpleasant experiences for those undergoing quarantine. This means getting separated from loved ones, losing freedom, and boredom which can result in dramatic psychological effects on individuals. Those who have been quarantined because of their possible exposure to virus experience fears of getting infected and suffering, leading to a negative impact on their psychological well being. Another observation is that those who have been diagnosed as corona positive, fear the possibility of infecting others who are close to them and as a result feel guilty leading to further psychological problems (Brooks et.al.,2020). Sprang and Silman (2013) compared those who were in quarantine due to H1N1 in USA and Canada on the symptoms of PTSD in parents and children with those who were not quarantined and the outcome of the study reflected that the mean score of PTSD was four times higher in children who had been quarantined than in those who were not quarantined and 28% of the parents quarantined reported symptoms that warranted a diagnosis for a mental health problem as compared to 6% of those parents who were not quarantined. Other studies have also reported high depressive symptoms among the quarantined (Brooks et.al.,2020, Kang et al., 2020, Mowbray, 2020). In addition, fear due to lack of information related to the pandemic, fake news, lack of threat to the perception that there is no no cure of COVID19 also lead to worries and tensions impacting well-being (Mowbray, 2020). Studies have reported that those quarantined are more likely to experience stigmatization, rejection from people around the neighborhood (Brooks et al., 2020; Hawryluck, 2020). Participants reported experience of them being avoided by others, being treated with fear, suspicion and critical comments by others Another study reported that some respondents in their research reported not being able to resume work in office after quarantine as others feared of getting infected by them (Cava et al., 2005). The above findings from other countries indicate that the customs in our society to invite relatives and friends in large numbers for most of the social functions like marriage and other life events, post COVID-19 scenario is likely to be very anxiety provoking and stressful. The exclusion of people with or without

26

COVID-19: Challenges and Responses of Psychologists from India

! infection is also likely to create unpleasantness and negative emotions. People Infected with COVID-19 and Mental Health Issues Studies conducted in China suggested that people diagnosed as SarsCov-2 positive experienced adverse mental health problems. Gou et al., (2020) compared COVID-19 patients with non-COVID-19 participants in Shanghai and found a higher prevalence of mental health problems like depression, anxiety, PTSD, insomnia and tension among COVID-19 patients. Huang and Zhao (2020) had reported suicidal tendencies among the patients in China. Hossain (2020) reviewed other studies and reported that there is reduced quality of sleep among patients with COVID-19. The current pandemic more adversely affected those who have pre-existing physical and psychological problems. Intensive care unit patients reported more confusion (65%) and 21% of those who subsequently died reported altered consciousness. In the same study 33% patients reported ‘dysexecutive syndrome’ which Baddeley et al., (1998) described, after their discharge from hospital (Hossain (2020). Psychological Problems of Health Care Workers Healthcare workers could develop symptoms of psychiatric disorder when coping with such stressful events. Lee et.al., (2018) in their study in Singapore during the 2013 SARS-COV outbreak revealed 27% of healthcare workers experienced Post Traumatic Stress Disorder (PTSD). Similarly, in Democratic Republic of Congo, medical staff reported to experience high levels of anxiety due to the work they were engaged in (Park et al., 2018). Interpersonal isolation and feeling that they would transmit infection to relatives was also reported among health care workers (Lee et al., 2018). Another study from Wuhan related to COVID-19 revealed that risk of infection, overwork and inadequate protection measure increased experience of negative emotions, frustration, insomnia, depression, stress, denial, anger, fear and exhaustion among health care workers.

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Further, it was noted that these psychological problems can in turn affect attention, decision making capacity and have long term impact on their well-being (Kang et al., 2020). Niuniu Sun et al., (2020) in their research on nurses caring for COVID-19 patients in China concluded that negative and positive emotions intertwined and co-existed in them and in early stages negative emotions were dominated and as time passed on, gradually positive emotions appeared. The evidence suggesting psychological impact of COVID-19 from other countries can be a pointer to the impact that COVID-19 can have on our health workers and even among psychologists who are responding to COVID-19 in different health settings. Comorbidity of physical health problems like diabetes as well as mental health problems were associated with poor subjective and psychological wellbeing and mental health problems among healthcare workers in Singapore and India (Chew et al., 2020) and among people with psychiatric illnesses in China (Hao et al., 2020). Socio Demographic and other related to Mental Health Problems Huang et al., (2020) and Thakur et. al (2020) identified young age as a risk factor due to prevalence of high level of generalized anxiety disorder and that the effect of the pandemic situation in older people was associated with higher risk, because of pre-existing depressive symptoms and their inadequate access to mental health services. In relation to gender, females reported to have experienced more anxiety and depression compared to men (Kang, 2020; Li et al., 2020; Ozdin & Bayrak, 2020). Marital Status was significantly related to mental health problems (Tan et al., 2020). More mental health problems have been reported among those less educated (Lei et al.,2020). Zhou et al., (2020) reported that students with high grades experienced symptoms of depression, which could be due to academic stress. Occupation and income are another risk factor. For example, Huang et al., (2020) reported that healthcare workers experienced poor sleep compared to those from other occupations. Moreover, loss of economic opportunities because of “Social Vaccine” can be a trigger for psychological problems. In the Indian context, it was hypothesized that marginalized people are more likely to be susceptible to mental health problems due to lockdown (Hossain, Purohit, Sharma, 2020). 28

COVID-19: Challenges and Responses of Psychologists from India

! Research evidence suggested that living in urban areas is significantly related to mental health problems like depression, stress and people who live in areas with high infection rates are more likely to experience psychological problems (Lei et al., 2020,). Impact of Media and Psychological Issues Inadequate information by public authorities can act as a stressor. Studies have reported that if rational and clear guidelines are not given related to quarantine it could cause PTSD (Brooks et al., 2020). Hawryluck (2020) reported that having clarity about levels of risk was related to the level of feeling of distress. In an online survey he reported that 50% of respondents didn’t receive adequate information regarding home infection control measures and that resulted in distress. Another study reported the impact of Fake news on social media can also result in lack of threat perception and not adopting the required safety measures (Hao et al., 2020). In addition, Hao et al., also reported that spending more than two hours per day seeing, reading COVID-19 related news was found to be associated with anxiety, stress and generalized anxiety disorder. What is Being Done and Needs to be done? Psychologists around the world need to understand the variable effect of COVID-19 on people. We need to appreciate the fact that it is not affecting everyone equally or in similar ways (Zhao, 2020). Realizing the psychological impact of COVID-19, various psychological associations in India and universities across India have come forward to render their services by providing free tele-counselling (Divyaprabha et al., 2020, Kumar, 2020). Research is being carried out to assess the psychological impact of COVID19 which is a step-in right direction, as all the above observations and studies have indicated. People need to be educated about the psychological impact of pandemic, people need to be encouraged and motivated to adopt healthy behavior practices, they need to be taught strategies to cope with the current crises, COVID-19 patient and their care-givers to be empowered and need to be sensitized about the problems faced by survivors of COVID-19 and the families. In addition, special 29

teams of qualified professionals were made to address emotional distress among people (Duan & Zhu,2020). However, for these efforts to be successful, we need trained manpower, infrastructure and acceptance from people. As the number of cases are on the increase, it can be seen that the psychology professionals are facing challenges as well as opportunity. The challenge remains addressing the issues discussed above and opportunity is to implement the suggestions that are feasible. Liang et al., (2020), Lei et al., (2020), Li et al., (2020), and Hunag& Zhao, (2020) have reported that the coping style is significantly and positively related to psychological wellbeing. Therefore, we need to think of innovative strategies that can help people of different sections of our society. (Mishra & Sayeed, 2020) The Way Forward: We need to improve methods and measurements of tools for assessing the psychological welling as their reliability and validity during pandemic is not known. Therefore, we need to develop instruments that are more reliable during emergency situations. Conducting multi-disciplinary research is need of the hour as COVID-19 is posing challenges across all aspects of human life (Holmes, et al,2020). There is a felt need to synthesise research evidences globally and we need to do that inter state research that helps in understanding the reactions as well as coping in a better way. People have different levels of resilience and coping style that results in the experience of different metal health problems, which may have cultural influence. At present, most research evidence in relation to COVID-19 available is cross-sectional in nature and therefore it is not appropriate to infer incremental changes over time. Effective mental health interventions and multi pronged strategies need to be developed that can be offered via digital platforms but their effectiveness and quality needs to be ascertained before using them on people (Manickam, 2020). Efforts to bridge the digital divide for this is crucial. It is need of the hour for integrating psychological care with existing primary healthcare by providing psychological services in family health care centres to effectively deal with the current pandemic (Anindya, Debora & Manickam, 2020). Community based social health care program 30

COVID-19: Challenges and Responses of Psychologists from India

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Schaller, M., Murray, D. R., & Bangerter, A. (2015). Implications of the behavioural immune system for social behaviour and human health in the modern world. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 370(1669), 20140105. https://doi.org/10.1098/rstb.2014.0105 Sprang, G., &Silman, M. (2013). Posttraumatic stress disorder in parents and youth after health-related disasters, Disaster Medicine Public Health Preparation, 7,105–10. https://doi.org/10.1017/dmp.2013.22 Tan, W., Hao, F., McIntyre, R. S., Jiang, L., Jiang, X., Zhang, L., … Tam, W. (2020). Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce. Brain, Behavior, and Immunity. https://doi.org/10.1016/j.bbi.2020.04.055 Taylor, M. R., Agho, K. E., Stevens, G. J., & Raphael, B. (2008). Factors influencing psychological distress during a disease epidemic: data from Australia's first outbreak of equine influenza. BMC public health, 8, 347. https://doi.org/10.1186/1471-2458-8-347 Thakur, K., Kumar, N. & Sharma, N. R. (2020). Effect of lockdown and pandemic on mental health of children, Indian journal of paediatrics. https://doi.org/10.1007/s12098-020-03308-w Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research Public Health.;17: 1729. https://doi: 10.3390/ijerph17051729 Wang, L., Wang, Y., Ye, D., Liu, Q. (2020). A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence, International Journal of Antimicrobial Agents. 105948. https://doi:10.1016/j.ijantimicag.2020.105948. 36

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! World Health Organization. (2020). There is a current outbreak of Coronavirus (COVID-19) disease. Retrieved from https://www.who.int/health-topics/coronavirus#tab=tab_1 World Health Organization. (2020). Statement on the second meeting of the international health regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). https://www.who.int/newsroom/detail/30-01-2020-statement-on-the-second-meeting-ofthe-international-health-regulations-(2005)-emergencycommittee-regarding-the-outbreak-of-novel-coronavirus-(2019ncov) Zhou, S.-J., Zhang, L.-G., Wang, L.-L., Guo, Z.-C., Wang, J.-Q., Chen, J.-C., … Chen, J.-X. (2020). Prevalence and sociodemographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787020-01541-4

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4 SOCIO-EMOTIONAL RESPONSES WITHIN AND OUTSIDE FAMILY BOUNDARIES DURING COVID-19 DR. ANAGHA LAVALEKAR Jnana Prabodhini’s Institute of Psychology, Pune. Scenario 1: An Indian metro city during the first three COVID-19 lockdowns. Empty streets, tall building complexes, tiny zuggis in slums, families ‘forced’ to stay together 24/7, all activities outside home almost frozen, adults busy in cooking, feeding, doing daily chores, worrying how to procure food/ grocery/ veggies for next few days, children in holiday mood: no studies, glued to television or mobiles smuggled from mom or dad’s pocket. Scenario 2: A countryside village, people confused why they are not allowed out on roads, every service provider’s shutter down, mothers checking the food stock at home, fathers loitering around, children trying to understand suddenly shut schools, being asked to look after the cattle/ farming duties, can sense the clear anxiety of livelihood on parents faces. Scenario 3: Big, fat and wide roads joining the metro cities to middle and smaller ones, flocks of barefoot people with minimum luggage walking along the roads under the scorching sun, women in saris and salwar suits with young kids clutching their fingers or resting on their shoulders. Their eyes filled with hopeless pursuit of food/ water and some rest if allowed by ‘Time’. An unwarranted challenge: We have been experiencing these scenarios around us in the last two months. This was completely unwarranted, unexpected until a few months back. Life was flowing with its usual zest, wants and disappointments, love and anger, hope and worries with much 38

COVID-19: Challenges and Responses of Psychologists from India

! familiar manageable boundaries. However, a very tiny, microscopic entity has toppled everything upside down. It has withered the way we loved and mingled with each other, converting us into silkworms trapped in our own cocoons, struggling to see through the midst of contradicting and sensational information pouring from all sides. Changing perceptions: The COVID -19 pandemic has not only created paradigm shifts in our health care needs and economic postulates but has evoked a deep change in the social and emotional response sets among us as people are living together as a society. It has been perceived by every country as almost equal to a third World War between nature and human race. The response patterns are being shaped in that manner. Many people who were a part of the ‘survival running race’ in the fast track metro cities, initially took it as some sort of a ‘time off’ from their usual tight schedules, keeping a little low to rest back, but slowly the other side of the coin showed up. The enjoyment of being with each other for a ‘LOT’ of time was enjoyed for the first few days. Then, as the numbers of infected people started rising, with household helpers no more in the picture (burdening the ‘home-maker’ with triple the usual load), news clippings portraying coffins all over the roads in some European countries and Facebook- WhatsApp getting flooded with all sorts of true/ half true/propagandized/factual bits of happenings, - the emotional turmoil stepped in and started affecting the socio-emotional fabric within and outside the family boundaries. Needs and grievances across groups: With the huge complexity of family patterns in Indian society, the impact of this challenging situation also varies across groups. Within different age groups, the children slowly started experiencing boredom with innumerable questions in their minds about the situation around, to which their parents can hardly provide satisfactory answers. Youth, who are used to freedom and peer involvement, cannot meet and see friends, have to be confined within four walls, are confused and irritated due to uncertainty about the exams and future career opportunities. The adult 39

population is burdened with work-life balance issues due to limited resources and assistance at both places while the elderly, being most vulnerable, are having the fear clock of getting infected ticking at the back of their minds. The emotional turmoil: More than the immediate physical safety issues, the socioemotional conditions of people are becoming grave and need long term attention. The constant calls to available helplines and news flashes representing the psychological comorbidities are going to pose a serious threat to our future as a society. How long will the pandemic continue? What if I get infected? Will I be in the ‘mild’ category or the ‘ventilator’ one? What if I never recover? What will happen to my job after the lockdown is over? What if I spread the disease to my own family members? Will I be able to feed my family enough in these circumstances? Will my relatives help me if I catch COVID? What will happen to my family if I succumb to the infection? Will I not be able to see my loved ones again once I am admitted to the hospital? So many haunting questions...most of them not having any predictable, definite answer, and it is prevalent across all socioeconomic groups. Crumbling of the so called civilized humanity: Whenever there is ambiguity beyond a level that a person can tolerate, withdrawal or aggression (flight/ fight) is the obvious emotionally driven (evolutionary) response unless mediated by a rational mindset. People committing suicide due to fear of catching COVID-19, or confining themselves to rooms with ‘covido-phobic’ or ‘corona phobic’ perceptions are examples of such withdrawal. On the other hand, increasing incidences of domestic violence towards women and children indicate poor but desperate attempts to exercise power over that part of life (relationships) which will give a false sense of some control over the situation. The superficiality of so-called social bonds is evident through incidents of refusal to claim the dead bodies of COVID-19 patients, refusing the years-old neighbors to either stay quarantined or re-enter their own homes after release from hospitals, attacking saviors like doctors-nurses and police persons in blind confusion. The issues 40

COVID-19: Challenges and Responses of Psychologists from India

! faced by the people in the countryside are even more complex. They are experiencing high levels of anxiety and suspicion due to the reverse migration taking place. The transiting population has been forced to distance itself from local villagers by not allowing them entry in the localities. A sense of humiliation, distrust and shame has filled their minds with no outlet in the present circumstances, posing a serious threat to social cohesion. Humans are known for their ability to communicate through structured language. However, often what talks more than words is the ‘touch’! COVID-19 has attacked this very spontaneous and obvious expression of emotional connect. People have started feeling insecure, threatened by thinking of getting touched even by their near and dear ones. A powerful remedy on negativity itself is getting negative valence –a real concern for all of us. Generating ‘Dialogue’- the only way out: The only known elixir which can help us overcome all this unforeseen, shattering emotional burden as individuals and as a society is through consciously increasing our ‘will and ability’ to generate positive dialogue with the social ecosystem and our own self by focusing on the good things happening around us. In spite of all these negativities the medical fraternity is steadfastly serving at the cost of their own lives. There are thousands of volunteers gathering and distributing help to the needy and deprived sections. Forced household duties as well as the huge reverse migration has made people recognize the dignity of labor, people are finding out ways to adjust with each other in forced coexistence under a roof, trying to use the available virtual platforms to keep alive our social and emotional bonds with the outside world to the best! A dialogue which balances the style and clarity of objective can both help us remain grounded and responsive to the circumstances as individuals and as society. The blending of ‘My ego’ and ‘Your ego’, understanding the thin line between expectations and demand, selfishness and submission, misunderstanding and manipulation are the components of this elixir called ‘dialogue’. 41

‘Upasana’ / daily prayers / meditation are also practices that help us keep our faces above the water in such circumstances. It has nothing to do with practicing a specific religion. Atheists can have their own ways of ‘worship’. It is mostly turning inward and gathering enough strength by diving into the realms of the philosophy of life. Trigger intrapersonal dialogue. Psychologists very well understand its unique place in healing and combating emotional challenges. Helping people understand human limitations in terms of the factors within and outside our control reinforcing internal locus is required. How to multiply small but happy moments and subtract the stress triggering moments has to be a part of our therapeutic intervention. This is an opportunity for us as individuals and professionals of psychology to facilitate such ‘dialogue’ within and outside the family boundaries, to make our community psychologically strong and immune enough to ride above such waves.

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5 COVID-19 AND MIGRANT WORKERS: CLINICAL PSYCHOLOGISTS’ VIEWPOINTS ASIMA MISHRA and DR. NEHA SAYEED Department of Clinical Psychology, Central Institute of Psychiatry, Ranchi Introduction Coronavirus disease has achieved pandemic status worldwide and people everywhere are in a state of constant fear and deep anxiety as there is no final word on how long this pandemic will last. People are now being told to make up their minds to live with this virus for a long time without any clarity. The worst affected are the migrant workers. Mental trauma and the threat of infection are now very firmly etched into the minds of people which ultimately has an adverse impact on their mental health. Long periods of isolation and lack of access to resources also may have a negative impact on mental health and psychological functioning. Various studies are being conducted to explore the long-term impact of COVID-19 on mental health. It is essential for physicians and mental health providers to have open conversations about the importance of mental health and to encourage people to seek help (Singh, 2020). There are around 100 million internal migrant workers in India. Most of them are daily wage labourers who travel from various states like Uttar Pradesh, Bihar, Jharkhand, Odisha, West Bengal and other states in that region, to perform unskilled or semiskilled jobs and are currently facing major economic fluctuations due to the sudden lockdown ( Hazarika, 2020). By the time the country was put on lockdown, the workers had already started facing a decline in their income due to social distancing and isolation. Amidst all the chaos, confusion, uncertainty and fear spreading across the country because of COVID-19, the migrants 43

are trapped in an extremely upsetting situation which has brought the spotlight on invisible labour migrants. The International Labour Organisation (2020) has highlighted that, migrant workers are experiencing the worst of the economic crisis as prices of basic hygiene products, including detergents/soaps/sanitizers for personal safety are rising rapidly, as well as food items, because of which many workers are unable to afford them. As businesses are now required to close, many employers are terminating the employment of migrant workers without prior notice or have stopped paying salaries. Panic and fear of the COVID-19 virus is increasing prejudice and abuse against migrant domestic workers. The economic crisis combined with COVID-19 is increasing pressure on lower-income families to pay salaries, cover expenses for food, clothing and medicines, or provide a suitable private room in the household. This article is a clinical observation based on the review of existing literature on mental health symptoms and interventions relevant to COVID-19 pandemic along with review of various news articles highlighting the plight of the migrant workers. The articles which were reviewed focused on the psychosocial issues of migrant workers and what steps are essential to manage these issues. Mental Health and Migrants Widespread outbreaks of infectious disease, such as COVID-19, has always been associated with psychological distress and symptoms of mental illness (Bao et al., 2020). Under normal conditions, migrant workers have a high burden of common mental disorders (e.g., depression) and a lower quality of life than local populations. Many studies across the globe have consistently found a positive association of common mental disorders with adverse circumstances such as poverty, inequality, and financial debt. Firdaus (2017) in his study found that prevalence of poor mental well-being was higher among those who were single/widowed/separated/divorced, unskilled, unemployed, daily wager, illiterate and older in age. It was also found that poor mental health was in turn associated with poor housing, educational and medical facilities. These factors lead to poor social support, feeling of insecurity and adjustment issues. Migrant 44

COVID-19: Challenges and Responses of Psychologists from India

! labourers due to their unique and disadvantageous position are particularly vulnerable to all these risk factors. Migration often brings with it stress, strain, and risk factors such as poor medical care, separation of family and children as well as other relatives. It also includes homelessness, lack of food and water, xenophobic attacks, poor education, perceived and experienced discrimination, and a high risk of death and injury. Furthermore, social factors, like cultural bereavement, culture shock, social defeat, as well as a discrepancy between expectations and achievement, and acceptance by the new nation can also affect adjustment. Further risk factors in new communities can include social exclusion, stigma, and discrimination. According to Firdaus (2017), the migrants feel unwelcome by their host societies and perceive cultural differences such as language, traditions, food habits as the main reason hindering development of social networks outside their own communities. Cantor-Graae and Selten, (2005), reported that chronic experience of social defeat was related to poor mental health and risk of psychosis in migrants. Henssler, et al., (2020) found that there is increased risk for the manifestation of schizophrenia and related non affective psychosis among first- and second-generation migrants. The study suggested that increased rates of psychotic experiences in migrant workers are due to experience of discrimination and social exclusion. Petit, et al., (2001) reported that the risk of developing dementia among certain groups of migrants is higher in comparison to people who grew up in the host country. The authors discussed that cardiovascular comorbidity may be responsible for the higher rate of dementia. However, there seems to be a lack of screening tools for the educationally disadvantaged migrant population as highlighted by Nielsen and Waldemar (2010). Systematic reviews have also found high prevalence of PTSD among the migrant workers. Morina et al. (2018), reported that the highest prevalence of psychiatric disorders was registered for post-traumatic stress disorder from 3% to 88%, depression from 5% to 80%, and anxiety disorders from 1% to 81% in refugees and internally displaced persons after forced displacement. This pointed out that there is an urgent need for large-scale 45

interventions that address psychiatric disorders in refugees and internally displaced persons after displacement. It was also found that greater exposure to pre-migration traumatic experiences and post-migration stress were the most consistent factors associated with all three disorders. Importantly, a poor post-migration socioeconomic status was associated with depression. On the other hand, Giacco, Laxhman, and Priebe (2018) observed that in the first years of resettlement, only PTSD rates were higher in refugees as compared to host country populations. However, after five years of resettlement, rates of depressive and anxiety disorders were elevated. Traumatic experiences during migration may explain the high rates of PTSD, while poor social integration and difficulties in assessing care may contribute to higher rates of mental disorders in the long run. Psychological Impact of COVID-19 on Migrants Mahanirban Calcutta Research Group (MCRG, 2020) have written extensively about the issues the migrant workers are facing in this economic crisis due to COVID-19. The sudden announcement of lockdown for twenty-one days with a notice of less than four hours created havoc to the labour migrants in different parts of the country. Since the lockdown, there were distress calls from stranded migrant workers for food and cash from various parts of India. There is much agony, hunger, trauma -- physical and psychological -- and a desperation to return home. Migrant labourers from different parts of India even marched back hundreds of kilometres carrying their belongings to reach home in different parts of the country. Along with bearing the physical exertion, they had to shield themselves from continuous assault from the police which in many places lathi-charged and humiliated them. Nonetheless, the migrant labourers, having no other options, continued their long marches which, at times, even resulted in deaths of many due to hunger, dehydration, and exhaustion. More than 20 people have lost their lives in this mayhem since then (MCRG, 2020). They faced stigma from their neighbours since they were seen as carriers of the coronavirus, faced ostracization which led to clashes and hiding the truth about returnees. Similar struggles were reported by Knoll & Bison, (2020) and Modak, (2020). 46

COVID-19: Challenges and Responses of Psychologists from India

! The ongoing reverse migration of day workers to their villages is likely to accelerate the deterioration of mental health. Due to the sudden influx of migrant workers and at-risk farming community, rural India may be particularly susceptible to suicide according to Nelson Moses of Suicide Prevention India Foundation (Krishnan, 2020). Since the lockdown, the media had highlighted the plight of the migrant workers in different parts of the country. In Bareli of Uttar Pradesh, hundreds of migrants including women and children were forced to take chemical baths as disinfectant (MCRG,2020). While in the Siwan district of Bihar the migrants who managed to reach the district town of their home were put in very small space under an iron gate in a very infectious condition. They were rescued the next day and were put in trucks to take them to their respective panchayats where corona isolation centres were located. In shelters with high concentration of migrant domestic workers and few protective measures, there is often a significant risk of infection. In most places, the migrant labourers were stuck in makeshift camps, with poor infrastructure and inadequate food supply. There has also been unrest among the workers over rumours on the resumption of train services and complaints about the food in Mumbai and Surat. Their predominant experiences were hunger, hopelessness and fear about if and when this nightmare would end (Mahanirban Calcutta Research Group 2020). For them it appeared that it is more of a problem of basic needs not being met, leading to anxieties. Intervention strategies that need to be adopted It appeared that migrant people will continue to have an elevated need for mental health care, but simultaneously have less access to it. Reasons for this gap may be due to stigma and shame regarding mental illness, cultural beliefs, lack of language proficiency as well as financial constraints. Furthermore, real economic barriers and perceived social consequences could impede service seeking because they may often lack health insurance (Firdaus, 2017). It is likely that the number of migrants and refugees will continue to increase over the years and health care services have to 47

be prepared for them. Adequate resources need to be given to health care professionals and policy makers to meet the needs of the migrant population. Collecting more information about the impact of culture on key aspects of a migrant patient’s clinical presentation may help provide better care. Furthermore, the cultural competence of all professional staff and regular use of cultural mediators could be very useful to access health care services and reduce the key barriers to service access and use. Improving the institutional, cultural competence could increase the quality of care at a systemic, organizational, and institutional level. Therefore, cultural competence training for all professional staff and initiatives to facilitate institutional, cultural competence should be implemented to increase the utilization of mental health services (Schouler-Ocak, 2020). COVID-19 outbreak and consequent nationwide lockdown have resulted in significant deterioration in all the social determinants of health. Loss of income and jobs, insecurities, and social isolation are increasing and are likely to deteriorate the mental health of migrant populations which may worsen in post lockdown periods. There are high chances of increase in suicide considering the poor utilization of health services in general and mental health services in particular. Faruqui, director of Centre for Evidence-based Policy, Practice and Interventions (CEPPI) at Oxford stated that, “The evidence-based approach to diminishing the effects of these problems is to carefully deliver psycho-social interventions that operate on the feedback of standardised outcome measures. The interventions should be exercised as primary (directed towards all Covid-19 patients or lockdown affected), secondary (intended to reduce existing risk), or tertiary (aimed at improving outcomes for affected people with mental issues in Covid-19 context) (Khan, 2020).” They also reported that the COVID-19 period provided opportunities to explore new ways and methods for mental health professionals such as establishment of wider public e-mental health approaches, a shift towards digital, novel interventions that are mainly powered by theories of behaviour change and prosocial behaviour (Khan, 2020).

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COVID-19: Challenges and Responses of Psychologists from India

! Role of mental health professionals Banerjee (2020) identified six important roles for mental health professionals during this period and suggested that educating the public about psychological effects of a pandemic, motivating to adopt health promotion strategies, integrating mental health into available health care, teaching coping strategies, empowering patients and caregivers and providing mental health care to the healthcare workers are essential. From our perspective, for providing more specific therapeutic strategies, it is essential to develop teams of qualified psychologists to address emotional distress and training community health personnel in mental health care. Using online platforms to assess mental health of public and developing materials may be considered. Apart from this, providing online counselling and self-help services and using telepsychiatry and telemedicine services are essential (Joshi, 2020; Amulya, 2020). However, the most important aspect is to make online mental health services accessible to everyone, particularly, the individuals in lower socioeconomic strata. The Government of India (MOHFW, 2020) has released detailed guidelines to deal with the psychosocial issues of migrants who have been impacted by the nationwide lockdown to deal with the spread of the coronavirus disease. Orders are in place to treat migrant workers with dignity, respect, empathy and compassion by listening to their concerns patiently and understanding their problems and to recognise specific and varied needs for each person/family. As per the guideline, it is essential to provide them with all possible information and make them stay in their present location since mass movement could greatly and adversely affect all efforts to contain the virus. Trying to understand their issues and reminding them that it is safer for their families if they themselves stay away from them, is essential. Instead of reflecting any mercy, seeking their support in the spirit of winning over the situation together is important. COVID-19 has led to a multifaceted response from mental health professionals and mental health is now clearly being taken into consideration at all levels - be it general population, health care workers or the vulnerable populations. The long-term impact of 49

COVID-19 on mental health may take months to manifest and managing this impact requires the effort from the health care system at large, as it happened in the case of SARS (Maunder, 2009). In our country where the mental health infrastructure is less developed, the impact is likely to be severe and further research is necessary to assess the scope of the pandemic (Duan and Zhu, 2020). Identifying the groups of people who are at high risk for psychological morbidities will be the first step at providing early intervention. Those people who are in isolation centres in hospitals or the migrant workers who are quarantined in shelters are prone to increased risk of psychological issues as they are deprived of social support and uncertainty of their return to their homes, and particularly demand emotional support. Therefore, it is of utmost importance to research on vulnerable populations like children, those in rural areas with poor access to health care and those belonging to economically deprived. Strategies for Intervention There is a need to develop interventions which are time limited, culturally sensitive and can be taught to healthcare workers (Liem et al., 2020). These interventions need to be tested so that the information regarding effective therapeutic strategies can be disseminated among those working in this field. Since there is a shortage of staff, all physicians, practitioners and emergency staff need to proactively screen for psychological issues. Taking advantage of the digital era, interventions should be planned and designed to make them easily deliverable. Online psychotherapy through video conferencing applications can be used. However, to meet the needs of the nation it would be necessary to provide online or smartphone-based psychoeducation to provide information regarding the virus, promote wellness and initiate psychological interventions like cognitive behaviour therapy and mindfulnessbased interventions. Challenging cognitive bias of individuals who exaggerate the risk of contracting the virus and teaching them behavioural strategies of relaxation to reduce anxiety and schedule activities to combat depressive feelings can be taken up. Teaching stress management strategies and instilling positive coping is important. Helping individuals in mindfulness meditation also may help in alleviating stress and anxiety (Ho, Chee & Ho, 2020).

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COVID-19: Challenges and Responses of Psychologists from India

! Another challenge is to relay accurate information and evidence based health practices to the public. Minimising fake news and providing safety tips on basics like maintaining hand hygiene, mask wearing and physical distancing are needed. Coping with the current situation emotionally through positive mindset and relaxation/breathing techniques have to be promoted. These can be done through video clips and images that are easily understood. The Ministry of Health and Family Welfare (MOHFW, 2020) has several videos, audio-visual aids as well as advisories for the behavioral health of every individual under the campaign ‘Help us to help you’ on their website. There are practical tips to take care of one’s mental health during the lockdown and an audio-visual aid on managing stress and depression in the website. The Ministry has also provided measures on dealing with social isolation, emotional problems, emotional issues which may occur after recovery, ways to recognize mental health problems in beloved and caring for persons with mental illness (Saini, 2020). Several mobile applications like Arogya setu by Govt. of India, COVID-19 Feedback by Indian Ministry of Electronics and Information Technology, SAHYOG app by survey of India have been launched to help in keeping the public updated and help in self evaluation and contact tracing as well. Several state governments have also developed apps like COVID- 19 quarantine monitor-Tamil Nadu, COVA- Punjab and Test yourself Goa (Geospatial world, April 2020,). Integrating community resources into the health care system will also help in reaching out to a wider population (Ho, Chee & Ho, 2020). This serves to strengthen the community’s mental health resilience and reduce the possibility of developing psychiatric morbidities. Several premier mental health institutes of our country like NIMHANS, CIP, IHBAS and others in collaboration with various NGOs have taken up this challenge and are running a 24/7 mental health helpline since lockdown. Organizations like Indian Association of Clinical Psychologists (IACP), regional psychology associations and Indian Psychiatric society (IPS) have prepared and widely distributed lists of professionals providing pro bono services through telephonic and 51

video calls through which several distress calls have been answered (Kumar, 2020). Conclusion The coronavirus emergency is rapidly evolving. Nonetheless, we can more or less predict the expected mental/psychological health consequences of the most vulnerable populations. It is essential for mental health professionals to provide necessary support to those exposed and to those who deliver care. In order to minimise the impact, providers should promote positive stress management strategies and normalise the experience of anxiety and fear during this time. It is imperative that mental health professionals be part of the task force for COVID-19 to advise the government on mental health policies and psychological interventions. Hospitals and community workers are now working individually to conduct psychological intervention with limited interaction with each other. If they collaborate with one another through training and case discussions, our limited resources can be well utilised. Training the community personnel at this time can facilitate better identification as well as management of distress. This pandemic has taught our country to be more medically prepared to deal with future outbreaks, have better equipment and infrastructure. However, the psychological impact that this outbreak has caused should not be ignored. The pandemic has highlighted the need for mental health and psychological intervention to the nation and we need to strengthen this particular aspect in order to win this war with COVID-19. References Bao, Y., Sun, Y., Meng, S., Shi, J., & Lu, L. (2020). 2019-nCoV epidemic: address mental health care to empower society. The Lancet, 395(10224), e37-e38. Banerjee, D. (2020). The COVID-19 outbreak: Crucial role the psychiatrists can play. Asian journal of psychiatry, 50, 102014. Cantor-Graae, E., & Selten, J.P. (2005). Schizophrenia and migration: a meta-analysis and review. American journal of psychiatry, 162, (1), 12-24.

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! Duan, L., & Zhu, G. (2020). Psychological interventions for people affected by the COVID-19 epidemic. The Lancet psychiatry, 7(4), 300-302. Firdaus, G. (2017). Mental well-being of migrants in urban centers of India: Analyzing the role of social environment. Indian journal of psychiatry, 59(2), 164. Geospatial world. (2020, April 29). Top Indian apps to fight COVID 19. https://www.geospatialworld.net/blogs/top-indian-appsto-fight-covid-19/ Giacco, D., Laxhman, N., & Priebe, S. (2018). Prevalence of and risk factors for mental disorders in refugees. In Seminars in cell and developmental biology, 77, pp. 144-152. Academic Press. Hazarika, S. (2020, May 28). The echo of migrant footfalls and the silence on policy. The Hindu. https://www.thehindu.com/opinion/lead/the-echo-ofmigrant-footfalls-and-the-silence-on-policy/article31689921.ece Henssler, J., Brandt, L., Müller, M., Liu, S., Montag, C., Sterzer, P., & Heinz, A. (2019). Migration and schizophrenia: meta-analysis and explanatory framework. European archives of psychiatry and clinical neuroscience, 1-11. Ho, C. S., Chee, C. Y., & Ho, R. C. (2020). Mental health strategies to combat the psychological impact of COVID-19: Beyond paranoia and panic. Annals of the Academy of Medicine, Singapore, 49(3), 155–160. International Labour Organisation. (2020, April 4). Impact of COVID-19 on migrant workers in Lebanon and what employers can do about it https://www.ilo.org/wcmsp5/groups/public/---arabstates/--ro-beirut/documents/publication/wcms_741604.pdf Joshi, S. (2020). Telepsychotherapy: The bridge to continuity in care and mental health services in COVID-19 and post Covid era. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.170-181). Thiruvananthapuram: The Editor. 53

Khan, M.N. (2020, May 21). Scarred minds: There is more to the psychological impact of Covid-19 crisis than meets the eye. News18. https://www.news18.com/news/opinion/scarredminds-there-is-more-to-the-psychological-impact-of-covid-19crisis-than-meets-the-eye-2630607.html Knoll, A. & Bison, A. (2020, March 30). Migration, mobility and COVID-19 – A tale of many tales. ECDPM blog, https://ecdpm.org/talking-points/migration-mobility-covid19-tale-of-many-tales/ Krishnan, M. (2020, May 14). Mental illness, suicides rise in India during Covid-19 crisis. RFI. http://www.rfi.fr/en/international/20200514-mental-illnesssuicides-on-the-rise-in-india-during-covid-19-lockdown Kumar, D. (2020). Contributions and challenges of psychologists in private practice in India and their responses to COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.166-169). Thiruvananthapuram: The Editor. Kumar, N. S., Jayaraman, S., & Rangaswamy, K. (2020) Tamil Nadu Association of Clinical Psychologists (TNACP) responding to COVID-19 pandemic. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.204-208). Thiruvananthapuram: The Editor. Liem, A., Wang, C., Wariyanti, Y., Latkin, C. A., & Hall, B. J. (2020). The neglected health of international migrant workers in the COVID-19 epidemic. The Lancet Psychiatry, 7(4), e20. Mahanirban Calcutta Research Group, (2020). Borders of epidemic. http://www.mcrg.ac.in/RLS_Migration_2020/COVID-19.pdf Maunder R. G. (2009). Was SARS a mental health catastrophe? General hospital psychiatry, 31(4), 316–317. https://doi.org/10.1016/j.genhosppsych.2009.04.004 Modak, S. (2020, April 22). Not just hunger, psychological factors, job insecurity behind migrants’ exodus. The Indian Express.https://indianexpress.com/article/cities/mumbai/m

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! umbai-not-just-hunger-psychological-factors-job-insecuritybehind-migrants-exodus-6373260/ Morina, N., Akhtar, A., Barth, J., & Schnyder, U. (2018). Psychiatric disorders in refugees and internally displaced persons after forced displacement: a systematic review. Frontiers in psychiatry, 9, 433. Ministry of Health and Family Welfare. (2020). Psychosocial issues among migrants during Covid-19. Understanding the issues of the migrant populationCOVID-19. https://www.mohfw.gov.in/pdf/RevisedPsychosocialissuesof migrantsCOVID19.pdf Nielsen, T. R., & Waldemar, G. (2010). Dementia in ethnic minorities. Ugeskrift for laeger, 172(20), 1527-1531. Pettit, T., Livingston, G., Manela, M., Kitchen, G., Katona, C., & Bowling, A. (2001). Validation and normative data of health status measures in older people: The Islington study. International journal of geriatric psychiatry, 16(11), 1061-1070. Rajkumar, R. P. (2020). COVID-19 and mental health: A review of the existing literature. Asian journal of psychiatry, 102066. Roy, P. (2020). The psychology behind response of people in wake of the COVID-19 pandemic in India. Indian Journal of Psychiatry, 62(3), 330-331 Saini, P. (2020, April 16). The war against COVID-19 is a psychological one and our nation is winning it right! The times of India. https://timesofindia.indiatimes.com/readersblog/prepsablogs/the-war-against-covid-19-is-a-psychological-one-andour-nation-is-winning-it-right-12108/ Schouler-Ocak, M., Kastrup, M. C., Vaishnav, M., & Javed, A. (2020). Mental health of migrants. Indian Journal of Psychiatry, 62(3), 242. Singh, O. P. (2020). Mental health of migrant laborers in COVID-19 pandemic and lockdown: Challenges ahead. Indian Journal of Psychiatry, 62(3), 233. 55

6 SUPPORTING STUDENTS AND THE SCHOOL COMMUNITY DURING A PANDEMIC DR. ANNIE JOHN Head, Counselling Services Mallya Aditi International School, Bengaluru

To say that the COVID-19 situation caught us unawares would not be the complete truth. We, in India, were aware of it in December 2019, when students studying in Wuhan began to return home. But we did not imagine the magnitude and severity of the illness till early March, just before the lockdown was announced. The adverse impacts of an epidemic, and of the subsequent quarantine measures, on the psychological health of society have been recorded after the severe acute respiratory syndrome (SARS) in 2003 and the Ebola outbreak in 2014 (Brooks et al., 2020). Emotional disturbance, stress, low mood, irritability, insomnia, post-traumatic stress symptoms, anger and emotional exhaustion were some of the psychological symptoms reported in the review. Some of these were short term and some were experienced even three years after the quarantine was lifted. The wellbeing and the psychological safety of all members of a school community, in so far as they affect student wellbeing, fall under the care of the School Psychologist (SP). Anticipating consequences of the novel coronavirus lockdown and quarantine on the mental health of the school community, the SP is in a position to put in place preventive measures, in addition to responding to needs that arise, to alleviate distress in the school community – the students, teachers and parents. Students are the focus Proactive mental health measures are a part of the SP’s job and the most effective way to do this is through adults who regularly interact with students. Younger students as well as older 56

COVID-19: Challenges and Responses of Psychologists from India

! students are influenced by the way their teachers and parents respond to any crisis. In a situation like the pandemic, the first point of contact for students being teachers and parents, it is crucial to reach out to this section of the school community – be it conveying information, instructions or attitudes that need to be imparted. Teachers and parents need to be provided with information regarding the virus from a reliable source, and communicate this information in ways that are both reassuring and supportive to students. The SP cannot interact with each student directly, in times of a crisis, but can guide the behaviour of the adults around them to make students feel safe. The World Health Organization, (2020) on the 31st of January, declared the novel coronavirus a Public Health Emergency of International Concern and shared information on how the virus was transmitted and recommended measures that would keep a community safe. The SP, who is usually also involved in the teaching of Life Skills could share such information with teachers, and ensure that students are given instructions on hygiene, imparted in such a way that they are not made anxious, reassuring them that the precautions taught are intended to keep them safe. This could be explained in language that is adapted for students depending on their age and level of understanding. When ‘Social Distancing’ becomes a necessary part of the preventive action, and schools are closed down as a result – educating teachers and parents on various aspects of keeping themselves and the students well can be done online. Once the magnitude of the illness reaches pandemic proportions, an increase in psychological distress resulting from anxieties arising due to the fears associated with the pandemic should be anticipated. Anxieties related to falling ill with the virus, that those vulnerable would fall ill with poor chances of recovery, to whether family members living far away would be safe; anxieties regarding the future which consist largely about how long the lockdown would last; and anxieties about coping with the current change in lifestyle can be anticipated as those that need to be addressed. 57

The pandemic made everyone, including students, anxious about the future, especially the lack of clarity regarding when institutions of learning would function normally. A measure of predictability in our lives is necessary for our sense of stability (Grupe & Nitschke, 2013; Peters et al., 2017). This applies to school going and college students at all ages as well. Younger students are unsure when they will be able to see their friends again, they are anxious that their friends might forget them or that they will never be able to play again. Older students are uncertain about the scheduling of exams, or whether colleges will admit them or even reopen for classes. The SP could explain to parents, by way of an email, or through a Webinar, that children of different ages express their anxieties in different ways. To look out for these expressions of anxiety, and to support and reassure the child and that it is an ongoing process. In addition, it should be pointed out to parents that this time with their children is an ideal opportunity to bond and to spend meaningful time with each child in the household. In situations of scattered families, this may need to be done through ‘virtual’ means. Parents can be encouraged to use instances from the crisis situation to teach skills of empathy and resilience, given that the pandemic throws into sharp relief the vulnerability of many. Children can learn household chores, help their parents with household work and develop an appreciation for all the effort it takes to make the home run. They can take responsibility for their own learning and learn to plan their days, revisiting the plan if necessary, as having a schedule or routine at home will help them attain some amount of normalcy in their lives. Online classes for grades 6 and above bring with them a different set of concerns to student well-being. Attention span, fatigue that sets in when listening to long periods of time learning online, the amount of synchronous and asynchronous learning that is taking place, and a careful balance of the two so that the students are not overwhelmed with work, and the amount of time needed to make shifts in attention from one subject to another are subjects for discussion with teachers on an ongoing basis. For the younger student, that is from grades 1 to 5, a contact time of 15 minutes with teachers up to 3 times a week would help to give a sense of normalcy and continuity to the students. Teaching material could be posted online for parents to access. When students turn off their 58

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! video, teachers should understand that it may be that the student does not have a space in the house that they feel can be shared with the rest of the class, rather than assuming that the student is skiving out of the class. Teachers also need to look out for signs of stress among their students and know how they may extend help, which might be in the form of a simple chat with the student or a referral made to the SP. While most students would be happy to return to school and their friends, those with social anxiety who experience difficulties in interacting with their peers will find their anxieties returning when schools open for regular classroom instruction. Teachers will need to look out for signs of stress in this group of children post lockdown. Teachers need support too Teachers, realising that their work would be largely online in the opening weeks of the new school year, that could perhaps continue in some instances for an indefinite period of time, would have worked tirelessly through the vacation, learning new methods of teaching and being trained in online schooling. Learning these technologies would have been unchartered territory for most teaching staff. This adds a new dimension to the scope of tasks to be managed, adding on to growing anxieties, teachers would question their ability to master these technologies sufficiently to conduct a smooth flowing online class, with students restless, irritable from the long time away from their normal school day, perhaps watched over by a critical parent in the background - the success of this new way of teaching and interacting with students becomes a new challenge to master. As SPs we need to prepare for what could become an enormous stress for teachers in these times. The SP’s role is to advise the teaching community on how to manage these anxieties, to be realistic about expectations and to be patient with themselves and with each other. To look out for manifestations of continuing stress amongst colleagues and sensitize each other with the awareness that support mechanisms exist, and that these could be put into place for staff members who require them. Tools that 59

help bring down stress levels, and techniques and practices that lead to distressing and relaxation should be highlighted to the group in online meetings. Reaching out to teachers regarding their own well-being can be done in an online meeting, either with groups of teachers or with the whole teaching community together, fostering the idea that they are not alone in this, that the concerns they experience are commonly shared. This would help them feel a sense of belonging to a group that shares similar distress. To be prepared for feelings of vulnerability, to recognise and identify these, and understand the distressing emotions that arise in response to the situation; that there will be anxiety, perhaps even escalating tensions as a result, and to accept these feelings of anxiety as something that is natural, and reasonable in these fraught times, and to learn to manage them. Understanding that the changes in emotions and behaviours experienced are common to the group gives a sense of calm and instils hope. However, when these emotions begin to overwhelm, leaving them feeling inadequate and unable to cope, the SP can direct them to support systems that they can access. The SP is also in a position to convey the unique predicament that teachers might find themselves in, to management teams, and encourage that the latter be supportive of their staff. Teachers can learn that self-care, in its various forms – physical, emotional and social connectedness is essential for their own mental health and a necessary asset when they are required to extend their support to colleagues and students. (Norcross & Phillips, 2020). Parents can help Parents are part of the school community and home school connections work in many ways to keep our students safe and well. During the lockdown phase of the pandemic, students and parents, and may be even extended members of the family, are together at home for many hours giving rise to situations that are stressful for both. Parents who are used to spending a few hours with their children are now confronted with the task of keeping them 60

COVID-19: Challenges and Responses of Psychologists from India

! entertained, busy, dealing with the emotions and behaviour that arise out of long hours of being together in “a lockdown”, locked up space. Furthermore, parents must deal with their own emotions, their insecurities regarding their own jobs, their work as well as keep the household running. They must make sure that they do not involve their children in situations of domestic disagreement and learn to draw boundaries in these interactions. Parents with children of varying ages will face challenges of explaining the situation to young ones, dealing with the frustration of older children not permitted to meet up with their friends, and managing the elderly without being unduly impatient or hurtful. Online sessions with parenting tips will support them and provide some consistency of care to the students. In view of the fact that there is so much information available and accessible to parents, these sessions can be brief and illustrative, and effectively designed. In closing The School Psychologist can also be available for individual online sessions with the school community – students, teachers and parents. Parents and teachers need to be made aware of the pandemic-specific signs of distress that may present and be encouraged to refer children for counselling, when relevant. As the mode of the counselling session changes to an online session, concerns about privacy and confidentiality need to be addressed at the outset. It is also to be recognised that very young children find online sessions difficult to manage, and if necessary should be kept to a short duration of perhaps 20 minutes. When necessary, the SP can initiate a referral to a clinical psychologist or a psychiatrist. School Psychologists can have a powerful impact on the wellbeing of the school community, with the students, teachers and parents and this is especially evident in times like a pandemic when anxieties tend to overwhelm and take over our lives. Students are exposed to the uncertainties of the time and the realities of loss and grieving; they feel disconnected, isolated and unsure; yet with the right advice, reassurance, and support they will learn how resilient they can be. School Psychologists who are part of the faculty of a school or learning institution have a responsibility to the school 61

community in times of crisis, and the COVID-19 pandemic is one such situation. Acknowledgement Radhika Srinivas D’Costa, School Psychologist at Mallya Aditi International School, for her suggestions. References Brooks, S. K., Rebecca, K. W., Louise, E. S., Woodland, L., Wessely, S., Greenberg, N., Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. Vol. 395 (10227), p 912-920 Grupe, D. W., & Nitschke, J. B. (2013). Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature Reviews Neuroscience, 14(7), 488-501. Norcross, J. C., & Phillips, C. M. (2020). Psychologist Self-Care During the Pandemic: Now More Than Ever. Journal of Health Service Psychology, 46, 59-63. https://doi.org/10.1007/s42843020-00010-5 Peters, A., McEwen, B. S., & Friston, K. (2017). Uncertainty and stress: Why it causes diseases and how it is mastered by the brain. Progress in neurobiology, 156, 164-188. World Health Organization. (2020). Mental health and psychosocial considerations during the COVID-19 outbreak, 18 March 2020 (No. WHO/2019-nCoV/MentalHealth/2020.1). World Health Organization.

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7 PROMOTING WELL-BEING AND RESILIENCE OF YOUNG PEOPLE DURING COVID-19: AN INITIATIVE WITH SCHOOLS DR. CHETNA DUGGAL and LAMIA BAGASRAWALA School Initiative for Mental Health Advocacy, TISS, Mumbai Introduction The month of March, 2020 was a period of sudden setbacks and disruptions as the country was presented with unprecedented challenges in the face of a global pandemic. As India began to report an increase in the prevalence of COVID-19, a nationwide lockdown was imposed resulting in mayhem, fear and confusion for many. India, a country of over 135 crore people was forced to witness a complete shutdown, rendering large numbers of daily wage earners, migrant workers and homeless people in a state of complete loss and helplessness. As the country tried to stay afloat, it was apparent that some people and groups were more vulnerable during these times. Support for the marginalized and vulnerable groups was being mobilized. Civil society organizations and individuals across the country came to the forefront to join the state and central government agencies in their efforts to ensure safety and care for the vulnerable and at-risk groups. During these trying times, a significant part of the population that was highly affected were children and young people of India. While children may have been less vulnerable to infection, they were experiencing increased psychological and emotional vulnerability. As schools closed abruptly in March 2020, most children had no access to any physical space beyond their homes. The rhythm of regular routine was gone, and play, learning and access to peers was also limited for many. Children who were living in unsafe or violent homes had no place else to go. The UNICEF Monthly Report published on 63

March 31st 2020, reported a 50% increase in calls received by CHILDLINE India, a helpline for children in distress, resulting in 9,385 direct interventions within a 10-day period from March 20-31 during the first week of the nationwide lockdown (UNICEF India, 2020). About 20 per cent of these interventions responded to child protection issues such as preventing child marriage and physical, emotional and sexual abuse, trafficking, abandonment, neglect, and child labour. The data was alarming, and it became clear that children and adolescents were an extremely vulnerable group during this time who have been affected not only by the uncertainties and anxieties of the pandemic but also by the absence of safety networks and routines that offered some stability and anchoring. However, there was a complete dearth of resources or information to support children’s well-being during this pandemic in India. The need Through the School Initiative for Mental Health Advocacy (SIMHA), our work has always been guided by the primary objective of advocating for children and young people’s mental health and well-being. During these changing times, it was imperative for us to acknowledge how discourses around children’s well-being were pushed further away, making it critical for us to play an active role in promoting children’s mental health and psychological needs. As the lockdown continued, the SIMHA team began to receive information about risks and vulnerabilities that children were experiencing during these times. Schools and educators started reaching out to us for support with specific challenges that they were encountering. In our work over the last three years, we have recognized the significant role that schools can play in not only enhancing children’s well-being but also supporting children who are at-risk. In view of the information we were receiving about children’s safety and well-being during the pandemic, the SIMHA team began to understand and conceptualize the needs of different stakeholders in children’s lives. As we engaged with schools through informal conversations we recognized that many schools had devised strategies and plans to transition into online teaching and learning but a large number of schools in India were struggling with issues 64

COVID-19: Challenges and Responses of Psychologists from India

! of accessibility. India has a complex school education system with a large network of schools managed by local governments and other affordable private schools, which operate in under resourced contexts catering to children from highly vulnerable and marginalized backgrounds. Children from these contexts had limited or no access to digital devices, internet, and electricity. In the absence of this, while few children were reachable only through regular telephone calls or messaging services, many others were unreachable. Most schools were therefore unable to resume teaching-learning activities. By early April, many children had already started moving to their hometowns as their families struggled for wages and livelihood. It became even more challenging for schools to reach out to these children and check in on their well-being. The emerging need to integrate mental health and well-being within existing structural systems was quite clear. Schools and educational systems had to become spaces that promoted and cared for the mental health and well-being of children and young people, now more than ever. Children’s wellbeing could no longer be seen as a secondary objective but instead a primary goal for every school. While we continued our conversations with schools, we also reviewed guidelines and information that was published internationally, and many unique challenges and needs specific to children’s well-being emerged. In the absence of school routines and restrictions on physical mobility, children with access to devices had started relying heavily on online games and social media to engage themselves and connect with friends and peers and may also experience restlessness (Kumar & Nayar, 2020). Information from international organizations were also highlighting increased risks for children with neurodevelopmental concerns (UNICEF, 2020) or other pre-existing physical or psychological special needs. The absence of routines and school structure can be extremely frustrating and confusing for children with special needs and this can further compound the distress that the parents and families are experiencing. Children who have previously experienced or witnessed trauma or children who were currently in violent or abusive environments could not access safe spaces or connect with their friends and peers. Recently there is also 65

published data which indicates that children and adolescents in various districts of China have reported increased behavioural and psychological difficulties such as fear of family members getting contaminated, clinginess, distraction, irritability, and fear of asking about the epidemic or health of their relatives (Jiao et al., 2020) as well as signs of depression and anxiety (Xie, et al., 2020) during the COVID-19 pandemic. A study by Young Minds in UK found that 83% of youngsters below the age of 25 years concurred that the pandemic exacerbated previous mental state conditions, mostly due to school closures, loss of schedule/routine, and limited social interactions and 26% reported that they couldn't get the specified or desired psychological support in view of the COVID-19 flare-up (Young Minds, 2020). The initiative With these challenges in mind, we began our outreach and community work by April 9th with a key focus on advocating for children’s well-being. We reached out to the network of schools that have previously collaborated with SIMHA and shared resource compilations which had a list of documents, videos, exercises and activities for schools to support children during the pandemic. The compilation included mental health related resources compiled by international agencies like the World Health Organization and UNICEF to name a few and also contextually relevant material from organizations like Ummeed Child Development Centre and Apnishala Foundation that was specifically designed for parents, teachers and school counsellors. With the objective of initiating a conversation about children’s wellbeing with different stakeholders, SIMHA shared this resource compilation with over 200 schools across India. Schools started reaching out to us sharing the usefulness of those resources and were actively looking for more support to address their needs and challenges. We realized that there was an imminent need to listen to the voices from the field and create a space to advocate for children’s well-being through dialogue and discourse. Since our launch in 2017, one of our key areas of work at SIMHA has been to strengthen capacities and competencies of school leadership teams, teachers and counsellors working with young people. We believe that children will be better supported if adults and stakeholders working with them are adequately 66

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! supported. The feedback and requests we were receiving from schools in response to our compiled resource document led us to revisit our roots and strategize our response to meet the needs of various stakeholders working with children across diverse contexts within India. With the objective of creating a collaborative learning space for different stakeholders, SIMHA launched its first webinar series in April 2020. The 3-part webinar series was designed to promote the well-being of children in schools and included one webinar with each of the three stakeholder groups: school leadership, teachers and counsellors. The webinars were informed by the key principles that are core to our work at SIMHA. All webinars were designed to promote, recognize and ensure children’s safety, agency and rights at all times. The content and discussions were designed to be contextually relevant and rooted in principles of intersectionality. The recommendations and practices suggested during the webinars were trauma-informed. While we advocated for children’s rights and needs, our webinars adopted a strength-based approach which recognized the resources and skills that children employ to resist and respond during any crisis. The registration process for the webinar required participants to complete a registration form which asked for their specific needs, concerns and challenges during the current crisis. This information provided a glimpse into some of the needs and we designed the 3 webinars to address these needs too. Through this first webinar series, we created the first of its kind virtual platform for school leaders, teachers and counsellors to come together and discuss challenges and needs related to students’ mental health and well-being during the pandemic and lockdown. The webinars were designed to present a whole-school response to mental health needs of children and adolescents. The WHO whole-school mental health approach was referred to as a guiding framework in developing the strategies and frameworks presented in the webinars. Through the webinars safe and collaborative spaces were created for participants to share the mental health and psychosocial challenges that children may be experiencing during these times, the impact on their well-being and learning and the role that different stakeholders can play to support children. For the school leaders, the webinar focused specifically on the need for strategic 67

action at a whole-school level with a focus on integrating mental health within school policies and protocols during the pandemic. Specific action steps like focusing on children’s well-being during parent communication and creating forums and platforms to listen to the mental health needs of teachers and staff were also discussed. The webinar also invited participants to share ways in which they have been responding to these challenges thereby encouraging shared learning and sense of collective responsibility. The webinar for school teachers emphasized on the importance of children’s well-being and recognizing how the uncertainties and anxieties of the current times influence learning processes. We also shared a framework with teachers that offered an overview of the different action steps they could take to give prominence to mental health of children within their classrooms. The third webinar was designed for school counsellors and it focused on providing a contextually relevant framework informed by trauma sensitive school practices. The framework offered a few recommendations for school based practices that could help promote students’ well-being in the midst of a crisis. These webinars received an overwhelming response from over 124 schools across 10 States and 02 Union Territories of India. Participants shared how the webinars were not only informative but also helped them reflect on their existing practices and build perspective on the changing nature of their roles during these times. As we concluded the first webinar series, we also took a deeper look at the various needs that had emerged during these three webinars. School leaders shared their unique challenges as they navigated through pressures and demands from various stakeholders, especially school management and parents. Teachers shared that they were facing challenges like sustaining student engagement in online classrooms, increased absenteeism during online classes and also difficulties with parent engagement and responsiveness. Teachers also shared that they were also struggling with challenges that came along with the transitions to online teaching-learning like redesigning curriculums and lesson plans and working from home. Many teachers also shared that their wellbeing had taken a back seat since schools were also demanding a lot more from them. The picture was more complex for teachers, some of whom shared their own experiences of living in violent or abusive home environments. School counsellors shared that they 68

COVID-19: Challenges and Responses of Psychologists from India

! were feeling confused and did not seem to have the skills required for online counselling. They shared that reaching out to students who may be at-risk or supporting students with special needs through tele- and online counselling was challenging. Counsellors also shared that the current times were already difficult and offering counselling services was also taking a toll on their own mental health. The challenges and concerns that were shared by different stakeholder groups demanded that we continue our work to address these emerging needs. We therefore devised a three pronged strategic approach to address the needs that schools across India were presenting with during the COVID-19 pandemic and lockdown: advocacy for children’s well-being, knowledge and skill building for all key stakeholders and reflective practice and selfcare. During this time, as we began designing our capacity building programme to meet the aforementioned objectives, we were also planning a 3-part webinar series on “Self-care” for the Adhyayan Quality Education Services Pvt. Ltd. Adhyayan is an education movement of Indian and international educationists, dedicated to improving the quality of leadership and learning in schools. Adhyayan approached us with specific needs that had emerged during their programmes with school leaders and teachers during the pandemic. They shared that leaders, teachers and counsellors were all experiencing distress and required support with their own health and well-being. Since this was aligned with the objectives we had put forth, SIMHA offered to curate a three-part webinar series with one webinar for each of the three stakeholder groups: leaders, teachers and counsellors. The SIMHA team planned this webinar series as workshops that incorporated narrative and arts-based practices that encouraged reflective discussions. The webinars were designed to create a safe space for participants to reflect on their own well-being and deconstruct the meaning of “self-care” during such uncertain times. The webinars, attended by over 124 participants from 7 States across India, received phenomenal feedback as participants left feeling heard and rejuvenated.

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Webinar series for teachers and counsellors With the successful completion of six webinars in April, we were geared to launch our capacity building programme in May 2020. The programme was aimed to address the needs of school teachers and counsellors during the pandemic. We launched two series of webinars: a 4-part professional development web-series for counsellors working with children and adolescents and a 3-part web-series for teachers. Similar to the initial webinar series on “Promoting well-being of students during the COVID-19 pandemic” and “Self-care”, both the webinar series, for teachers and counsellors, emphasized child rights and safety, and were designed to be trauma-informed and strengths-based. Taking into account the feedback and responses we received during the first six webinars, we continued to ensure that our pedagogy was collaborative and involved a mix of didactic information sharing and participant interaction. The webinars also included reflective processes and encouraged participants to share with one another. We ensured that webinars were a space for learning, reflection and discussion by leveraging technology to share information, invite participant views through interactive polls and create a space for shared reflection by using break-out rooms and other platforms like the Padlet. Participants were also encouraged to share feedback for every webinar through a detailed Google Form which also guided our planning and facilitation for future webinars. The webinar series for teachers included three webinars dedicated to promote well-being of all students, support specific students at-risk and promote self-care and well-being of teachers. The first webinar aimed at integrating emotional well-being with teaching-learning practices during the pandemic. This webinar guided teachers on specific emotional needs that children across different age-groups may present with during these times and offered specific strategies to create safe spaces for emotional expression. Through various hands-on activities and sharing of resources like classroom activities, worksheets and videos, the webinar presented participants with ways to promote children’s well-being during synchronous and asynchronous teaching. The second webinar in this series focused on specific skills required to respond to students who may be at-risk or in distress during the lockdown. Specific indicators to assess and identify vulnerable 70

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! students through online/ telephone/ chat communication were also discussed. Through the use of polls and case vignettes, teachers reflected on the various ways in which they can respond to students’ distress and offer appropriate support. The webinar also highlighted specific protocols to be considered while responding to students who are/were witnessing or experiencing violence/ abuse. The third and last webinar in this series was designed as an experiential workshop that created a space for teachers to reflect on their challenges, their emotional needs during this time and connect with their values, intentions and aspirations. Through discussions, arts-based activities, the webinar offered participants a space to reflect on their journeys as teachers and identify pathways to enhance their well-being. The third webinar series was attended by over 88 teachers from 42 schools across 10 States and 01 UT within India. Participants found all three webinars to be extremely relevant, contextual and informative. Some of the participants also shared how they had started employing some of the recommended strategies and action plans with their students. Webinar series for counsellors While we were facilitating the web series for teachers, we had also initiated the 4-part webinar series for counsellors. This series was developed in response to the absence of any specific resources or training within India for counsellors working with children and adolescents during a pandemic. The series was therefore curated as a professional development series with each of the four webinars covering pertinent topics relevant to the current needs. For this series, SIMHA invited resource persons with relevant expertise to facilitate the webinars. Towards the end of every webinar, facilitators responded to case related queries and questions posed by participants. Counsellors from different regions had reached out to us asking for support as they transitioned into online and telephone service delivery. Counsellors working with schools shared their helplessness at not receiving clear guidelines and protocols on the same. The first webinar in this series, therefore, was on conducting online therapy for children and adolescents. The webinar presented a framework for conducting online sessions for children and 71

adolescents, taking into consideration specific developmental needs and challenges. This webinar also introduced participants to various platforms that can be employed for counselling online and also highlighted specific features and tools available on these platforms. Through this webinar, counsellors were also taken through a detailed understanding of the process of online counselling, including simple and effective ways to create a therapeutic frame and effective strategies and activities that could be used with children of different ages. Second in this series was a webinar designed for counsellors supporting children at-risk. The webinar focused on specific factors and experiences that could challenge children’s safety and place them at-risk such as witnessing and/or experiencing violence or abuse, neglect, as well as factors like increased use of digital devices, increased gaming, substance use and/or self-injury. For this webinar, risk assessment protocols and strategies were discussed in the context of online and tele-counselling. Webinar for working with children who have experienced trauma Our third webinar was aimed at working with children who have experienced trauma. During the pandemic, as we mentioned earlier, children who may have already experienced trauma may need additional support, especially as they may not have access to their safe spaces and might find it challenging to cope. The webinar focused on different theoretical and conceptual frameworks to understand trauma including the polyvagal theory. The neurobiology of trauma was explained and participants’ perceptions about trauma were also explored through intermittent polls. This webinar also outlined trauma-focused interventions, with an emphasis on the process of stabilization while working online with children who might have experienced trauma. Experiential workshop on self-care and support The last webinar was designed as an experiential workshop on self-care and support for counsellors during the pandemic. This webinar was interactive, reflective and created a space for personal sharing and discussions. Through various reflective processes and arts-based activities, this webinar created a space for counsellors to reflect on their own well-being during this pandemic and the 72

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! impact it has had on their personal and professional journeys. As facilitators, this webinar was an extremely humbling experience as participants invited us into their life stories and experiences of hope, pain, gratitude, helplessness, despair, optimism and uncertainty. It was a reminder that support and compassion can go a long way even for mental health professionals and the series concluded with exchanges of gratitude as participants left us with requests for more webinars and similar learning spaces. SIMHA was able to reach 271 counsellors affiliated with over 164 schools and organizations from India, Nepal and Indonesia in these four sessions. Feedback for this webinar series indicated that the content and case discussions were extremely helpful and enriching for the participants. The reach Over the course of these two months, we have conducted 4 series of 13 webinars for school leaders, teachers and counsellors with the objectives of advocating for children’s well-being, building competencies to support children’s well-being during a pandemic and engaging in reflective practice and self-care in the context of the COVID-19 pandemic. Through these webinars, we have reached out to over 600 participants from over 140 schools across India, Indonesia and Nepal. Within India, our webinars received participation from across 18 States and 02 Union Territories. The way forward The feedback we received only strengthened our intentions and enthusiasm to continue the work we have been doing to foster schools as communities of care. We are aware that with the pandemic still impacting our lives, normalcy and routine are not going to return in the immediate future. There are questions on when schools will reopen, when our young people will be back in classroom spaces and when teaching-learning will happen in person. As schools prepare for the next academic year, SIMHA plans to continue supporting school leaders, teachers and counsellors to facilitate the well-being of young people through these transitions by advocating for and building safe and nurturing communities that promote resilience. 73

Conclusion Schools have a huge potential to develop into communities of care that build resilience and promote well-being of young people. Research has indicated that a positive and safe school climate, considerate and safe learning spaces, and trusting and respectful relationships with teachers can be critical in promoting resilience among children experiencing adversity. Over two months of engagement with different stakeholders of the school community, we recognize the crucial role that mental health professionals can play in advocating for the well-being of children and adolescents with school leaders, teachers and counsellors, especially during a crisis such as the current pandemic. Advocacy efforts, combined with presenting frameworks and resources and creating spaces for dialogue, can create pathways for integrating mental health into teaching-learning spaces and can contribute to the safety and well-being of our young people. About SIMHA: The School Initiative for Mental Health Advocacy (SIMHA) is an initiative of the School of Human Ecology, Tata Institute of Social Sciences. Through its three pronged approach of advocacy, research and capacity building, SIMHA endeavours to improve mental health systems within educational institutions across India. Over the last three years, through on-field research and multiple stakeholder interactions, SIMHA has established a contextually relevant framework for whole-school mental health practices in schools in India, based on the World Health Organization’s (WHO) whole-school mental health approach. SIMHA connects with schools that wish to create a safe, emotionally healthy environment for students and promote the mental health and well-being of students and educators. References: Jiao, W., Wang, L., Liu, J., Fang, S., Jiao, F., Pettoello-Mantovani, M., & Somekh, E. (2020). Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. The Journal Of Pediatrics, 221, 264-266.e1. https://doi.org/10.1016/j.jpeds.2020.03.013

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! Kumar, A., & Nayar, K. (2020). COVID 19 and its mental health consequences. Journal Of Mental Health, 1-2. https://doi.org/10.1080/09638237.2020.1757052 UNICEF India. (2020). UNICEF India COVID-19 Pandemic Monthly Situation Report No. 1. UNICEF India. UNICEF Serbia. (2020). Children with autism and COVID-19. Retrieved from UNICEF Serbia: https://www.unicef.org/serbia/en/children-autism-andcovid-19 Xie, X., Xue, Q., Zhou, Y., Zhu, K., Liu, Q., Zhang, J., & Song, R. (2020). Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China. JAMA Pediatrics. doi:10.1001/jamapediatrics.2020.1619 Young Minds. (2020). Coronavirus: Impact on Young People with Mental Health Needs. UK: YoungMinds. Retrieved from https://youngminds.org.uk/media/3708/coronavirusreport_march2020.pdf

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8 COVID-19: THE PANDEMIC AND PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES S. VENKATESAN Professor in Clinical Psychology All India Institute of Speech and Hearing, Mysuru

My story: A personal narrative My name is Raj. I am a 35-year old. People call me Downs rather than by my name. Never mind. I have now got used to it. I love having people around. I enjoy greeting, chatting, or being with them. Some people tease me by asking when my marriage is. I smile and avoid such people. I have a job in an institute. My mother has been taking me there since my childhood. For a few years, I used to sit at the entrance of the library. I would observe everyone who enters or goes out. I was told to see that no one comes inside with their bags or books. Before they enter, they leave their things inside a locker. When they go out, they must carry only the books sealed at the counter. I enjoy my work. Some months later, another sir joined the library. He said that I could also dust the bookshelves once in the morning and again in the evening. I was taught how to dust the books arranged in rows. If any book was outside the row or upside down, I would rearrange them. If I found any book torn or damaged, I would hand it over at the counter. They repaired and sent it back to me. I would keep them back in their place. I know which book is kept where. If someone tells me the book's size or color, I can fetch it. Many times, I do 76

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! this correctly. Everyone praises me for this. They say that I am an expert in finding books. I know to read a few words in English. I can write my name and address in my mother tongue. I have a cell phone with some contact numbers. I have learned to dial home on it. The phone has a section with photos of my parents and me. Everything was okay with my job. An autorickshaw driver takes me to work every day. He arrives when the clock in my house shows the small needle at eight. My mother packs my lunch and water bottle by then. I don’t fully understand the clock. But I know when it is time to leave home, have lunch, or go to the library by the needle's position. I am told not to leave the main gate of the institute. My parents give me three ten-rupee notes every morning before I leave for work. I use the money for coffee with a snack in the morning, mid-day, and afternoon. I enjoy munching those bites with hot coffee. My dad says it is from the money I earn. I don't know how much I am paid. But, I have a beautiful orange bank passbook in my name. If we open that, we can know how much money is there in my name in the bank. Some people ask me how much money I have in the bank. Really, I don't know. But, if I sign a slip along with my father, the bank will give money. For some days, things have changed. I am told that I cannot go to work. When I asked why, they said, there is a dangerous disease out there. If we go out, we will fall sick. Every day, I hear others talking about it. Many people who are going out are falling ill. Some are even dying. First, they told me that I must not come to work for a few days. I marked that date on my calendar. Every day I tear 77

out one sheet off the calendar. Once we reached the marked date, I said that I will leave for work. Then another fresh time was marked again on the calendar. I am told to wait until that date. I don't know how long to wait. The books in the library would have all gathered dust by now. I am told that no one is being allowed inside. Even if I am permitted for work, my mother tells me to practice covering my face. I tried once. I did not like it. It hurts behind my ear. I can't breathe easily. I am now being taught to wash my hands. I used to clean my face and hands before also. But, now I must do it again and again. I am also told not to shake hands with others. Hereafter, they ask me to stand far away from people. When I was young, I used to fall sick frequently. I used to get coughs and colds regularly. Now, it is better. Others say that I will get them back if I go out. What shall I do now sitting at home? How long can I just watch TV? I promise not to touch others. I won't go to the canteen. I will not sit next to anyone. I won't mind any of these things. Can someone tell me when I can go to work? The preceding first-person narrative says it all. People with disabilities (PWDs) in general and Persons with Intellectual and Developmental Disabilities (IDDs) are the worst affected by the COVID-19 pandemic. To start with, such persons may not fathom these sudden changes in circumstances. Why is no one going out? Why don’t people come close to each other? Why are autos, buses, trains, or planes not running? Of course, they may understand a close down for a day or two. But why it is all prolonged is confusing to most of these persons. IDDs are conditions that are usually present at birth, and that negatively affect the trajectory of the individual's physical, intellectual, and emotional development. The lifelong disability starts any time before the developmental period of eighteen and is 78

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! characterized by intellectual functioning and adaptive behavior problems. Affected persons have below-average levels of intelligence and adaptive behavior. This is expressed as Intelligence Quotient and Social Quotient, which is indicated by limitations in communication, self-direction, social skills, self-care, community resources, ensuring personal safety, and requiring continued support for daily living (AAIDD, 2010). COVID-19 Etiquette The newly enforced corona etiquette is learning yet to be mastered. Handshakes, hugs, a kiss on the cheek, or embraces are all now going to be things of the past. A bow and greeting with folded or waving hands are now being propagated (Samanta, 2020). Social distancing is the latest buzz word that has to be understood and practiced. Wearing masks is becoming an inherent part and parcel of everyone’s daily attire. Hand washing regularly is no more to be diagnosed as a compulsive disorder. Teaching or maintaining personal hygiene by itself is a daily challenge for caregivers of these persons. Coughing, singing, sneezing, and spitting in public, particularly without covering the mouth, are now seen even as criminal behavior liable for punishment. The same is to do with littering and clearing one's nostrils. When a mask covers nearly half of the face, reading emotions becomes a challenge in day-to-day interactions. Smiling or scowling beneath the mast cannot be differentiated. The muffled voice from under the mask is tough to be understood and more so by persons with intellectual disabilities. There are also rules on how to dispose of used masks. Sharing food is now almost no-never (Kelly, 2020). It is challenging to keep track of who is meeting us, when, where, how, or how long as part of contact tracing is difficult. Many children and adults with intellectual disabilities having additional mobility issues may have to fall back for physical support from others. How this can be helped without touching is a huge challenge. With or without corona, society is replete with several faulty stereotypes, prejudices, or misconceptions about individuals with disabilities. During these challenging periods, such notions are likely to get aggravated. A steady flow of facts, figures, news, and views in the simple form is needed to meet PWID's information 79

needs. Society tends to scapegoat the vulnerable and weaker sections of society whenever there is a natural or man-made disaster. It is understood as a catharsis mechanism to give vent to pent-up energies, as explained by social psychologists. Social media posts are already doing rounds that doomsday is not far away (Depoux et al. 2020; Lin, 2020). Increasing screen time is the most convenient and commonsense solution used by most caregivers of such affected persons. This is likely to only aggravate than mitigate the problems. At one point in time, it might become difficult to wean them away from gadgetry. Professional service providers face unique difficulties when handling such children. Clinic or institution-based services are out of consideration, at least for now, when the corona situation is acute. Innovations are being worked out to check whether telebased services are preferable to real-time face-to-face therapies. If this is to be so, the guidelines that could work with most mentalhealth conditions are different for PWID. Efforts are on to establish toll-free, pre/post-paid time-bound or consultant specific community-radio talks or helpline services. Parents or service receivers expect individualized and instantaneous solutions during such consultations. This is not feasible or practical since each case requires a detailed work-up, diagnosis, intervention planning, and intervention. Lockdown and Quarantine These terms have become the catchphrase of the times. Lockdown or shutdown describes the more general and widespread restrictions on movement, work, and travel in a city, region, or country. Quarantine is a way of separating and restricting people exposed to a disease, such as COVID-19. Lockdown and quarantine with isolation, social distancing, and community containment are taking a psychological toll and impacting the lives of millions across the world at personal, professional, and societal levels. It is creating a variety of emotional-behavioral reactions like irritability, intolerance to rules, whim and excessive demands, fear, anxiety, panic, depression, suspicion, guilt, anger, helplessness, boredom, and restlessness (Girdhar, Srivastava & Sethi, 2020; Jayadev & Shetty, 2020). 80

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! A lockdown induced emotional and behavioral sequel is not an explored area of study. Absence of social contacts, diminished activity levels, sedentary preoccupation for the most part of the day, and lack of variety in daily routes in these times can lead to irritability, anxiety, panic, fears, and depression. For some of these persons, it may manifest as problem behaviors. These may be reciprocated by high intensities of expressed emotions, even by the other family members. The overly charged family system could also react with increased child abuse and domestic violence. One is already hearing anecdotal accounts of intellectually challenged children being abandoned by economically starved and stressed weary parents during these difficult times (Chakraborty & Chatterjee, 2020; Dalton, Rapa & Stein, 2020; Horesh & Brown, 2020). Play behaviors and leisure-time activities are minimally given to children with ID (Venkatesan & Yashodharakumar, 2016; Venkatesan, 2000; Khoshali & Venkatesan, 2007). Their well siblings find their presence at home, disturbing and companionship immature, dull, boring, or uninteresting (Venkatesan & Ravindran, 2011). Toys are seldom given for play to children with IDD (Venkatesan & Yashodharakumar, 2017). Parents have been observed to have minimal understanding of their child’s condition (Venkatesan, 2003). There are structural and attitudinal barriers that prevent the optimization of home-based problem behavior interventions for such children (Venkatesan, 2017). It is indeed a challenge how such children can be kept constructively engaged at home by the family members themselves amidst the shutdown. While this is all true of the so-called healthy controls, it can hit hard on PWIDDs. There can be symptom exacerbations in instances wherein they were dormant during the pre-lockdown period. They are likely to have disruptions in general health, mood, appetite, and sleep. The lockdown also means a sudden deprivation of specialized rehabilitation services and work opportunities. Among them, the bed-ridden or wheelchair-bound are forced to make the bedroom their world and cannot come out of its confinement. They cannot be wheeled to nearby parks, for a 81

stroll, or into community areas. All this boils down to a near dehumanization of these people. In China, a family made headlines when a teenager with cerebral palsy died in Wuhan after his father and brother diagnosed with coronavirus were quarantined in a treatment facility that was unable to care for him (Courtenay & Perera, 2020; Rose et al. 2020). Risks and Vulnerabilities The vast majority of PWDs have a hard time surviving, let alone living lives with reason to value. Most PWIDDs have fragile health. They can likely have one or more associated conditions like epilepsy, respiratory or cardiovascular disease, diabetes, cardiovascular problems, and obesity. Available evidence suggests that they are five times more likely than the general population to develop COVID-19, and those who get it are about five times more likely to die from it. The WHO has declared that PWDs be included in the high-risk, susceptible, marginalized, and vulnerable group for the pandemic (WHO, 2020; Yao, Chen & Xu, 2020). Apart from health-related threats, added social prejudice and negative attitudes deprive them of needed medical attention during a crisis. They are susceptible to coercion, verbal, sexual, or physical maltreatment and abuse. Unfortunately, harm often comes from the hands of those who are assigned to provide care, support, and protection. Lay people view them as "less human" and, therefore, "less valuable." The limited or lack of opportunities for them to learn, dependence on others, physical defenselessness, social isolation, and limited cognitive and communication abilities form a deadly concoction to aggravate their vulnerabilities for abuse or maltreatment. Women with intellectual disabilities are the most vulnerable due to their double disadvantage based on their condition and disability (Fogden et al., 2016; Green & Stykes, 2007). Economic and Occupational A small percentage of adults with a borderline and mild degree of IDs are remuneratively employed in protected environments (Venkatesan, 2017). The ongoing pandemic has adversely impacted the Indian economy. With the prolonged country-wide lockdown, global economic downturn, and associated disruption of demand-supply chains, job losses have 82

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! become inevitable. There is an ongoing impression that more people are dying not owing to Covid-19, but due to losing jobs and ending in poverty. In these circumstances, employment and job retention for PIDs can be a real challenge. Empirical studies are needed to examine how many of the PWIDDs entitled to receive the monthly pension for their sustenance are continuing to receive them even during the ongoing epidemic (Kachroo, 2020; Singh & Raju, 2020). Research Research on COVID-19 vis-a-vis PWIDDs is yet to take off all over the world. Available literature for key-word searches for terms like “corona-epidemic-intellectual disability-mental retardation” on the world-wide-web currently shows anecdotal views or news, interviews, and opinions of experts. There are few stand-alone websites and blogs on the subject advocating on this neglected issue and offering guidelines for practice. There are no authored books on this topic so far except those from national or international organizations for health promotion. Data based empirical research on the theme is awaiting inquiry. There is an acute shortage of public education material on corona and PWIDDs (Box #1; Das, 2020; Courteney, 2020; Roy, 2020; Tummers et al., 2020). Summary In sum, an attempt is made in this article to highlight the unique challenges in addressing the acute and long-term needs of PWIDDs in the context of the ongoing pandemic. Beginning as a personal narrative, critical psychosocial issues related to COVID-19 etiquette, lockdown-quarantine, risks-vulnerabilities, economic and occupational fallouts, and research are highlighted. Admittedly, the matters addressed are not exhaustive. The road ahead is unknown, at least for the time being. Like the protagonist in the personal narrative at the beginning of this article, one can only ask: how, when, or where can we get down to work? The challenges are for all takers.

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References American Association of Intellectual and Developmental Disabilities. (2010). Intellectual Disability: Definition, Classification, and Systems of Supports, 11th Edition. Silver Spring, MD: Author. Chakraborty, K., & Chatterjee, M. (2020). The psychological impact of COVID-19 pandemic on the general population in West Bengal: A cross-sectional study. Indian Journal of Psychiatry, 62(3), 266. Courtenay, K., & Perera, B. (2020). COVID-19 and People with Intellectual Disability: impacts of a pandemic. Irish Journal of Psychological Medicine, 1-21. Courteney, K. (2020). Letters: Covid-19: challenges for people with intellectual disability. British Medical Journal, 369. https://doi.org/10.1136/bmj.m1609 Dalton, L., Rapa, E., & Stein, A. (2020). Protecting the psychological health of children through effective communication about COVID-19. The Lancet Child & Adolescent Health, 4(5), 346-347. Das, N. (2020). Psychiatrist in the post-COVID-19 era–Are we prepared? Asian Journal of Psychiatry, 51, 102082-102082. Depoux, A., Martin, S., Karafillakis, E., Preet, R., Wilder-Smith, A., & Larsom, H. (2020). The pandemic of social media panic travels faster than the COVID-19 outbreak. Journal of Travel Medicine, 27(3), 31. Fogden, B.C., Thomas, S.D.M., Daffern, M., et al. (2016). Crime and victimization in people with intellectual disability: a case linkage study. BMC Psychiatry, 16, 170. Girdhar, R., Srivastava, V., & Sethi, S. (2020). Managing mental health issues among the elderly during the COVID-19 pandemic. Journal of Geriatric Care and Research, 7(1), 29-32.

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! Green, D., & Stykes, D. (2007). Balancing rights, risk, and protection of adults. Chapter 3. In: C. Bigby, C. Fyffe & E. Ozanne. (Eds.). Planning and support for people with intellectual disabilities: Issues for case managers and other professionals. London and Philadelphia: Jessica Kingsley Publishers. Pp. 65-83. Horesh, D., & Brown, A. D. (2020). Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities. Psychological Trauma: Theory, Research, Practice, and Policy, 12(4), 331. Jayadev, C., & Shetty, R. (2020). Commentary: What happens after the lockdown? Indian Journal of Ophthalmology, 68(5), 730-731. Kachroo, V. (2020). Novel Coronavirus (COVID-19) in India: Current Scenario. International Journal of Research and Review, 7(3), 435-447. Kelly, B. D. (2020). Coronavirus disease: challenges psychiatry. The British Journal of Psychiatry, 1-2.

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Khoshali, A.K., & Venkatesan, S. (2007). Play behaviors in children with mental retardation. Psychological Studies. 52(1): 90-94. Lin, C. Y. (2020). Social reaction toward the 2019 novel coronavirus (COVID-19). Social Health and Behavior, 3(1), 1. Rose, J., Willner, P., Cooper, V., Langdon, P. E., Murphy, G. H., & Kroese, S. B. (2020). The effect on and experience of families with a member who has Intellectual and Developmental Disabilities of the COVID-19 pandemic in the UK: developing an investigation. International Journal of Developmental Disabilities, 13. Roy, P. (2020). The psychology behind response of people in the wake of the COVID-19 pandemic in India. Indian Journal of Psychiatry, [cited 2020 May 30]; 62: 330-31. Available at: http://www.indianpsychiatry.org/text.asp?2020/62/3/330/2 84449 85

Samanta, S. (2020). “Namaste” the Indian Culture Plays Important Role For Prevent Corona (Covid-19) Virus: An Appraisal. Studies in Indian Place Names, 40(74), 450-459. Singh, T. K., & Raju, M. V. R. (2020). Psychosocial impact of COVID19 to the general population in India. An Annual Interdisciplinary Journal of History, 6(6), 643-652. Tummers, J., Catal, C., Tobi, H., Tekinerdogan, B., & Leusink, G. (2020). Coronaviruses and people with intellectual disability: an exploratory data analysis. Journal of Intellectual Disability Research, 1-7. https://doi.org/10.1111/jir.12730 Venkatesan, S. (2000). Play activities in children with mental retardation. Indian Journal of Clinical Psychology. 27(1): 124-128. Venkatesan, S. (2003). A survey on knowledge & opinion rights, immunities & privileges for persons with mental retardation. Disability, CBR, and Inclusive Development (formerly Asia Pacific Disability Rehabilitation Journal). 15(1): 59-68. Venkatesan, S. (2017). Barriers and facilitators in home-based problem behavior interventions for children. Indian Journal of Health and Wellbeing, 8, 5, 345-351. Venkatesan, S. (2017). Demographic, cognitive, and psychosocial profile of adults with borderline intellectual functioning. Journal of Contemporary Psychological Research, 4(1): 1-12. Venkatesan, S., & Ravindran, N. (2011). Attitudes in well-siblings of children with developmental disabilities. Journal of Disability Management and Special Education. 1(2): 1-23. Venkatesan, S., & Yashodhara Kumar, G.Y. (2016). Leisure and community exposure in persons with disabilities. Journal of Disability Management and Special Education, 6 (1): 1-14.

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! Venkatesan, S., & Yashodhara Kumar, G.Y. (2017). Toy index of children with or without developmental disabilities. Indian Journal of Clinical Psychology. 44, 1, 60-67. World Health Organization. (2020). Disability considerations during the COVID-19 outbreak (No. WHO/2019nCoV/Disability/2020.1). Geneva: Author. Yao, H., Chen, J. H., & Xu, Y. F. (2020). Patients with mental health disorders in the COVID-19 epidemic. The Lancet Psychiatry, 7(4), e2

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Box#1 Recommended outline for public education on COVID-19 and PWIDD A. Format • Must contain single-line statements; • Write-up or audio/video must be short and simple; • Content must directly address the receiver; • Must be colorful, illustrated, readable, and attractive; B. Content • What is the coronavirus? o It is a new illness spreading around the world. • Where does it come from? o Someone who already has it • How does it come? o When they cough or sneeze the germs get into the air on you and on things o Then they get into your body through mouth nose or your eyes. • What happens if you have it? o Will have a cough, sore throat, fever, and shortness of breath. • What should be done then? o Every cough or fever need not be corona. o Most people with coronavirus will feel unwell. o But not everyone needs to go to the hospital. o Some will have to go to the hospital. • How does the virus spread? o Through the air from a cough or a sneeze o If you touch the things that someone with the virus has touched o It can go from your hands into your body when you touch your eyes, nose, or mouth.

contd…

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!

Box#1 Contd. Recommended outline for public education on COVID-19 and PWIDD • How to avoid coronavirus? o Wash your hands with soap and warm water often. o If you can’t wash your hands, then use hand sanitizer. o Avoid touching your mouth, eyes, and nose o Try to wash or sanitize your hands before you do o Stay away from people who are sick o Tell people to stay home if they are sick o Cough and sneeze into your elbow o It stops germs from getting into the air and onto your hands @ Try not to touch your face or nose o Don’t rub your eyes o Do not share food drinks. • What is social distancing? o Means that you must keep a space of at least two steps between yourself and others o Don't get too close when meeting or talking to people. o Don't shake hands, hug, kiss, or touch others. o Avoid big crowds like shops, cinemas, weddings, etc. o Go to the shops when they are not busy. o Use public transport at quiet times. o Stay home and be protected. • What is a lockdown? o The social practice of people willing to stay at home to avoid the spread of the virus o Not a holiday when you can travel, meet people, plan or go for outings and picnic

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9 OUTBREAK OF CORONA: GIFTED RESPONSE DR. SUJALA WATVE Jnana Prabodhini’s Institute of Psychology, Pune, Maharashtra. The Pandemic: The pandemic of Corona virus started in December 2019 from Wuhan in China and spread all over the world in a very short span of time. Many epidemics of diverse diseases, specific to countries and locations have been recorded earlier; a few of them can spread all over the world and then are considered as Pandemics. The World Health Organization (WHO) has declared 10 main Pandemics till date. These earlier Pandemics are named as The Antonine Plague (165 AD), The Plague of Justinian (541-542), The Black Death (1346-1353), The Third Cholera Pandemic (1852– 1860), The Flu Pandemic (1889-1890), The Sixth Cholera Pandemic (1910-1911), The Flu Pandemic (1918), The Asian Flu (1956-1958), The Flu Pandemic (1968) and The HIV/ AIDS Pandemic (20052012). Each time, there was some new germ behind these pandemic diseases and it took years of research to find a definite drug treatment for these diseases. Scientists have devoted their whole lives with the commitment to find creative solutions. To see how these intelligent people, take these calamities as challenges and how these challenges become their life goals, is of interest. Scientific efforts Here is one very interesting story of Dr. Hultin and his passionate efforts for getting to the root cause of the Spanish Flu that occurred in 1918(Taubenberger, et. al., 1997). During the Spanish Flu Pandemic in 1918, 80 inhabitants from a small place in Alaska contracted this disease. 72 people died and were buried at a place, which was mentioned as the Brevig Mission. Sometime in 1951, 25 years old Hultin, studying for his doctoral degree in Microbiology at the Iowa University, came across this event, which aroused his curiosity. He strongly believed that the virus must exist in those frozen dead bodies. With the help of University students, Hultin planned for its exhumation. He took the permission of 90

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! elders in the town to dig the graves and get the necessary samples for his study. With his team he thawed the earth, dug the graves and got samples of lung tissues from a few bodies. Preserving those samples till they travelled from Alaska to Iowa was a challenge. He travelled by a DC-3 propeller-driven airplane, which had to halt for refuelling multiple times. During every stop, Hultin used to get down from the plane and refreeze the samples with the help of carbon dioxide from a fire extinguisher to preserve them in good condition. The co-passengers made fun of his ‘noisy’ and weird practices, which he just ignored. With all those efforts he brought the samples to the lab, took out a sample with a pipette (which needed to be done at that time by mouth), and injected it into a chicken egg. All these efforts were in vain as the virus could not survive in the egg. What a frustrating experience it must have been! But he kept on working. After 46 years, in 1997, Hultin read an article on ‘Sequencing of Genome of a Spanish Influenza Virus’ by a molecular pathologist Taubenberger from the Armed Forces Institute of Pathology in Washington, D.C. That gave him an idea how the research could be continued. Bearing the expenses himself, Hultin again went to the same place, retrieved the samples of the influenza virus using more advanced techniques and technology. The experts at Washington joined hands with him and the riddle of RNA of the virus was solved! He did not expect money or fame in return, but only wanted to solve the riddle. Cure for the disease During the earlier pandemics, people were under the spell of religious faith, magic and other unscientific practices. With no medicine and due to lack of insight about the problem, a trial and error approach was used to save the people from the terrible contagious diseases. Staying away from patients was seen to be the only successful way to save others. Through the observations of medical practitioners in those days, isolation of patients, staying apart from others (social distancing), staying at home (quarantine) were the strategies used in those times.

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Advancements in science and technology have made it easier to pinpoint the causes of these diseases now. The microorganisms such as bacteria, viruses, algae, fungi, protozoa, helminths etc., of various types are identified and successfully treated. A new strain of corona virus seems to be the cause behind COVID-19. Its nature and functioning is also revealed. The world is now waiting for the proper treatment to cure and stop it from spreading. Until then, practices like social distancing and quarantine are being used to control its spread. Facing the challenge Initially when there was an appeal from the Prime Minister Mr. Modi for a voluntary lockdown, people responded with vigour. On 22nd March 2020, the Janata curfew was well observed by the 1.3 billion population of India. The first lockdown was announced from 24th March for 21 days to prevent further spread of the COVID-19 virus. The second lockdown was announced from 14th April for 19 days, the third lockdown from 4th May and the fourth was announced on 18th May 2020. This has partially taken care of slowing the rate of spreading of the disease but what about the mental health of the people undergoing such a long period of lockdown? Mental health professionals are trying to take care of this issue, from their point of view. Educationists are finding ways to reach the masses using advanced technology and to continue formal education at all the levels. Educational policy-makers are modifying the existing practices to adapt to the situation. Farmers, industrialists are trying to ensure continuity in production. Economists are reinventing ways to maintain the balance between existing systems. Naturalists are already hinting that the frequent occurrence of natural calamities is because the balance of nature is disturbed due to human greed. It is a big challenge for the medical and paramedical fraternity to save the human race. In case of earlier pandemics, it was the joint effort- from scholars to microbiologists- that could help the human race. The trend shows that the viruses have undergone evolution and are attacking the human race with a more modified DNA structure. To tackle this, experts from all over the 92

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! world across various fields are working with their intellect and passion. This is a challenge for the entire human race. Will our National Education Policy, the current education system based on ‘equality’ (and not ‘equal opportunity’) support the highly intelligent children for that? Need of the time To take up this challenge, individuals with high intelligence, innovative and critical thinking, passion, and commitment to science are needed. Such personnel need to be developed through proper efforts. In the view of nature-andnurture principle we all believe that some potential is inherited by birth and some need to be nurtured. Highly intelligent children can be identified from certain indicators such as having quick grasping and learning, good memory, reasoning, and critical and logical thinking. But intelligence and thinking alone are not sufficient for effective working. Along with high intelligence, a passion for certain goals, creativity, skills and subject-expertise are essential. Intelligence is mostly inherited (almost 75%), but creating motivation, passion, and resilience definitely require scientific efforts. Are our children, with high potential, getting adequate opportunity to be identified and nurtured at home and in school? The answer is No! Offering scholarships, organizing competitions, disseminating information does create challenges, but it is not the way to ‘raise’ them. As mentioned before, high intelligence needs to be accompanied by commitment and creative approach, which needs to be nurtured from an early age. Assumptions Psychologists working on giftedness strongly believe that intelligence, giftedness and talents are different terms having very specific meanings. Intelligence is also conceptualized from different angles and seems to be mostly measurable, where many intelligence tests have been designed by all countries from time to time and as per the needs. But a gifted child (or child with gift) and giftedness (as behaviour) are still debatable points. Talents are assessed only when they get expressed in practice. So keeping this limitation in mind, some relationships are assumed. It becomes 93

very convenient to use a single word like ‘gifted’ and hence it gets used very synonymously. ‘High Ability Learner’ is the assumed meaning of ‘gifted’ for the current purpose. The individuals who have inherited (not contaminated by environment) high potential in any walk of life are ‘high ability’ individuals. Probably those can be measured with special instruments. Simultaneously she/he should be an ‘ able learner’, who is interactive with her or his environment. Identification of the gifted Every human being is born with some natural inheritance. It is a unique constellation of certain assets and a few weaknesses. Need for physical and psychological survival acts is the inspiration behind learning. Maslow’s Needs Hierarchy Model (1943) is one of the best explanations to support this. Right kind of exposure to surroundings, opportunities to interact freely with the environment, and a conducive atmosphere provides the strong foundation for the learning of the child. Observing the child and her/his development helps to understand and build up the profile of the child. Observing, rather than teaching, becomes very important in the early years of life. Parents and observers need to have this skill for letting the child ‘do’ and not force them to learn. In school though the purpose is stated to be ‘all-round development’, the emphasis is on academic development, which needs to be corrected. Teachers need to be observers and facilitators of a supportive and encouraging atmosphere. For the later years, there are some non-formal and formal procedures of assessing development of children which need to be functional. This will definitely help to compare the child’s objective profile with the background of the population of her/his age. The profile will highlight the strengths of the child as well as areas of weakness. Parental expectations and teacher biases could be minimized with such an objective profile. Nurturing the giftedness School system, for the cause of ‘equality of education’, is uniform for all. Though the ‘child centric’ approach is suggested in educational policy, the uniqueness of a child gets neglected for various reasons. There are no efforts taken to whet the extra appetite of a high-ability child. Here, to have ‘equal opportunity to 94

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! education’, it is of utmost importance to view education with a broader meaning. Individuals use their preferred senses while learning. Teachers should always ask themselves, ‘Am I allowing the child to use one’s preferred language? (visual, auditory, kinaesthetic, olfactory, gustatory).’ Freedom of learning, choice of learning language, choice of time and duration, providing own ‘space’ and appropriate encouragement can develop passion within a child. Educationists do not advocate readymade answers for most of the questions. Questioning, experimenting, experiencing, doing independent work, need to be fostered for developing a creative urge within the child. This will provide ‘appropriate’ challenges to learn on its own. During these challenges, the child gets the satisfaction of using its preferred strengths. A larger goal needs to be shown for channelizing the learning path. A true educationist never insists on the ‘right’ path but encourages the child taking ‘its own’ path. Most of the high ability children prefer to have their innovative ways of achieving goals. This will foster passion for learning, applying and finding novel and off-beat solutions to problems. Putting them through a single uniform system may help to build subject expertise and skills but it is less likely to encourage creative solutions. Gifted children can provide solutions to problems of uncommon nature. Here, all the characteristics of the gifted are at stake and the individual uses all her/his potential to find one or many solutions to a problem in a scientific manner. Jnana Prabodhini (JP) School for the gifted JP believes that high ability individuals have a more complex and more integrated neural system of interacting with the external world and they are more sensitive towards the environment. This can help in more efficient learning as compared to the normal population. High ability individuals also show extraappetite and hunger for learning new things in their own unique way. They learn faster and with more accuracy as compared to the normal population. For them, learning is multidimensional, interwoven and integrated in nature. Identifying potential in childhood 95

and fostering them appropriately is the ideal way to transform giftedness into talents. At the same time parents and parent-like mentors seem to be the right agency for helping children learn. By the time they are in standard 5, the children start using their own potential more efficiently. Bapat (2017) explains ‘Man-making’ as an objective of education. The founder of JP Dr. Pendse mentioned the objective of the school as developing leadership among ‘gifted’. For identification, Jnana Prabodhini Prashala (JPP) selects children, based on Indian standardized intelligence tests. To support the school, Jnana Prabodhini’s Institute of Psychology (JPIP) works on continuously developing and standardizing psychological tests and implementing them in practice. It has started out-of-school programs for gifted students from Pune on weekends throughout the academic year. Here also, standardized measures are used for selection of students. At the same time, monthly workshops are conducted as part of a 2-year training for parents, to identify gifts in their children in non-formal ways. All these initiatives at JPIP are done with a nurturing purpose. Nurturing the high-ability learners Jnana Prabodhini has three more schools, which are general schools, without any selection based on intelligence tests. The nurturing practices are similar to the gifted school. (Bapat, 2017). For nurturing their high-abilities, it is necessary to consider their six characteristics as per the Model of Potential for Advanced Development (Khire, 2000). High ability learners are sensitive to their surroundings, they have a large source of energy to be responsive to the happenings around, they select and assimilate new information and can well adapt to the new circumstances. They have great learning capacity as well as capacity to grow horizontally and vertically, they demonstrate capacity to create, reproduce and regenerate innovative solutions to problems, and lastly, have the capacity to throw out unwanted or useless information. This happens in all domains of life, physical, intellectual, emotional, social, moral and spiritual. The activities planned throughout the school years can transform the abilities into talents in any of the above single or multiple domains. 96

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! There are a complete six years’ span at hand to nurture students’ specific potentials through all-round- development, create passion and commitment to work, and enhance creativity. The goal of the school is reflected through its motto ‘motivating the ‘able’ for social change’. Throughout schooling, efforts are planned and implemented to nurture the child’s potential to the fullest extent and to motivate them for creating social change and solving national problems. The activities and the school model are unique for the gifted education in India (Bapat 1998, 2017). Lavalekar did her doctoral work on creating social awareness among gifted children through special activities. (Lavalekar, 2004), which is again a very special effort for channelizing intelligence for social change. Lockdown: Turning to opportunity for home- learning From the beginning of the lockdown, the Principal and teachers shifted to online teaching. Classes were held each day for about 5 hours with breaks in between, through mobiles, emails and apps. This went on for 15 days until the portions were completed. New things like projects, experiments and activities were advised at home. The Internet was available at hand for help. Ample material regarding curriculum and outside curriculum was provided. Every change became smooth and comfortable. Students had several questions regarding Corona and COVID-19- What is this Corona? Can it infect me and my parents also? Will we be kept apart from each other? What happens to the infected person? Can we talk to such persons to know how they suffered? Is there any medicine to cure it? How to avoid Corona? Can we touch things like.........? With the increasing age, the questions went more in-depth of the topic. Nature of the virus, how it spreads, how it is transmitted from one person to another, how to halt its spread, its comparison with other viral diseases were some common questions. The online lectures by teachers covered such queries regarding Corona. They also inspired students to explore more information from available sources. A prompt feedback of students was collected over Google Forms. (Marathe,2020) The responses revealed points such as: 1. They felt some abrupt change and a little stress but could cope up with the new routine. 2. Uncertainty about the future was felt, but had time 97

for introspection 3. Space to think on complex issues 4. Getting good space for self was a very pleasant feel. 5. They could utilize their free time with family members and could do activities of their choice. 6. No strict routine, except online lesson hours. 7. Lockdown was an opportunity to learn, and experiment, learn different things. 8. At the same time friends were distanced. 9. Technology helped here, and 10. New apps and related technology were learned. They reported many things they learned and experienced. It was a positive approach to look at this period as ‘turning lockdown into an opportunity to think in innovative ways and find many options to use the period for ‘diverse learning’ for self-enrichment. Lockdown: Service to humanity The alumni of JPP (JP-youth) continued to come to JP for diverse types of activities such as teaching JPP students and mentoring them. The school education in JP is very highly focused on futuristic thinking (though under different titles) right from standard 5. Hence the JP-youth were very much aware of the Corona pandemic since the beginning of January 2020. They were very much aware of the trend and expected the lockdown to happen. They could immediately shift to online teaching tools, a variety of technological applications, and homebound learning activities (using Jnana Prabodhini distance learning site). Besides they were highly concerned with the needs of the lay and disadvantaged people, who were unprepared for the lockdown. The JP-youth also realized difficulties of people who could not travel to their own towns due to unavailability of public transport. Their innovative practices of serving the specific needs of particular groups and reaching the needy (exercising due caution) merits a separate discussion. Jnana Prabodhini members at Beed, Ambajogai, Solapur and Harali (Osmanabad) are engaged in providing support for the needy affected by the Corona lockdown. There are special efforts to help the migrated labour by providing them food and shelter. Last year there was intense participation in work regarding water scarcity. All these members are gifted as per definition given by Columbus Group (1991). As per this definition, “Giftedness is an asynchronous development in which advanced cognitive abilities and heightened intensity combine to create inner experiences and 98

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! awareness that are qualitatively different from the norm”. To conclude, gifted is not equivalent to only high intelligence, but it is a constellation of potentials, characteristics and motivation to use the resources within. All the above facts suggest that the ‘gifted’ can see challenges in difficult situations, and travel the path of betterment and progress of society, but they need to be provided with opportunities and encouragement for using their potential for larger goals. References: Bapat, G.S. (1998). An Unique Experiment in Gifted Education. In Proceedings of Fifth Asia Pacific Conference on Giftedness. N. Delhi: Department of Education, University of Delhi. Bapat, G. S. (2017). Man-making: nurturing abilities, motivating the able. Pune: Jnana Prabodhini. Columbus Group, (1991) http://www.gifteddevelopment.com/isad/columbus-group. Khire, U. (2000). Potential for Advanced Development. In (Ed.) Maitra, K., Towards Excellence: Developing and Nurturing Giftedness and Talent, New Delhi: Mosaic Book, pp 48-72 Khire, U. (Ed.) (2013). Jnana Prabodhini: a new experiment in education, Vol. IV-Part II. Explorations into psychology of human abilities: research journey of 50 years. Pune: Jnana Prabodhini Samshodhan Sanstha. Lavalekar A. (2004). Samajik Janiv Samvardhan- prayogatun prashikshanakade. (Nurture of social awareness- from experiment to training). Pune: Jnana Prabodhini Samshodhan Sanstha. Maslow, A. H. (1943). A Theory of Human Motivation. Psychological Review, 50(4), 370-96. Marathe, P. (2020). Study of Online Learning experience. An Unpublished presentation prepared for Jnana Prabodhini Prashala, Pune.

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Piirto, J. (2002). Motivation is First – Then they can do anything: Portrait of an Indian School for the Gifted and Talented. Gifted Child Quarterly, 46, (3). Khire, U. (2013) Giftedness and talent in the Indian context: nature, identification and nurture. In D.P. Chattopadhyaya (Gen. Ed.), History of Science philosophy and culture in Indian civilization (pp 621-662), vol. 13, part 3. Perspectives on human cognition. New Delhi: Centre for studies in civilization. Taubenberger, J. K., Reid, A. H., Krafft, A. E., Bijwaard, K.E., & Fanning, T.G. (1997). Initial genetic characterization of the 1918 "Spanish" influenza virus. Science, 275, Issue 5307, pp. 17931796. Watve, S. (2013) Why gifted education? Pune: Jnana Prabodhini Samshodhan Sanstha.

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10 PSYCHOLOGIST’S MIND ON MISSING BEATS OF AN EXPATRIATE LIFE REENA THOMAS Clinical Psychologist, Medeor, Burdubai, Dubai, UAE “I would cast a spell on you”!!! Now one would wonder how I am going to do this. Yes, by taking them through dreams to conquer deserts, realities, masks, miseries, loneliness, and the magic of this beautiful city of Dubai, sprung up from a barren desert.. Here is the brief account of an experience of a psychologist during COVID 19. We were all immersed in the wild chase of building our dreams that came to a standstill when the world clock stopped in front of a tiny organism. The journey begins with a multitasking outlook to the incredible realities of life, COVID-19. I see faces striving to thrive, burdensome shoulders, suppressed hearts, unwritten unbelievable stories in the desert land, intricacies of the human mind and its futile attempts to connect with others. As the nation grapples with the spread of COVID-19, the majority of the people all over the world are being told to go home and stay there, for their safety and everyone else’s. Sadly, there comes an alarming rise in the number of child abuse and domestic violence when people see each other, but don’t see eye to eye. And, for victims and survivors of domestic violence, including children exposed to it, being home may not be a safe option- and the unprecedented stress of the pandemic could breed unsafe conditions in homes where violence may not have been an issue before. With this pandemic, people are more at risk for violence due to unfamiliar circumstances compounded with reduced access to resources, forced change of lifestyle, increased stress due to losing one’s job or strained finances, and disconnection from widely presumed coping sources of social support systems when we live far away from our native place. There are many who are fighting it 101

alone, living far away from their native lands, all alone, trying to hide their COVID-19 stories from their loved ones in an attempt to project glory and hide the reality, so as to keep loved ones always happy. No matter what anguish they are in! STORIES: Here we are struck by some experiences where one is bound by the law and four walls, out of sheer helplessness and not able to bid farewell to blood ties or the umbilical cord. The agony smacks and spanks the deaf walls and doors, and pours out into my heart which can only take a deep sigh! Similar ones with all the fruits of a same tree hit hard by COVID-19 except for a small bud taken away into unknown hands not knowing whether it will ever unite back with its mother tree. What is more to come, is a newborn watching masks all around it, not letting it breathe in and the helpless, COVID-19 affected father expressing his pain on seeing his partner almost dead and two young girls left behind. Imagine the plight of an infant not able to see the beauty of its mother's smile, or sense its mother's touch, the first social connections out of the security of the mother’s womb. The soreness continues! So cry out for help. Alas, I have heard more stories of devastation, despair, fear, anxiety, panic, helplessness and hopelessness! Needless to say, the media terrifies. People are flooded with information and the free gift is a crippling worry. Sleep is far away in sky heights and the escape is alcohol/smoking or gaming ‘the new companion’’ of mankind. The unforeseen evil which is going to wipe out the human resources before one recognizes it. Young or old, get hooked by veiled peace and a pseudo sense of connectedness. STOPS: I have never seen or experienced the state of “stuck” in life with all forms of transportation coming to a halt as curfews are declared in different places. The world is so immobile and we crave to be in our motherland but the very realization that she cannot fit all of us in, forces many of us to remain stranded here. We are caught in double pain as we watch our home country struggle to balance the economy and contain COVID-19. The uncertainties of incomplete higher studies, a sinking economy throwing many 102

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! jobless, unable to meet the ends of life, structural and functional changes of various organizations, tends to move people into a collective agony and a state of worry. RISE: Every cloud has a silver lining! A ray of hope comes in with the reports of how this foreign land and its highly respectable leaders are trying to embrace us in times of need, regardless of caste and creed. A glimpse of happiness prevails as we notice the function of the government of the State of Kerala, not to leave behind the organized efforts of Smt. Shailaja teacher, Minister for Health and the team which glorified my motherland into the limelight in the world. A sense of responsibility steps into the minds of people to save themselves and others from the virus. Nevertheless, eyebrows go up if I don’t mention that there are flaws everywhere. This seems to be the turning point of life where one realizes the need to have a lot of presence of mind so as to not to get crushed. Yes, readjustment into life is the only key in such an adversity in life. The age of positive psychology and its concepts are flowing all over the world in different forms. WHO and other organizations along with other professionals are competing and/ or complementing each other to bring the world into well being. The survival of the fittest comes in the forms of webinars/ online sessions. That’s what pumped in so much energy to move to an online platform and continue to provide psychological help to mankind. Here we see the richness of the world with different faces, races, motives. Some benefactors are so genuine that you feel for them, some belong to a utilitarian culture, as these services are provided free. The month of Ramadan helped to buy time to settle down with the new trend in life. SHINING STAR: Hey, I found a glittering star in the sky! The happy moments dropped in when the initial proposal came to form a team of mental health professionals to extend help to a COVID-19 affected population. Quite overwhelming, but I cherish those proud moments that I could be a tool for a noble cause. Several 103

nights of meetings, discussion, team building, classes, paperwork brought the best out of us. It unfolded into a charity organization – HEALING MINDS -- with plenty of multilingual professionals catering to the needs of an affected/ isolated, quarantined, and panic stricken public. I am sure we will make this country feel proud of having us. To my surprise, I have seen selfless commitments from many professionals as they volunteer in an afflicted population. Nonetheless, some people with vested interest are expected or seen everywhere. REVAMP: Like COVID-19 refurbished the earth and its habitations, investing in self-care, which might revamp our nature, is the need of the hour. A much discussed, easily forgotten area of life that got several reminders in the form of aches and pains. I could find time for myself, for catching up with long cherished activities, to balance home and work, though Corona demanded that the love life come to a standstill. An unseen, unacknowledged pain is hidden in the darkness of the night. But I am thankful I got the best moments of my life with my little one and parents. I saw COVID-19 digging the best out of me, unveiling the shells. We still keep the hope and faith to roll on to be resilient, despite uncertainties. As Robert Frost says, there are miles to go before I sleep. I am, amongst many others, relentlessly waiting for the COVID-19 to unveil the realities in 2021 to which we will all be forced to walk into. Never ending stories, just preparing the mind to be strong enough to give shoulders to the suffering end. Here comes the bell to resume functioning, to catch up to the race again, amidst a deep recognition of the unsettled fears and rising COVID-19. Who wins the battle, ME, YOU or CORONA! Whatever, it decided my next destiny… the journey continues.

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11 LOCKED OR UNLOCKED: TWO SIDES OF THE COIN AARZOO Assistant Professor in Clinical Psychology Department of Psychiatry, Government Medical College & Hospital, Chandigarh The Alert India’s COVID-19 cases started appearing furiously in February 2020, affecting the nation and was followed by the declaration of Janata Curfew on March 22, 2020. National Ministries and those in authority declared the first phase of Lockdown followed by curfew, which was expected. It was welcomed by the country but later the lockdown 2.0 started creating some restlessness in certain segments of society; such as financially hit small business holders, travel and hospitality industries and many others with maximum attention gained by the migrant labourers spread across the nation. The measures were considered in their best interest taken along with many schemes introduced specifically to extend possible support in the times of COVID-19 crisis. Many citizens, celebrities, non-governmental organisations came forward and joined hands with the Government to extend support. Every coin has two sides, so there were appraisals and critical comments prevailing in all types of media. Spotlighted too were the mental health issues of citizens staying indoors and complying with the lockdowns. And in addition, the mental health of migrants, keeping in view their suffering under such circumstances, also cropped up. There was the perception that they all needed counselling. Counselling: A panacea All of this generated several questions in my thoughts. Has counselling become a panacea for issues of contemporary society?. The media has been full of highlights such as migrants should be counselled, children should be counselled, mothers should be 105

counselled, senior citizens need counselling and so on. Every individual needs counselling, for what, to survive? Or to live? Another highlight is that every individual is a counsellor. It can be a teenager ‘counselling’ younger sibling or a peer. Adults ‘counselling’ other adults or younger ones, older ones ‘counselling’ all those younger in age. Is Counselling used as a verb or as a profession? Is counselling a tool in the hands of authorities to seek consent from stakeholders? Is this kind of attention emphasizing the importance of Psychology or Clinical Psychology professionals or is it actually side lining professional counselling and psychotherapy? These are some questions that psychologists of this country need to ponder on. Coping or falling Any change is known to bring about a package of adjustments at various levels. However, the reasons for change and the consequences associated with change need to be examined. It was somehow a hurried hypothesis that the lockdown due to COVID-19 may lead to increased mental health issues. The anxiety that arose was highlighted and was the centre of attention. The news and several media platforms were releasing information on tips to take care of one’s ‘mental health’. The crisis gave an opportunity to every layman to share their expertise. It made me uneasy, as I wondered, whether we were living in an era of awareness where mental health is no more neglected. Or, were we, as a society portraying poor resilience and inadequate coping to sail through transitions in human life. This image of social structure and system reflects a lack of adaptably to deal with any alterations in lifestyle or national as well as global crisis. The usual human tendency is to get healed when we join hands with those who have undergone similar suffering, empathy healing us. But where is empathy if it is presumed that people sitting at home will never understand that the human race is suffering globally?. A pessimistic view of human nature adopted by non-specialists advising on resilience and coping appeared contradictory to Roger’s person centred approach. In my social interactions during the lockdown, my curiosity to explore human behaviour brought to my observation that the negative communication about anxiety and mental health 106

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! issues was so hyped that any individual functioning well in this lockdown was forced to question his sanity. Am I insensitive or indifferent that I am not anxious? Shall I be guilty that I am reconnecting socially and emotionally and not entirely unhappy about the entire situation. Not only this, many must have wished for the lockdown to extend to spend time with loved ones. The barriers such as pent-up emotions, suppressed interests, mechanical lifestyles and other undesirable behaviours started to fade. Many began investing and utilizing their time to do things that they wished, or at least explored them. Lockdown paused a fast-pacing life uniformly and therefore equally, nobody feared losing or lagging behind. It permitted certain segments of population to pause, rethink, rediscover, rejuvenate and repair. Many aspects of human life got blocked but few others were liberated and resurfaced during this crisis. After dusk breaks the dawn!

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‘THE RETURN OF THE REPRESSED’ IN COVID-19:

THE NEED FOR INTERVENTION AT SOCIO-CULTURAL INSCAPE PAULSON V. VELIYANNOOR Forge Center for Claretian Renewal, Madrid, Spain

Faithful to the globalized spirit of the times, the COVID-19 pandemic has gone global, invading space and time universally, and leveling the developed, the developing, and the underdeveloped countries to a more or less undifferentiated, egalitarian status. The pandemic has been considered even to have led to the end of civilization as we know it (Garretón, 2020). The sudden disruption of life and the new normal have left individuals and communities psychologically distressed and wounded. Unsurprisingly, the trauma has also led to a resurgence of past wounds long thought to have been healed, not only at the individual level but at the level of the collective as well. My purpose in this paper is to explore, phenomenologically, theoretically, and interdisciplinarily, the return of the repressed at various levels, very specially at the societal-cultural levels, focusing especially on the Indian scenario. I begin from the therapeutic couch—sharing insights from a short-term psychodynamic psychotherapy with a client who reported re-emergence of past wounds during the pandemic. Using it as the totem, I then explore the re-emergence of past traumas at different levels, particularly analyzing in detail their symptomatic manifestations in the larger societal level in India, using the insights of the inter-disciplinary perspective of mimetic theory. I end the paper with some reflection on the role of psychologists and other behavioral scientists to engage in a more concerted and sustained intervention at the socio-cultural inscape to prevent worse cultural malaises.

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! “My past wounds are re-emerging”: A Brief Case Analysis A middle-aged school teacher, Sarika (pseudonym), was referred to me during the pandemic, with the presenting problem of acute anxiety. Sarika lived in her brother’s house, away from the house she owned elsewhere, for reasons of her job and for the purpose of taking care of her mother. She sought out psychospiritual therapeutic help, with a statement that was revealing: “In the confinement, the past wounds, which were thought to have been healed, are re-emerging.” Sarika did not contract the virus; but due to the lockdown, she was confined to the inner spaces of the house, cut off from her job and social life. Such confinement triggered much anxiety, which in turn, re-opened the can of past wounds, thought to have been resolved and outgrown. We agreed to have weekly sessions over skype. For the very first session, she chose to connect with me from her car. Almost three quarters of the time into the session, her mobile went dead. Not realizing what happened, I tried to reconnect several times, but did not succeed. I waited for her to reconnect, but nothing happened. Sometime later, I received her email, explaining that the battery of her mobile had run out. That she chose to connect with me from her car and not from the house, and that the battery failed to last the whole session were revealing to me, but I kept the insights as hypotheses until further verification. In the second session, Sarika chose to connect with me from within the house, but not from her room. While being at the session, the actual occupant of the room walked in, and she had to move out, finding another suitable location to continue her session with me. By the time we were into the fourth session, Sarika was suffering badly from severe back pain, bed-bound and unable to move around or do the daily chores. Further, she had an obsessive thought and image: that the columns of the floor would give in and the large washing machine on the floor above would break and flood her floor with water. Sarika was a fairly successful woman with a good job and steady income. A well-grounded woman with fairly good ego strength and a healthy sense of spirituality, she had certain mastery over life, had a healthy social life, and engaged in much social 109

service as well. However, the confinement triggered much anxiety, which in turn, re-opened some past wounds, especially in relation with her father. Her father was not expressive of his affection, but was very demanding; she had to earn his love and approval by doing her best and being useful. He had two families, and hence, Sarika missed her father when he was spending time with his second wife and children. There was the constant fear of losing him and the compulsion to win him back; the fear of being rejected by him. She had lived on the edges of anxiety of losing what she had, fighting hard to earn what had been in fact rightfully hers. When I felt that she would be ready for some interpretation, I brought up some of events that unfolded within the sessions, with their possible meanings, for her reflection and verification. Living in a home that was not hers was like having a home, yet not owning. Wasn’t choosing to talk to me from her car and not from the house symbolic of a life that is unsettled and is still on the move? And, when she did talk to me from the house, choosing to do so from the room of another and not of her own: didn’t it communicate the same? Forgetting to keep the battery charged for the first session that led to the cut off of the session seemed symbolic of her fears of not having enough fuel to live her life to the full and the fear of losing the job and being cut off from life-supply due to the insecurities of the lockdown. The nearly paralyzing pain of her spinal column and the obsessive image of the collapse of the columns of the house and flooding of the room with the dirty water from the washing machine seemed to communicate the dread of flooding of anxiety and the loss of a secure life that had been built up so far, now by the stains of the past. Every one of these elements pointed to a sense of displacement, fear of losing one’s much fought for space in life, something that correlated with the dynamics of the pandemic lockdown. These interpretations were not suggested at one go, but across several sessions, at opportune times. They struck a chord with Sarika, who responded at one moment with a solemn, pensive voice: “Paulson, it is not just about losing my space; it is all about not having space at all. I never had my space; I had been trying to win my space all my life!” This insight led to a re-assessment of her past fears that had lurked within, her present compulsions to be useful, 110

COVID-19: Challenges and Responses of Psychologists from India

! productive, and win approval. She began reconnecting with her friends, gave up the compulsion to clean the house almost every day, enjoyed physical hugs from her daughter, lost fear of losing her job, enlisted for some courses online (interestingly, the first course she attended was on the Christian prayer “Our Father”, as if re-defining her relation with her own father, who is now “in heaven”). Her back pain gradually disappeared and so did the compulsive image of column-break and flooding. We mutually felt she was ready for termination of therapeutic accompaniment, and so we ended the sessions. ‘Return of the Repressed’ in the COVID-19 I have chosen to discuss the above case on account of two reasons: Firstly, it is a case of a therapeutic intervention from the pandemic times. Secondly, it points, revealingly, to the phenomenon of the “return of the repressed,” a concept made famous by Sigmund Freud (1900/1953; 1915/1957; 1939/1964), during the present pandemic times. No trouble comes alone; it often brings with it several companions, often opening up wounds that are thought to have been healed long ago. As the demon within the man who lived among the tombs answered when Jesus asked for its name— “My name is Legion, for we are many” (Mark 5:9)— it is a multitude of complexes that surface together, with a combined strength to waylay the person. More importantly, all these can happen not only at the individual level, but at the macro levels of family systems and societal-cultural systems, and therefore, call for careful, concerted, sustained, and anticipatory intervention. The consequences of the pandemic at personal and family system levels have been discussed at various fora. Here, I will only briefly recapitulate them more as a launching pad for the more urgent discussion on the return of the repressed at the sociocultural level. At Interdividual and Family Systems Levels Given that the expression ‘self-made person’ is a lie and no individual is a solitary, unaffected, closed system, I prefer to use the term “interdividual” to the term “individual” in this context. Interdividual psychology was first introduced by René Girard and 111

Jean-Michel Oughourlian (Girard, 1978/1987; Oughourlian, 2010; 2016) to explain the mimetic (imitative) dynamics that run amok in our lives. Everyone is a self that is created within the matrix of relationships, and hence, interdividuality refers to the true psychological reality that “is not situated within the individual but lies in the mysterious transparency of the relation between two persons” (Oughourlian, 2010, p. 34). As we are incurably relational, our traumas are also necessarily relational and interdividual. That any new trauma may serve as a trigger for reactivation of past traumas and result in a chain reaction has been well documented (Herman, 1997). As one of the foundational assumptions of psychotherapy goes, the presenting problem is not the real problem. Hence, beneath the presenting problems associated with the pandemic may lie many unresolved interdividual issues that had been dormant until now. The pandemic has merely served as an opening for the pains of the past to re-emerge and make the scenario worse. Prohibition to touch. One of the psychologically most disruptive features of the current pandemic has been the proscription of touch and prescription of physical distancing. The sense of touch is thought to be the first sense to emerge and is one of the foremost forms of perceptual experience (Fulkerson, 2016). The 1971 classic Touching: The Human Significance of the Skin by Ashley Montagu (1986/1971) highlighted the role of skin and touch in human development, the deprivation of which could be even fatal. The mental life begins in the fetal stage (Mancia, 1981) and is so integrally linked to the sense of skin and touch that Anzieu calls the rudimentary sense of self as “skin-ego” (1989; 2005). If the daily metaphors we live by are windows to our psyche (Lakoff & Johnsen, 2003), the pervasive use of skin- and touch-related metaphors in our daily conversations reveal the significance of touch. Sample this passage: We speak of “rubbing” people the wrong way, and “stroking” them the right way; of “abrasive” and “prickly” personalities. We speak of “the personal touch,” … essentially his personality expressing itself by “getting in touch.” We say of someone that he has “a happy touch,” of another that he has “a magic touch,” 112

COVID-19: Challenges and Responses of Psychologists from India

! and of another that he has “a human touch,” or that he has “a delicate touch” …. Some people are “hard” to deal with, others are “softies.” Some people have to be “handled” carefully (“with kid gloves''). We speak of someone who is quick to take offense or over sensitive as “touchy,” or “tetchy.” Some people are “thickskinned,” others are “thin-skinned”; some get “under one's skin,” while others remain only “skin-deep.” Others are “out of touch,” or have “lost their grip.” Things are either “palpably” or “tangibly” so or not. (Montagu, 1986/1971, p. 10) The sudden prohibition of touch is in many ways a drastic cut-off from our normal, necessary, life-giving, and taken-for-granted ways of living. Though Indians are generally reserved about hugging in public or within families, we still reach out and touch in manifold ways. The extremely high density of population has ensured that we live in touching proximity to others. We mill around touching and being touched by others whether it is in a bus, train station, mall, market place, or festival, an experience that can be overwhelmingly suffocating for a foreigner. Majority of us live with little sense of personal space. In this context, the prohibition to touch another person and the mandate to maintain physical distancing would be to speak a foreign language, totally unfamiliar to us. Whereas such new norms can be disturbing for any human being, it is all the more disruptive for our culture. This experience can undermine our sense of self, security, and connectedness. Ambivalence of the virtual world. There has always been an ambivalent attitude towards the virtual world, especially in India. However, in the pandemic times, the technological world suddenly has become the lifeline—to receive and pass on information, to connect socially while keeping physical distance, to see and communicate with members of the family stranded in various places, to participate in religious activities, etc. Educational institutions that would generally discourage use of mobile phones among students suddenly made it imperative that students resorted to attending virtual classes on social media. Parents who were concerned about their children 113

glued to their mobiles and laptops now had to be cheerleaders for the use of the media. The use of Augmented Reality (AR) and Virtual Reality (VR) suddenly received a boost, and have been found to be useful for treatment, medical marketing, medical training and learning, and spreading disease awareness during the pandemic times (Singh, Javaid, Kataria, Tyagi, Haleem, & Suman, 2020). The AR, VR, and MR (Mixed Reality) have been the go-to solutions for the disruptions caused at work, schooling, travel, and other areas of social life (Dialani, 2020; Kumar, 2020; Riva & Wiederhold, 2020). However, besides their many benefits, they come with much psychological cost as well. The social isolation, increasing loneliness, being out of touch with reality, bullying, the deprivation of the innate human need to interact in person with fellow beings (Best, Manktelow, & Taylor, 2014; Lavoie, Main, King, & King, 2020). During the pandemic, we have had stories of student suicide due to the shame and anxiety caused by the lack of technological devises to log on to online classes. Spectrum of disorders. The loss of job, forced confinement, inability to communicate or provide for one’s family, the uncertainties of the future, fear of contagion and death—all these contribute to various psychiatric symptoms and a generic loss of sense of self and meaninglessness. Widespread negative psychological consequences have been reported within entire communities including students, casual laborers, healthcare professionals, and the general population (Bhat et al., 2020). It goes without saying that the mental health of children is significantly affected by the sustained and seemingly never-ending lockdown and the uncertainties about reopening of schools, examinations, meeting friends, outdoor life, etc. Studies have either predicted or confirmed the same, across the world (Grechyna, 2020, Liu, Bao, Huang, Shi, & Lu, 2020; Thakur, Kumar, & Sharma, 2020). Traumatized familial dynamics. The routine organization within the family of various roles and functions generally helps maintain certain balance, harmony, and status quo, where interpersonal tensions and relational disappointments are camouflaged and held in a delicate balance. Work can serve as a much-needed distraction and means for 114

COVID-19: Challenges and Responses of Psychologists from India

! healthy spacing between members. However, under the attack of the pandemic and the resultant lockdown, this delicate balance is offset which can trigger past wounds. Whereas there is no denying that lockdown can bring the usually busy members together in greater intimacy and communication, sometimes it can also work in the reverse: they may find the 24x7 presence of everyone together with nothing much to do but a bit too intense. If the emotional capital and relational bond have been weak among the members, it can intensify and speed up a break up. China witnessed a significant spike in divorce rates following the pandemic (Prasso, 2020). There was a 42% spurt in divorce inquiries in England since the pandemic began (Everett, 2020 June 3). A rise in child sexual abuse has been reported in the US (Kamenetz, 2020). The National Commission for Women (NCW) reported an increase in domestic violence in India (Roy, 2020). India faces its own unique problems within the family systems given the number of families living below the poverty line with no sufficient space or sanitation facilities; with huge numbers of migrants returning home unexpectedly and with no money in hand. Ironically, the couples may be deprived of space for sharing intimacy even when they are in the presence of each other more than ever; and the children, forced to be indoors with little space to vent their energies would also find the home atmosphere challenging. All these can lead to old ghosts reemerging to upset familial relations. Return of the Repressed at the Socio-Cultural Level This brings us to the heart of the matter: What are the repressed legions that may return to surface at the socio-cultural level in our Indian society in pandemic times such as now, and that compel our attention? I will begin with a few symptoms, which have been reported across mass media: ●! Ostracization and even physical attack of medical personnel for fear of contamination. ●! Refusal to bury bodies of those who died, or are thought to have died, of corona virus. Refusal to even claim such bodies by the families. ●! Opposition to the return of the non-resident Indians; hostile ostracization of those who returned. 115

●! The eagerness to disclaim the migrants in their states of work, and the refusal to accommodate them on their return to their residences. ●! Social media posts justifying and normalizing the old and banned practices of untouchability as wise and prudent practices of social distancing. ●! The Tablighi Jamaat event and the consequent targeted victimization of a community as the cause of the spread of the virus. ●! The persistent back-and-forth attempts to pin the blame on specific groups or agencies, between various governments. ●! Demonization or idolization of specific political leaders in the pandemic times. Mimetic crisis and sacrificial resolution. One might say that these are not singularly peculiar to India, and some of these symptoms are evident in other countries as well, during the pandemic crisis. That is precisely the point: What we see unfolding before our eyes is a universal human dynamic. However, they unfold in a more-or-less manner and with unique configuration in a given socio-cultural context, given the presence or absence of checks and balances. We will only be focusing on the Indian cultural context here. However, given the universality of the phenomenon and its dangers, it is necessary to understand the dynamics unfolding across the above symptoms that we have been witnessing in India. I do so hitchhiking on the insights of mimetic theory, first enunciated by René Girard (1972/1977, 1978/1987, 1982/1989, 2011; Girard, Antonello, & Rocha, 2007), and which has now been acknowledged to have wide-ranging explanatory and application potential across disciplines (Alison & Palaver, 2017; O’ Shea, 2010; Palaver, 2013). Given the limited scope of this paper, I do not attempt to present the theory in detail, but only apply some of its insights. According to the insights of mimetic theory, when a society is faced with a sudden crisis, its spontaneous, unconscious instinct is to resolve the crisis through a sacrificial, victimary mechanism. In fact, cultural anthropologists and social scientists have long argued that sacrifice is foundational to human culture (Hubert & 116

COVID-19: Challenges and Responses of Psychologists from India

! Mauss, 1898/1964); what Girard offers is to explore how and why sacrifice becomes foundational. According to Girard, when a society en masse faces a crisis that threatens to destabilize and destroy it, all the carefully built up social differentiation, stratification, and structuring collapses, leading to a complete undifferentiation that leads to massive violence which, if not checked, would destroy the society. Given the collective instinct for survival, there emerges then a spontaneous, unconscious search for a victim who ‘caused’ the crisis. The search often culminates in the identification of an individual or a group who are not fully an insider or an outsider, and hence, is sacrificable. Once a victim is identified as the cause of the crisis, there is a spontaneous reorganization of the society into ‘us’ versus ‘them,’ them being the victim so identified. A collective projection results, with all the ills projected on to the victim, making him or her the mother of all evils, dehumanizing and depersonalizing the victim. The entire collective truly believes in the guilt of the victim—truly believes, for it is an unconscious mechanism—and they discharge cathartically all their terrorizing anxieties and pulsating violence on to the victim by sacrificing him or her—be it by stoning to death, lynching, crucifying, burning at the stake; or by far more ‘civilized’ forms as getting the state to ostracize or eliminate them. With the violence unleashed on the victim, the collective acquits itself of its contribution to the crisis, peace results, order can be re-established, and life can go on smoothly once again. This might look far-fetched. However, an honest introspection will reveal that we order and re-order our lives in this sacrificial manner. When a crisis hits a family, our tendency is to identify one member as the cause for it, ostracize him or her from the family, cut off all relationships with him or her, or sometimes even to the point of murdering them, and “peace and honor” return to the family. When the economy crumbles, whom else to victimize other than the head of the state? Or, when a country is in total disorder, why not declare a war against an outside enemy or at least use a territorial infringement to help the citizens forget the crisis and unite as one? From a seemingly harmless gossip (verbal sacrifice) to international wars, multiple and subtle are the incarnations of sacrificial dynamics in our personal and corporate 117

lives. It is hard to recognize one’s own contribution to the disorder and withdraw the projections, which calls for epistemic and ontological humility. One may argue thus: “But, some of these people: they are really guilty.” Except in some cases, such as the extraordinarily psychologically meaningful (but ethically disastrous) ritualized sacrificial systems practiced in ancient Africa (e.g., the exchange of an innocent man to be sacrificed for a murder committed, as described by the Chinua Achebe in his novel Things Fall Apart, 1958/1994), no victim may be totally guilt-free. However, it is hardly the truth that he or she alone is the total and exclusive cause for the crisis faced by the society. One of the foundational characters for classical psychology and psychotherapeutic systems is the Greek tragic hero, Oedipus. We have taken the story so much for granted that we hardly ask ourselves: was he really and solely guilty for the crisis that gripped the kingdom of Thebes? The entire story pivots on a singular and persistent accusation by Tiresias, a blind prophet (how fitting that he was blind—a perfect symbol for the blind, unconscious dynamics of the collective accusatory, scapegoating syndrome!). Sophocles gives no foolproof evidence, and we will never know; but Oedipus ends up becoming the scapegoat for the healing of Thebes, and continues to be so in our psychological (mis)adventures (Anspach, 2020). There is every possibility that the accused victim may be innocent, or partly guilty, or no guiltier than the rest. Often it is their ‘outlier’ status that gravitates the collective to victimize them. Girard and fellow researchers point out that it is often people on the margins of the society, by virtue of their handicap, social status, religion, age, etc. who end up being victims. None of this is reason enough to merit the kind of destiny or treatment that he or she receives. It is when the collective is capable of realizing this fact, withdrawing the impulsive and violent collective projections from the victim, and owning up the collective responsibility for the crisis, that we graduate as civilized, cultured human beings. Critical vulnerability of the Indian context. With these insights, let us turn to the current Indian context. Like any culture, we have had a mixed cultural baggage—of many 118

COVID-19: Challenges and Responses of Psychologists from India

! achievements and victories a well as tragedies and traumas. Some of the deep-rooted cultural traumas that we have lived through and that remain in our collective (un)conscious are the caste system and its multifaceted and gruesome consequences, linguistic divisions, interreligious tensions, discrimination against women, many superstitions, sati, feudal wars and conquests, colonial past and its bruises, etc. Though we have theoretically risen above these malaises, practically, some of these traumas continue to exist, in subtle and gross forms, in many corners of India. For nearly a decade, India has been going through a crisis simmering at the surface and precipitated by political, economic, religious, and other extremist factors. The growing fundamentalist and intolerant tendencies in religious spheres, obliteration of historical facts and rewriting of history that suits hidden agendas of groups with vested interests, compromise of constitutional mechanisms, failure of checks and balances, suspicion of critical thinking, etc., have created an atmosphere of fear, mistrust, anger, frustration, and simmering collapse of societal systems. Such an atmosphere is the recipe for a mimetic crisis and its undifferentiation that leads to easy scapegoating violence. We have seen lynching in the name of religion and lifestyles. We have also seen the compromise of judicial systems that are too eager to hang anyone when the public turns blood-thirsty. Demonizing any accused even before the investigation begins, and projecting all societal evils into them make them easy targets for extrajudicial murders and help the society remain blissfully blind to its own share of the blame. It is in such context that the COVID-19 pandemic has emerged with its extreme provocation of death-anxiety, fears of contamination, and the prohibition of touch and proximate interactions and prescription of physical distancing. Some of these dynamics play directly into the hands of the kind of traumas the Indian collective has passed through in the past. Hence, it is least surprising that the contamination of virus and the prohibition of touch can easily and retrospectively validate the practices of untouchability of the past, reincarnating it in a modern scientific garb of hygiene, and a cultural chest-thumping. It is revealing to note that the use of the medical term cordon sanitaire in the pandemic times to refer to medical quarantine has already been 119

commented upon by Ambedkar in the context of untouchability! Observing that every village had a ghetto and the untouchables were confined to the ghetto, Ambedkar (1948/2018) shreds to pieces the argument that the isolation of the untouchables was for temporary hygienic purposes: It is not a case of social separation, a mere stoppage of social intercourse for a temporary period. It is a case of territorial segregation and of a cordon sanitaire putting the impure people inside a barbed wire into a sort of a cage. (pp. 21-22) Given the ease with which misinformation can be disseminated today thanks to the proliferation of social media, and given the proclivity of the masses towards rumors in times of crisis, it becomes easier to convince people of the truth of the new claims and effect a return to such practices of the past, which have been lurking in the collective unconscious as repressed history. Given the sensitive multi-cultural, multi-racial, multireligious, multi-lingual fabric of Indian society, the ‘insideroutsider’ differentiation can suddenly take shape. It is here the migrant laborers who have been until now an integral part of one’s society for its many needs can turn out to be unwelcome intruders, and be denounced both by the states of their origin and work. We have seen the haste with which states denounced them and how they had to walk thousands of miles to reach back home, with hardly anyone to provide for them. The same dynamics apply for the Non-Resident Indians (NRIs), who have been contributing significantly to the economic wellbeing of the country, suddenly turning out to be unwelcome and targets of hostility. A correlated sign of mimetic crisis and its sacrificial tendencies is to uncritically submit oneself to a leader, a collective subordination of the will to one person, without critical thinking, questioning, and airing differences of opinion. One of the key reasons Nazi brutality occurred was the uncritical submission of the collective will to one person. One of the legal maxims from Jewish Talmud, which has often confounded modern jurisprudence, yet carries great wisdom can be paraphrased thus: If everyone unanimously finds someone guilty, release him or her, for he or she 120

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! must be innocent. The wisdom of this maxim is that unanimity can be often suspect, for no one (dares to) think differently, a failure that can obliterate the truth (Glatt, 2013). Thus, the need to encourage diverse voices and critical thinking is sine qua non for avoiding collective tragedies. The intolerance to critical thinking and divergent views in the current Indian society is a genuine cause for concern. I have mentioned that it is those on the peripheries of the society who end up being victimized and sacrificed. One must not forget that every center is also a periphery: for, the one at the center is similar to us but is different as well, and hence, sacrificeable. Thus, it is also a dangerous sign for a society when the entire blame of the breakdown and crisis is attributed to an individual leader, be it a chief minister or a governor or a prime minister. This is not to say that no one should be held responsible for their failures in discharging their duties; what is important is to ensure that one is held responsible only for that part of the responsibility, and that too, not for scapegoating but for corrective purposes; and that the society collectively owns up the share of responsibility and does what each one can, to stabilize the social order. To sum it up, the historical phase India has been going through is characterized by the disturbing signs of many unconscious repressed elements of the past forming into a storm that pushes through and breaks the lid of the collective consciousness. The current pandemic may serve as the breaking point that throws the lid open, leading to a contagious mimetic crisis that, if not prevented, may prove to be too sacrificial. It is time for behavioral scientists to intervene not only at the micro levels of individuals and families, but at the macro levels of socio-cultural systems as well. Implications for Psychologists & Other Social Scientists James Hillman (1992), the father of archetypal psychology, begins his conversations with Michael Ventura thus: We’ve had a hundred years of analysis, and people are getting more and more sensitive, and the world is getting worse and worse. Maybe it’s time to look at that. We still locate the psyche inside the skin. You go inside 121

to locate the psyche, you examine your feelings and your dreams, they belong to you. Or it’s interrelations, interpsyche, between your psyche and mine. That’s been extended a little bit into family systems and office groups—but the psyche, the soul, is still only within and between people. We’re working on our relationship constantly, and our feelings and reflections, but look what’s left out of that…. What’s left out is a deteriorating world [emphasis added]. (p. 3) What Hillman goes on to argue is that it is time psychologists left their cozy couches and sound-proof rooms and walked right into the midst of society for engaging in a therapy of the cultural systems and processes. “The world has become full of symptoms” (1992, p. 4) and they need to be addressed, and addressed urgently. There is a certain comfort and convenience working with an individual or a few individuals in the secure boundaries of one’s office or a psychiatric hospital or a school or a corporate environment. However, the sample of symptoms that we deal with in an individual or a group of individuals has a long history and collective roots outside them, often in the socio-cultural realities. This does not mean that psychologists should abandon private practice or family therapy or other institution-based services; what is argued here is that, especially in the Indian context where the individual is an integral part of the collective, it is equally, and perhaps more than ever urgent, that we intervene at the level of socio-cultural systems, effecting a change in the collective consciousness as well as collective systems and processes, for the better. Reflecting on the relatively poor growth of psychology in India, Manickam (2016b) identifies three major reasons: The failure to develop an indigenous psychology that is relevant and responsive to the challenging reality of the diversities in castes, religions, cultures, ethnicities, and languages—what he calls “CARCEALD population”; lack of effective and coordinated response to issues that affect the general public, such as farmer’s suicide, disasters, communal riots or public health issues; and the lack of collaboration among various psychological associations and the absence of a united federation of Indian psychologists as an 122

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! umbrella organization that can have great advocacy potential. In his call towards greater professionalization of psychology in India, Manickam (2016a) calls for a unique “panchayat psychology”: Since Panchayat Raj Institutions (PRI) have become more powerful, we could closely work with the PRI’s and focus on preventive work in relation to suicide, resolving family conflicts, conflict resolution in the community, address issues related to Human rights, persons living with HIV/AIDS, Alcohol and Drug Abuse and provide career guidance to the adolescents and young adults in the community. (p. 246). It is an exciting proposal to make psychological services more accessible and user-friendly, and Manickam (2016a) rightly observes that “we need psychologists who can educate the people about mis-concepts related to epilepsy, mental illness and disabilities, differentiate between superstitions and religious beliefs, training them in providing psychological first aid” (p. 246). I would go one step further, stating that the panchayat psychology should also become a catalyst for a far deeper and influential bottom-up transformation in the collective consciousness of the communities, healing it of the centuries-old repressed societal illnesses to embrace a more egalitarian world with shared responsibility for the welfare of the other. This is possible, as he rightly proposes, by more relevant research and dissemination, working collaboratively with the governments, and participation in the local administration, and state and national level statutory bodies geared towards constructive social change. Manickam (2013) also argues for the development of an integrative theory of person and an integrative model of change, rooted in, and therefore relevant to, the indigenous cultural context of India. I would only caution here against a possible danger of splitting, which can be sacrificial: that all western psychology is wrong and all indigenous psychology is right. What is needed is a critical integration of what is good in all systems, choosing wisely for cultural relevance and integral well-being of persons and human communities. We must also be on guard against the baggage that some of the cultural philosophies carry, and which puncture efforts at an integration that is to be aimed at the service of the larger humanity. 123

To sum up, psychologists and other behavioral scientists have a scientific and ethical responsibility to preventively intervene to ensure that the crisis of the sort of a pandemic does not lead to more disastrous social consequences, not only for individuals but for everyone, very specially the vulnerable and marginal groups who might easily end up becoming a receptacle for the collective projection and thereby sacrificable. However, this cannot be done overnight. The intervention is only possible if behavioral sciences, especially psychology, can come out of highly structured environments right into the midst of the people, researching their long-standing cultural beliefs, stereotypes, fears and anxieties as well as the societal systems and cultural dynamics that are susceptible to creating victims. Such efforts would require massive conceptual, educational, and organizational changes within psychology, especially in the Indian context. There must be a move towards indigenously relevant psychology or psychologies that factor in indigenous realities, assets, liabilities, and challenges besides integrating from the insights of psychologies elsewhere. Creative ways of intervention at the level of socio-cultural systems must be researched, tested out, and disseminated. It would also require regular and creative updating of curricula for psychological training so as to reflect the latest findings from research and creative ways of interventions. It would also mean efforts at coordinating various and fragmented local associations of psychology into a coherent, efficient, and effective national federation that can develop aims and objectives as well as generic values and commitments to which Indian psychologists can be responsive and held accountable. Psychological sciences, more than ever, are relevant in India: not merely for the behavior modification of individuals, but for the transformation of the larger collective where it would be easier for the individual to change for the better and prevent a return of the repressed during crisis times such as a pandemic.

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! References Achebe, C. (1994). Things fall apart. London: Penguin Books. Alison, J., & Palaver, W. (2017). The Palgrave handbook of mimetic theory and religion. New York: Palgrave Macmillan. Ambedkar, B. R. (2018). The untouchables: Who were they and why they became untouchables? Chennai: Maven Books. (Original work published 1948) Anspach, M. R. (Ed.). (2020). The Oedipus casebook: Reading Sophocles’ Oedipus the King. East Lansing, MI: Michigan State University Press. Anzieu, D. (1989). The skin ego. New Haven, CT: Yale University Press. Anzieu, D. (2005). “Skin-ego”, In A. de Mijolla (Ed.), International dictionary of psychoanalysis (Vol. 3, p. 1613). Detroit, MI: Macmillan Reference USA. Best, P., Manktelow, R., & Taylor, B. (2014). Online communication, social media and adolescent wellbeing: A systematic narrative review. Children and Youth Services Review, 41, 27-36. https://doi.org/10.1016/j.childyouth.2014.03.001 Bhat, B. A., Khan, S., Manzoor, S., Niyaz, A., Tak, H. J., Anees, S., Gull, S., & Ahmed, I. (2020, April-June). A Study on impact of COVID-19 lockdown on psychological health, economy and social life of people in Kashmir. International Journal of Science and Healthcare Research, 5(2), 36-46. Dialani, P. (2020, April 2). How virtual reality is helping to deal with COVID-19. Analytics Insight. Retrieved from https://www.analyticsinsight.net/virtual-reality-helpingdeal-covid-19/

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Everett, F. (2020, June 3). 'I want a divorce': how lockdown tore us apart. The Telegraph. Retrieved from https://www.telegraph.co.uk/family/relationships/wantdivorce-lockdown-tore-us-apart/ Freud, S. (1953). The interpretation of dreams. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vols. 4-5, pp. 1-627). London, England: Hogarth Press. (Original work published 1900) Freud, S. (1957). Repression. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 14, pp. 141-158). London, England: Hogarth Press. (Original work published 1915) Freud, S. (1964). Moses and monotheism. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 23, pp. 7-137). London, England: Hogarth Press. (Original work published 1939) Fulkerson, M. (2016). Touch [PDF version]. In Stanford Encyclopedia of Philosophy. Retrieved from https://plato.stanford.edu/archives/spr2016/entries/touc h/ Garretón, M. A. (2020). El punto final de un tipo de civilización. In Covid-19 (pp. 106-117). Madrid: MA-Editores. Girard, R, Antonello, P., & Rocha, J. C. d. C. (2007). Evolution and conversion: Dialogues on the origins of culture. New York, NY: Continuum. Girard, R. (1977). Violence and the sacred (P. Gregory, Trans.). Baltimore, MD: Johns Hopkins University Press. (Original work published 1972) Girard, R. (1987). Things hidden since the foundation of the world. Stanford, CA: Stanford University Press.

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! Girard, R. (1987). Things hidden since the foundation of the world (S. Bann & M. Metteer, Trans.). Stanford, CA: Stanford University Press. (Original work published 1978) Girard, R. (1989). The scapegoat (Y. Freccero, Trans.). Baltimore, MD: Johns Hopkins University Press. (Original work published 1982) Girard, R. (2011). Sacrifice (M. Pattillo & D. Dawson, Trans.). East Lansing, MI: Michigan State University Press. Glatt, E. (2013). The unanimous verdict According to the Talmud: Ancient law providing insight into modern legal theory. Pace International Law Review Online Companion, 3(10), 316-335. Retrieved from http://digitalcommons.pace.edu/pilronline/35/. Grechyna, D. (2020, April 7). Health threats associated with children lockdown in Spain during COVID-19. SSRN. http://dx.doi.org/10.2139/ssrn.3567670 Herman, J. (1997). Trauma and recovery. New York: Basic Books. Hillman, J., & Ventura, M. (1992). We’ve had a hundred years of psychotherapy –And the world’s getting worse. New York, NY: HarperCollins. Hubert, H., & Mauss, M. (1964). Sacrifice: Its nature and function (W. D. Halls, Trans.). Chicago, IL: University of Chicago Press. (Original work published 1898) Kamenetz, A. (2020, April 28). Child sexual abuse reports are on the rise amid lockdown orders. NPR. Retrieved from https://www.npr.org/sections/coronavirus-liveupdates/2020/04/28/847251985/child-sexual-abusereports-are-on-the-rise-amid-lockdownorders?t=1592516513980

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Kumar, V. (2020, May 11). Will post-pandemic world see an uptake in AR and VR? Analytics Insight. Retrieved from https://www.analyticsinsight.net/will-post-pandemicworld-see-an-uptake-in-ar-and-vr/ Lakoff, G., & Johnsen, M. (2003). Metaphors we live by. London: The University of Chicago Press. Lavoie, R, Main, K., King, C., & King, D. (2020). Virtual experience, real consequences: the potential negative emotional consequences of virtual reality gameplay. Virtual Reality. https://doi.org/10.1007/s10055-020-00440-y Liu, J. J., Bao, Y., Huang, X., Shi, J., & Lu, L. (2020, May). Mental health considerations for children quarantined because of COVID-19. Lancet Child & Adolescent Health, 4(5), 347-349. https://doi.org/10.1016/S2352-4642(20)30096-1 Mancia, M. (1981). On the beginning of mental life in the foetus. International Journal of Psycho-Analysis, 62, 351-357. Manickam, L. S. S. (2013). Integrative change model in psychotherapy: Perspectives from Indian thought. Indian Journal of Psychiatry, 55(6), 322-328. https://doi.org/10.4103/0019-5545.105558 Manickam, L. S. S. (2016a). Challenges of professionalizing psychology in India: Where do we go from here? Indian Journal of Psychology, 244-250. Manickam, L. S. S. (2016b). Towards formation of Indian federation of psychology associations: Let us wake up for our causes. Journal of the Indian Academy of Applied Psychology 42(1), 40-52. Montagu, A. (1986). Touching: The human significance of the skin. New York: Harper & Row. (Original work published 1971) O’Shea, A. (2010). Selfhood and sacrifice: René Girard and Charles Taylor on the crises of modernity. New York: Continuum. 128

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! Oughourlian, J. (2010). The genesis of desire. East Lansing, MI: Michigan State University Press Oughourlian, J. (2016). The mimetic brain. East Lansing, MI: Michigan State University Press. Palaver, W. (2013). René Girard’s mimetic theory. East Lansing, MI: Michigan State University Press. Prasso, S. (2020, March 31). China’s divorce spike is a warning to rest of locked-down world. Bloomberg Businessweek. Retrieved from https://www.bloomberg.com/news /articles/202003-31/divorces-spike-in-china-after-coronavirusquarantines Riva, G., & Wiederhold, B. K. (2020, May 6). How cyberpsychology and virtual reality can help us to overcome the psychological burden of coronavirus. Cyberpsychology, Behavior, and Social Networking, 23(5). https://doi.org/10.1089/cyber.2020.29183.gri Roy, E. (2020, April 3). Domestic violence, abuse complaints rise in coronavirus lockdown: NCW. The Indian Express. Retrieved from https://indianexpress.com/article/india /domesticviolence-abuse-complaints-rise-in-coronavirus-lockdownncw-6344641/ Singh, R. P., Javaid, M., Kataria, R., Tyagi, M., Haleem, A., & Suman, R. (2020). Significant applications of virtual reality for COVID-19 pandemic. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 14(4), 661-664. https://doi.org/10.1016/j.dsx.2020.05.011 Thakur, K., Kumar, N., & Sharma, N. (2020, May 12). Effect of the pandemic and lockdown on mental health of children. Indian Journal of Pediatrics. https://doi.org/10.1007/s12098020-03308-w 129

13 TOMATO OR TENNIS BALL? TIPS FOR COPING WITH CORONA RESILIENTLY AND HELPING OTHERS PSYCHOLOGICALLY DR. B. J. PRASHANTHAM Professor of Counselling Psychology and Director, Institute for Human Relations, Vellore

Introduction I am happy to share three ideas in this chapter which I was invited to write by Dr. Sam Manickam, the Editor of this monograph, whose initiative is very timely and important. Looking forward to reading the entire contents when the book comes out. Yes, indeed psychologists have a very important responsibility in helping themselves and others cope resiliently with the current Corona situation. I would like to especially address the coping challenges we are all facing due to the global pandemic, Corona (COVID-19), which has called for very drastic measures of discipline, confinement, containment, social distancing, reviewing of hygiene etc., to avoid a catastrophic loss of people – and by these steps, slowing down the process of infection and resultant difficulties related to economy and livelihoods. No doubt it is a very difficult time, a time when our lives are disrupted. I am reminded of the book recently written by Satya Nadella, CEO of Microsoft, who said, ‘Hit Refresh’, and that's what we have to do. This Chapter is divided into 3 parts. 1. Survey findings, 2. Tips for resilience and 3. Some things Psychologists can do. As a result of following them even partially, it is hoped people can” bounce like a tennis ball rather than splash, and disintegrate like a tomato on impact of the fall”, a term I coined when working with large number of the survivors of Tsunami in 2004-05 in India and Sri Lanka. I. Survey Findings I have surveyed a few weeks ago over a hundred of our alumni friends from all over India, from Kashmir to Kanyakumari who 130

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! have willingly indicated their views on four questions associated with their experience of the Corona Crisis. 1.! The first question was: What are your feelings in these times? They reported feeling like: overwhelmed, scared, panicky, paranoid, frustrated, confined helpless, struggling facing difficulties, challenges, and fear of the unknown. 2.! The second question was: What difficulties did you actually face? Answers included: “… difficulties of meeting people, difficulties of buying things, difficulties of not being able to have direct person-to-person communication, finding emergencies really difficult to handle, not being able to meet classmates and friends, play outside as I used to, face stigma by others and my own family for working as a delivery staff”. 3.! Then I asked them: What insights are you getting from this? One person said, “I realize for the first time, I'm in a rat race of life not paying attention to relationships”. People who are socially minded are finding it very difficult to have limited contact. But they are also discovering that there are ways in which they can actually connect with people through technology, refocus on their life, and review their values and priorities. 4.! Finally, I asked them: What message would you like to give to others? And, they said we want to give the message that, “…let us be realistic, go through this pain, and get over this. We shall overcome. We have overcome many challenges before like, smallpox, polio, famines, tsunami and others. II. Tips for Resilience Next, I would like to deal with five ways for us to become resilient in this difficult time. The following have been found to be helpful not only to me but many others and are principles in simple language which have much support in the psychological literature. 1.! Relate. The first is ‘relate’. This means sharing your thoughts, feelings, actions, reactions, and choices of how you cope, with someone near you, like a family member or a friend. If for some reason that is not easily possible, write it down in great detail. Research has found that writing generally can also help us to express. Do it daily for the next one month, expressing real 131

feelings freely, and see how you will feel. Possibly better. Many found it to be so. 2.! Relax. The second point is ‘relax’. As you start relating, you'll also relax. Relaxation is very important, because when we are not relaxed, we are tense and anxious. When we are relaxed, our anxiety comes down. And there are varieties of means to relax. All the way from taking deep breaths for even five minutes with a simple formula 4-4-4: breathe in for four seconds, hold for four seconds, breathe out for four seconds. Pranayama, yogic asanas and other methods have also been found useful. By doing something different, also you can relax, which is enjoyable like, seeing a movie, talking to somebody by phone, listening to music or playing. Thereby, you activate your parasympathetic nervous system which helps you calm down. And that's what is needed. Other techniques like neuromuscular relaxation, and visualization have helped as well. 3.! Review. The third point is ‘review’. That is, look at your thoughts, feelings, actions. You can be aware of and then accept it is OK to have these feelings. Ask yourself, “Am I thinking negatively, catastrophically fearing too much?” Because in the midst of all the bad news we are getting, there is a lot of good news. Our thinking needs to be based on facts. The good news is most people can survive, if you follow the rules. The rules are: wearing a mask, washing your hands frequently, not touching your face, keeping a reasonable distance till the curfew is lifted. Accepting what cannot be changed will also release us to think realistically and feel and act appropriately. This will not go on. The pandemic will end. In the meantime, “How can you spend time usefully, doing things that you wanted to but did not have time so far? How about developing a hobby, or a new skill? How about being involved with causes bigger than yourself and helping the severely hit persons like guest workers and any others in need of basic requirements of daily life?” 4.! Routinize. The fourth one is ‘routinize’. Your routine is disturbed. But our mind requires an orderly life, a routine of doing physical, mental, social, spiritual things that are meaningful to you. Some people have found, for example, sleeping and getting up at the same time every day, eating the right diet at the right times, having a new routine to follow, 132

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! doing their prayers and devotions, etc. Helpful new behaviour is what we're all about. Wearing a mask, washing hands, not touching our face, are some of the behaviors that have been changing. Please continue to practice these new behaviors. 5.! Rebound. The fifth and last word is 'rebound'. Rebound is to be like a tennis ball bouncing back. We can bounce back by the efforts we take, the help we receive, counting blessings we receive from the Almighty. And by experiencing our successes incrementally, in whatever way we are doing, we can also learn to be concerned, to be cooperative. And at the same time, to rebound, because there is light at the end of the time. We can overcome. Scientists say that we are going to go through some very rough patches, some more economic difficulties are expected. But we will be able to save a large number of our dear fellow human beings. And in the meantime, we'll also protect them, especially the many care providers. Even if the recession leads to depression, as in the past century, we will bounce back with proper bio-psycho-social and spiritual values and measures. As psychologists we should not underestimate the impact of socioeconomic difficulties on mental health of all ages with anxiety and depression which are clearly expected to increase much post lockdown also. III. What psychologists can do In the context of the COVID-19 crisis, there is a great epidemic of anxiety and panic. People of all age groups are struggling with painful changes and limitations to their freedom to enjoy life. There are reports of domestic violence, incidents of suicide, the sheer pain of economic despair due to layoffs, and no work and wages. Individuals, NGOs and governments are doing many positive things. Along with all these, psychologists can use their competencies to help along with equipping themselves with skills that will help support others to bounce back like a tennis ball with hardiness, self-efficacy, and a changed mindset.

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In addition to the 5 R’s pointed above I found useful the approaches noted below: 1. Telecounselling and use of other digital media like video. 2. Psychosocial education in coping with stress. 3. Referrals to specialists of those needing medication or other interventions. 4. Mobilization of group and community support. 5. Use of Cognitive Behaviour Therapy (CBT) where appropriate. 6. Learn and use EMDR ((Eye Movement Desensitization and Reprocessing). 7. Mindfulness approaches. 8. “Learned Optimism” by Seligman is a useful book for Psychologists and helpless to read in this context of Corona 9. Any other evidence-informed methods that the psychologists are trained in, and are comfortable with, as well with helpees who are equally OK with them. My main approach is eclectic and I adjust the approach to the need and comfort of the helpee to feel comfortable as well as grow in resilience and bounce back like a tennis ball.

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14 SELF-TALK TO CHANGE YOUR PERCEIVED REALITY PROF. DR. MANJU AGRAWAL Professor of Psychology and Dean Student Welfare, Amity University, Lucknow Unprecedented crises such as the Corona Virus Disease (COVID-19) pose huge challenges, not just to the socio-economic fabric of the society but also to one’s inner self. The pandemic swept through the world, impinging in its wake women and men, young and old, privileged and deprived - leaving no one untouched! Dark clouds engulfed the horizon, doomsday prophecies started sprouting with an uncanny regularity. Lock-down meant measures being taken to contain or arrest a deteriorating situation. But this was unrivalled in history - unmatched in span and unequalled in scale! This entailed being bereft of any human contact leading to a sense of alienation unable to fathom. Multiple Personal Realities during Lock-down The human being is a social animal, craving for human interaction but was mandated to desist from it in the instant case. The induced lock-down held all plans in abeyance. Going against the grain of existence, one was totally confined to one’s home. Though homes are for free expressions and not uninhibited existence, being ensconced, the fleetingness of life became much too apparent bringing with it a plethora of overwhelming emotions ranging from love, bonding, relaxation and calm to fear, aloofness, impatience, apprehensions and even paranoia! In those uncertain and unpredictable times, scepticism ruled the roost. At times negative outlooks predominated one’s thought processes even more with 24-hour news channels broadcasting the numbers of positive corona patients and deaths. In comparison, broadcasts of reassuring facts about recovery rates was sporadic. 135

Human emotion, unable to be subdued for long found an outlet in technology. The eternal craving for human contact turned to virtual recluse, endorsing the mantra, ‘stay apart but stay connected’. During this lock-down period, it was observed that people who were positive and creative had become more positive and creative while people who were anxious, violent and depressed had sunk deeper into an abyss. Though substantial databased evidence was not available, adequate numbers of cases were observed. The conundrum also exists because of parallel and simultaneous reports and accounts available – overflowing social media narratives about learning new/enhancing existing skills, online meetings and partying, online and balcony housie, sharing positive mental notes, taking new media challenges of dancing, cooking on one hand vis-a-vis the complaints received by National Commission of Women on the doubling of the rate of domestic violence, more clients seeking help for anxiety and worry and muted pleas seeking counselling, on the other! The juxtaposition of both the positive and negative attributes as a fall-out of the pandemic has been very evident. A pertinent observation, based on data, has been that the world over the heart attack rates dropped significantly. This was suggestive of a reduction in stresses due to routine chores and activities. These could encompass stress arising due to mundane things like one’s appearance in public, choice of tourist destinations, selection of designer clothes, party arrangements and the associated rigmarole, so and so forth. Self-Talk and Changing Reality As the dust settled and people got aligned to the new normal, the mind started playing games with every increase in the duration of the lock-down. For many, the loss of livelihood became a perceived angst. Some of my clients called me and wanted therapeutic interventions as their anxiety levels and/or depression had increased. I endeavoured to explore their mental postulate i.e. the recurrent thought pattern in their mind and the associated words used to express these thoughts. What emerged as overriding concerns were, “I am afraid that my family members and I may get infected by Corona”, “God knows who will survive, who will not”, “What will happen to my children/ parents?”, “I will be doomed if I become jobless which I got with great difficulty”, “I will come to the streets”, “If something happens to my parents, I might not be 136

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! able to go for their last rites even”, “I don’t know if I will ever meet my family”, so on and so forth. Evidently, our personal reality is determined by the thoughts we harbour; forces that shape our choices. We have sixty to seventy thousand thoughts daily and 90% of them are the same as the previous day. As we think, so we make choices, so we have feelings, and so we behave and make our personal reality. The tool that is employed in the thought process is language which usually is one’s mother tongue. One needs to break the chain of negative and regressive thoughts to effect a change in the thought process because repetitive thinking, whether positive or negative, permeates into one’s subconscious mind which consequently starts guiding her/ his feelings, thoughts and behaviour. In order to break this chain, I decided to use the tool of selftalk. One of the easiest tools in one’s hand is to check, monitor and change one’s self-talk. We talk to ourselves for almost 24-hours, including during sleep but how many times have you actually met the real positive person within you? Even while conversing with others, there is an ongoing self-talk trying to formulate an appropriate response. Like someone has rightly said, ‘talk to yourself at least once in a day otherwise you may miss a meeting with an excellent person in this world’. Now when one tackles the self-doubts and apprehensions enumerated above, the person would be able to see things in a new light. For example, “I am afraid that my family members and I may get infected by Corona” metamorphizes into, “My family and I are taking all precautions required to protect ourselves”; “God knows who will survive and who will not” into “Life and death is not in my hand; my karmas are in my hand and I am doing my best”; “What will happen to my children/ parents” into “Every day I pray to God and ask him to keep my family and everyone safe from this virus”; “I will be doomed if I become jobless” into “When one door closes many other doors open, I am exploring my talents capabilities and options”. Similarly, for any such cascading negative thoughts, the positive assertion could be, “Let me not worry for something which has not happened, and which is not likely to happen. I am worrying unnecessarily as this situation is 137

unlikely to crystallise. I am creating a lot of tension and worry for something which is not likely to happen at all.” Technological Edge in Therapeutic Intervention The strategy also included putting out easily comprehensible media, comprising talking to self in positive language with an intent to evoke the dormant pleasant memories of the clients, to rekindle the feel-good emotions in them. Initial challenges of technology were overcome by learning and experimenting, resulting in me gaining confidence to conduct online counselling and therapy sessions. Personal first experience of video psychotherapy was with a 12-year-old boy whose obsessive-compulsive symptoms had heightened, and he had to be helped. He improved drastically and within a month almost all his symptoms were gone. Moreover, realisation dawned that the online platform enabled the clients to interact with the Therapy Cells from the comfort of their homes with the desired privacy. I also recorded a few self-talk videos for their relief from their COVID-19 induced anxiety, which they found to be extremely calming and soothing. In fact, this generated a wave of positive feedback as the videos got circulated around, triggering requests for more such videos. Interested readers of this article may find it at the following link of Mind Spa YouTube: https://youtu.be/8v1gw4CDDw . A Case Study The trigger for the article is an anecdotal narrative concerning the apprehensions of a peon in the University over the unfounded fear of losing his job. The fear of losing the job was affecting his mind and body. He was focussing on communication by other peons who had not received salary in the last two months. He started saying to himself and others that some peons have got a salary for one month and some others got for the other month and that peons will not be paid regularly during this lockdown. This appeared to be logical thinking. However, on being enquired as to how many had not got salary and how many had drawn regular salary, he could name only two peons who had not got salary for two months! He himself was drawing a regular salary. He was made to realise that maybe these two people did not get their salary due to technical reasons or such cases had happened even before the lockdown, which put him at ease. He was also made to 138

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! understand the consequences of generalization based on one or two stray incidents. He realized after this interaction that not only did he make himself anxious with such generalised self-talks, he created anxiety in others by talking like so. This consequently could have triggered a vicious spiral of negative thoughts amongst others too. On being probed further as to what his chances were of losing the job, he seemed quite uncertain. The next question intended to seek out his views about the other skills he thought he possessed and what else could he do to continue to be the breadwinner. Would he like to continue to stay in the city or return to his village and make both ends meet? Surprisingly, a comprehensive list emerged. The moment this list became apparent to him, one could sense a gradual loosening of taut nerves. It was suggested to him to nurture repetitive thoughts (a form of self-talk) as to what would happen if he lost his job and if so, to contemplate about his skills and his strengths, about various alternatives available and about the skills of his other family members who could also support him in the event of his assumption coming true! It was just meant to convey to him that the fear as such, of losing the job, was much more detrimental to the mind and the body. It was also quite likely that one may not lose one’s job but the fear that one entertained had a greater impact than losing the job itself. Post the session, he felt so unburdened and relieved that he requested me to communicate it to all who were worried at this time and that firmed up my resolve to pen this article. Conclusion COVID-19 has been a never-seen, never-imagined pandemic which has brought the world to its knees. Human beings have been impacted in ways never envisaged, including in the mental domain. Personal reality during this challenging time has been varied. People living in a happy and positive family environment with good domestic harmony perceived multiple advantages and opportunities and made constructive use of the available time. On the other hand, few others experienced depression, unwarranted alarm, apprehensions and paranoia. A technique of ‘self-talk’, which is basically positive pronouncement 139

or constructive proclamation to the self is a good response to emerge from the web of negative presumptions. A podcast was also recorded by the author which many of her clients found very soothing and calming during this challenging time.

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15 ROLE OF PSYCHOLOGISTS IN DEALING WITH TRIPLE DISASTER SITUATION DURING COVID-19 PANDEMIC DR. PRASANTA KUMAR ROY Department of Clinical Psychology Institute of Psychiatry, COE, Kolkata Background: Human society all over the world is facing an evolutionary crisis of survival of the fittest due to COVID-19 pandemic that has killed more than 3 lakhs of people in just 5 months. Lots of debates, allegations, discussions are going on regarding the origin, modality of infections, how to break the chain, treatment and appropriate strategies to deal with the pandemic. There are also debates about the waves of the disease, lethality, vaccine, role and impact of lockdown. Psychologists all over the world have become busy in helping people to cope with panic or anxiety and to manage the lockdown period without much psychological harm. Various strategies have been discussed and in India almost all the major mental health organizations are trying their best to contribute to the society. Probably, the mental health issues related to COVID-19 which are discussed by all sections of the society, ranging from children to geriatric population, community and media, have never taken place before. Many mental health professionals have also launched online research related to Covid-19 (Amulya, 2020). Disaster, India and Mental Health Professionals: Disaster has a long history in India and this country is one of the most vulnerable areas in the Asia-Pacific Region that can experience all sorts of disaster. With the beginning of the 21st century and in the last 20 years, India has witnessed many natural and man-made disasters with enormous repercussions in the community. Starting from the western part, i.e. the Gujarat 141

earthquake in 2001, most of the disasters, be it in the southern region of India (Tamil Nadu, Karnataka, Kerala etc.), northern part (Kashmir & Uttarakhand etc.) or eastern part (Manipur, Odisha, Bihar, West Bengal etc.) have claimed lives of several thousands of people including children and disabled, destroyed thousands of houses, agriculture, livelihood and ruined the economy and community feeling. Most of these disasters have received good media attention and also international attention. Unfortunately, mental health professionals including psychologists were mostly silent (A good exception is Kerala psychologists in 2018) and there was hardly any well planned research to learn from those disasters. It is painful to think that India has hardly produced any disaster mental health professionals except a self-motivated few. Most of the professionals were concerned about post traumatic stress disorder (PTSD) though the reality was something different. Prevention of mental health crisis during disaster was not thought of at all. The approach was more of a “wait till the diagnosis” treatment approach. I witnessed the same in 2015 during the devastating flood of a beautiful hilly state. When some of us approached the head of a mental health department in a government set-up after 2 months of the flood, we were told that there was not a single registration with post-flood PTSD and they were willing to treat when ‘cases’ came for treatment. This is a common scenario all over this country as most of these professionals believe that the role of mental health professionals comes only during the post-disaster period after everything has been restored. Now the question is, why is there so much involvement of mental health professionals during COVID-19? There might be four possibilities. One, they are under the threat of getting the infection and there is identification with the victim. Two, mental health professionals can visualize that there will be a huge mental health crisis and only prevention can minimize the burden. Three, there is a greater understanding of the community model of mental health and role of prevention in a disaster scenario. Finally the fourth is, availability of good mental health leadership in India. Whatever be the reason, there is no doubt that a revolution has happened in India in the field of mental health, specifically in relation to disaster mental health. 142

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! Complex Disaster- A unique experience: With this backdrop, this paper is going to focus on complex disasters or multiple disasters as recently the states of West Bengal and Odisha witnessed extremely severe cyclonic storm “Amphan” (Pronounced as Um-phun) on 20th May 2020. The cyclone touched the coastal area of the famous Sunderbans with 185 km/hr speed and ransacked a major part of Southern West Bengal including Kolkata. Even after 10 days of the landfall, many areas are still under water, without electricity and people have no adequate drinking water, food and clothes. Thousands of houses have collapsed and the current estimated report is that more than sixteen lakhs trees were uprooted. Some parts received salt water rain too and environmentalists had expressed concern about the change of nature of the mangroves after Amphan. The state of West Bengal has the burden of over 5,000 COVID-19 positive cases (as of June,1, 2020) and the lockdown is still in place. In such a situation the second disaster has made the condition more threatening even for a person with COVID-19. To approach this complex situation is a challenging task for the mental health professionals, especially disaster or emergency psychologists (Manickam, 2020). When we psychologists are encouraging the behavioural route to suppress the pandemic by improving the behaviour of proper hand washing, wearing mask and maintaining physical distance, the super-cyclone on the other hand demands the joining of hands of affected people through group activities, connecting them in the field to provide Psychological First Aid (PFA) in order to prepare a community based intervention and resiliency development programme (Anindya, Debora & Manickam, 2020). We are forced to use approaches that appear as contradictory or counter-productive. For example, due to prolonged lockdown people are deprived of medical facilities and while conducting a health-cum-mental health camp for the cyclone affected people, which is highly needed at this stage, there are two consequences. There are huge gatherings of people due to the lack of physical facilities that can increase the incidence of COVID-19 in the area, and the help/aid providers or organizers of those camps can be held responsible for spreading the virus in the community. Such a step can lead to the end of 143

functioning of any Non Governmental Organization (NGO) or volunteers to help those who are in need in this crisis situation. Therefore the disaster mental health services in India that highly rely on volunteerism, are at high risk since they are likely to become ‘social and COVID-19 victims’ and the loss of volunteerism is going to be unimaginably high!. Does that mean that the psychologists have nothing much to do in this never experienced crisis situation where biological/ health and natural disasters occur simultaneously? The Side-effect is Bigger: There is another more threatening disaster for the earth and will definitely have an enormous impact on society. This has emerged as a ‘side effect’ of lockdown but the impact may be much higher than the pandemic. I would like to call this a ‘social or economic disaster due to loss of job or job-role or business’( Mishra & Sayeed, 2020). Some might argue that this is a man-made disaster. We psychologists need to develop appropriate strategies to prevent increased mental health morbidity, addiction, suicide, violence and anti-social behaviours that are likely to manifest. Are we in a state to address these triple disasters? To me, this is an opportunity or a challenge for us to redefine our outlook as mental health professionals. If we start focusing on some of the strategies in such complex situations, we can achieve better psychological skills and better resilience. As we commonly say in disaster situations, “If you are part of the solution, you are no more part of the problem”, and this holds true for the psychologists too. I would discuss some of the issues that psychologists can give further thought to and then develop sustainable plans of action. 1. Assessing Risk: I have witnessed many mental health professionals stating that disaster mental health services are not immediately needed at the onset of disaster. Many of them believe that their role is more meaningful only after a month or so after the occurrence of a natural or health disaster. They are not wrong, though the experienced and trained workers of disaster mental health may not agree with this notion (Manickam, 2005). The training on disease 144

COVID-19: Challenges and Responses of Psychologists from India

! model, excessive dependency on psychopharmacological treatment or illness specific psychotherapy and lack of community based training or exposure might be responsible for this perception. Moreover, the administrative or government agencies are slow in realizing the importance of this tool for future disaster preparedness and immediate intervention of mental health professionals at the onset of disaster. Even these professionals are having a mainstream or primary role in need assessment and policy making for a particular disaster. One of the important aspects is risk assessment, which means identification of those at higher risk of developing mental health consequences in a hazard prone area if they are exposed to any hazard or disaster. Hazard can be a future event (e.g. Sunderban area of West Bengal is cyclone prone but not the city of Kolkata as per history) or a recent event (e.g. COVID-19 outbreak or large scale unemployment). Impact of the hazard can be determined by its severity (e.g. 2001 Gujarat Earthquake), novelty (e.g. 2004 Tsunami, 2020 COVID-19) and lack of preparedness (e.g. 2013 Uttarakhand Flash flood). However, the psychological damage due to the hazard more importantly depends on the population vulnerability (i.e. who are at higher risk to face the consequences?) and the coping capacity of that community. Here the psychologists have a huge role in identifying the vulnerable populations (e.g. reinforced vs non-reinforced building, aiddependent vs non-dependent, employed vs unemployed, migrated vs non-migrated, majority vs minority community etc.) and also in recognizing the existing coping skills (e.g. strong community bonding, better social and/or economic support, good leadership, presence of food/seed bank, number of initiative takers, belief in self-help etc.) or lack of coping mechanisms (e.g. lack of cultural identity, waiting for others to take lead, frequently complaining, poor emotional regulation etc.). That means, we need to have a separate risk assessment for all the 3 disasters and to identify the commonalities in all the three disasters. If we can focus on the commonalities to begin with, there is a good scope to decrease the mental health burden in the future. Psychologists may take the help of various agencies including the 145

local Anganwadi workers or local volunteers for assessment of this risk. Needs assessment through online and mobile apps is also possible with the help of local agencies. 2. Intervention Proper: Once the vulnerability and coping assessments are completed, planning for appropriate grass-root intervention may not be difficult. In the current situation, psychologists may take the help of the media to propagate their message on how to identify who are at high risk for developing morbidity. Distribution of handouts or leaflets (preferably pictorial) with the help of local agencies may be extremely helpful. We can also prepare leaflets on how to build resilience for various sections of the community including children. We need to identify a good leader from the community who can be prepared to implement some of the resilience building strategies. A tele helpline also may be introduced not only for COVID-19, but for other disasters where people can get an opportunity to ventilate and appropriate PFA can be provided by a trained lay counsellor or a volunteer. Many issues have been discussed about dealing with COVID-19 pandemic at various platforms. There is a need to prepare a psychological strategy or communication to bring about a change in the attitude of people to deal with the pandemic. Social and health psychologists together have a great role in formulating the attitude change communication. For example, they can discuss the role of reinforcing incompatible behaviors to minimize mouthnose-eye touching. Role of placebo (e.g. By washing my hand appropriately I am respecting my health more) vs nocebo or unhelpful statement (e.g. I need to wash hands to avoid COVID-19 infection or I should not be reluctant about washing my hand) to modify behaviour also may be considered for preparation of effective communication. Psychologists may also prepare differential communication approaches for those who are high on ‘monitoring’ but less on ‘blunting’ and people who are less ‘monitoring’ but high ‘blunting’. This is necessary as both these extreme groups are more vulnerable to mental health crises or infection prone.

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! In the case of the third one, the socio-economic disaster, the media has to be educated to stop devaluing and empathize with the people who are forced to change their income profile to a less valued one. Here the dynamic ideas of ‘Social Role Valorization’(SRV) have to be implemented which is useful for making positive or desirable change in the lives of disadvantaged people because of their status in society (Wolfensberger, 1992). Labelling of the workers from low economic conditions as ‘migratory workers’ is perceived as a devalued term and we need to put an end to such derogatory use of the term. A basic principle of role-valorizing is that the good things any society can offer are easily accessible to people with valued social roles. Conversely, people with devalued or marginally valued social roles, have a harder time obtaining the good things of life. Therefore valued names or labelling or social roles or the positive status are the key to obtain the benefits inherent in any society or culture. Once we are able to implement this SRV, displaced people will have better social resilience or identity. Thus, there would be better acceptance of changing the job role. Non-acceptance of the new role can be highly stressful and can precipitate or aggravate emotional disturbances including depression or suicide. Helping them to mourn the previous role can be therapeutic too. Conclusion: As psychologists, we need to conduct more research studies related to disaster and disaster related situations that can be product based. The research findings can provide direction towards planning appropriate prevention and intervention. Moreover, research can work as historical documents and can be extremely beneficial to plan interventions for future disasters without investing much time in need assessment or in understanding the nature of the disaster. We also need to look for strategies for resilience building of the community with primary focus on the children and adolescents so that we will have psychologically healthy future citizens.

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References: Anindya, S. N., Debora, M. A., & Manickam, L. S. S. (2020). Refining psychological services and strategies in India in the wake of COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.8-22). Thiruvananthapuram: The Editor. Amulya, D. S. L. (2020). An experiment with online group counseling during COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp. 182-197). Thiruvananthapuram: The Editor. Manickam, L.S.S. (2005). A Report of the trauma counseling service provided at the IAF training station, Tambaram, Chennai, Tamil Nadu—December, 30-31, 2004 http://kspope.com/torvic/trauma.php Manickam, L.S.S. (2020). COVID-19 Pandemic: A time for prudent and ethical action. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.218-228). Thiruvananthapuram: The Editor. Misra, A., & Sayeed, N. (2020). COVID-19 and migrant workers: Clinical psychologists’ viewpoints. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.43-55). Thiruvananthapuram: The Editor. Wolfensberger, W. (1992). A brief introduction to Social Role Valorization as a high-order concept for structuring human services. Syracuse, NY: Training Institute for Human Service Planning, Leadership and Change Agentry.

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16 PSYCHOLOGICAL RESPONSE TO COVID-19 PANDEMIC: VIEWS OF AN INDIAN BORN AUSTRALIAN COUNSELLOR SUNITA JITENDRA GAUD Counsellor, Department of Communities, Australia Introduction COVID-19 pandemic has hit the world. India is not an exception to this. Developed countries and developing countries are trying their best to overcome this pandemic. Regardless of the distance, religion and socio-economic status everyone has come together to solve this mystery and humility has been questioned by the act of the human in resolving, coping or trying to overcome it. It is important that everyone needs to contribute and take the initiative to support each other to build courage and resilience while going through this pandemic. As a public sector employee and a private practitioner, I come across feelings and distress of the people every day. COVID 19 has made it worse. I am putting my thoughts based on my experience in working with people and every day reports. COVID 19 has generated fear and uncertainty about the future for the middle class people (“the people”). Research in the period of the COVID 19 pandemic measures the responses to the issues and the psychological distress of the people in performing the day to day functions. The main components are culture, uncertainty, and affordability. Active involvement of psychologists, therapists, and counsellors are necessary to listen to the people and to make them understand their fight or flight responses and provide guidance to appropriate agencies. Psychological Response COVID 19 Pandemic has hit the entire world and Government of India, Non Government Organisations (NGO), agencies, families, and other sources are putting in lots of effort to 149

overcome the pandemic and control it to the manageable grade. The psychological aspect is one of the factors which needs to be incorporated while working towards this globally affected situation (Kalpna & Sharma, 2020). People need to be heard, provided with appropriate updates, and where possible, be helped to solve their problems. In addition to this, people need to feel included and the cultural and family dynamics need to be taken into consideration as this is the important portico of people’s life. Regardless of how bad the pandemic is, being together and having the same goals to handle it, is the need of today's world, as we are in this together in both the ways as a sufferer and the pacifier. Professional associations’ intervention in addition to the Government initiative is required because the people are uneasy, fearful, and uncertain (Anindya, Debora & Manickam, 2020). There has been a lot of misunderstanding, misleading information about the pandemic which is leaving the people with anxiety about the current situation and the future. This has resulted in feeling distressed, anxious, and fearful. The people responded in the panic state leaving themselves at significant risk of health, financial, survival, cultural practices, and other risks associated with day to day life (Subramanya, 2020). The factors influencing these risks are uncertainty about what may happen next, lack of knowledge, inadequate resources and access to the right support, economic breakdown, financial losses and not being able to/ limited access to the social setup and culture. Some Measures to address these challenges 1. Establishment of support services: Indians are family oriented and always surrounded by friends and neighbours. This makes it easy to develop a support system, having a few people to talk to. It is known that half of the burden is resolved if we have someone to talk to. People need to be encouraged to establish such a network using electronic devices and social media. The Government and the NGOs need to support people to get such devices and provide internet services to access mobile phone applications such as Zoom, WhatsApp and other similar applications. Each family can nominate a family member or a friend who can represent them and have access to the appropriate guidance to be able to make the members feel heard and equip them with the strategies. The nominated members can act as a 150

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! representative of the agency established by the Government to support the people. This will ensure that everyone is heard, valued and knows what to do should they become distressed. The people need to learn to respond and not react to the distressing situation or need additional information to make the decision. 2. Communication about accessing day to day needs and services: People need to know how they can access services and meet their day to day needs. There seems to be too much information being provided which resulted in misleading and mistrust. Appropriate services need to be prioritised and charities need to be monitored and guided by the Government. Every other service is required to limit its initiative and participation. If these services wish to contribute, they need to be registered with the voluntary services that are guided by the Government. The news and media can sometimes overwhelm the viewers and therefore filtering information is very important. Regular alerts by a community member or a society member about the local area situation is proven to be effective. 3. Rating the distress: Should the person access the psychology services, one needs to be rated on the scale of zero to ten on his fight or flight responses, where zero is being OK in response to day to day stress of the pandemic and ten is being distressed to a degree that professional help is required. Low rating will ensure the person about being fine and provide an insight that it is just the normal response. This can motivate one to continue with the day to day life in a safe and secure manner. This will also ensure that the service provided is trusted. 4. Access to psychological or counselling services: In addition to the health services, access to psychological and or counselling services is important. Having such a professional available in a local Family Health Centre (Primary Health Centre) will make a difference. Telecounselling has been activated in many developed countries and this needs to be considered more extensively (Joshi, 2020), but its ethical use has to be kept in mind (Manickam, 2020). However, in order to avoid 151

stigma associated with accessing services, people need to be educated regarding the need for seeking psychological services for their supportive needs. 5. Follow up of the services provided: Often the service delivery systems tend to forget the follow up on the services. For many, things can get worse and missed. A follow up must be completed which will lead to a feeling of being validated and considered as a valued citizen. 6. Domestic Violence and Family Domestic Violence helplines: It is well known that when one cannot cope, one feels frustrated, angry and the response to the stressful situation is verbal abuse, physical abuse, or emotional abuse. This could be

manifested towards oneself or others. Having someone to talk to or knowing how to respond to the stressful situation has helped to think wisely before responding, in the past. The major need in this situation is to be heard and it is a counsellor/support person’s job to do the same. Counselling services need to be made accessible to the people by employing tele counsellors. The need is for empathic understanding and someone to listen to. Recreation activities: Recreation activities such as sports, family gatherings, events and engaging in hobbies are an important part of people’s life, especially psychological wellbeing. Ideas about how to continue to engage in these activities can come from people. This will make them feel included and valued. Accountability will automatically come in effect as the trust is established. Culture: The World Health Organisation (WHO) has recommended social distancing, limiting people and hand washing is considered to be very effective in flattening the curve of the infection spread but the question is can everyone effort running water, soap, space, and simple things such as following the instructions. The people have come to the point where it is just not that easy to implement the WHO’s instructions on a mass level. Culture is a big part of this 152

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! agenda (Veliyannoor, 2020). As we are aware, a house is run by a lady of the house (a mother or a grandmother), a shop is run by the shopkeeper, the temple is run by the priest, the mosque is run by the imam and the cultural leaders play the important part as well. When this pandemic is a part of every individual's life, how can we afford to wait and rely on a vaccine, when no one knows when it will be ready. It is time to think outside the box and all people need to be given a charge of responsibilities to keep everyone safe. To summarise, let us all think differently, focus, and learn from what we know and support the Government initiatives during COVID 19 pandemic. Families, friends, counsellors, and access to psychological services are important to remain positive, learn coping skills, and handle our own emotions in this global pandemic. The importance of easy access to services shouldn’t be left behind. People need to feel included and valued. We should not forget it’s just not the Government's responsibilities, we are all in this together. Together we can win our fight against this heartbreaking pandemic and be responsible, mentally stable, and have a well- deserved safe, healthy and secure life. References Anindya, S. N., Debora, M. A., & Manickam, L. S. S. (2020). Refining psychological services and strategies in India in the wake of COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.8-22). Thiruvananthapuram: The Editor. Joshi, S. (2020). Telepsychotherapy: The bridge to continuity in care and mental health services in COVID-19 and post Covid era. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.170-181). Thiruvananthapuram: The Editor.

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Kalpna, T., & Sharma, N.R. (2020). Responding to the COVID-19 pandemic: Challenges of Indian Psychologists. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.23-37). Thiruvananthapuram: The Editor. Manickam, L.S.S. (2020). COVID-19 Pandemic: A time for prudent and ethical action. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.218-228). Thiruvananthapuram: The Editor. Subramanya, R. ( 2020, March 29) Covid doesn’t deserve the levels of panic we’re seeing in India, certainly not this lockdown. https://theprint.in/opinion/covid-doesnt-deserve-the-levelsof-panic-were-seeing-in-india-certainly-not-thislockdown/390606/ Veliyannoor, P.V. (2020). ‘The Return of the Repressed’ In COVID19: The need for intervention at socio-cultural inscape. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp. 108-129). Thiruvananthapuram: The Editor.

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17 RECLAIMING NEW HORIZONS: THERAPIST OF 2020 PANDEMIC ERA DR. PRERNA SHARMA Clinical Psychologist, New Delhi

Background This article is the account of my personal journey - from working in a hospital as a clinical psychologist to the experience of working in the evolving reality of COVID-19 at various quarantine centers across Delhi. This also provides an overview of changing socio-cultural dynamics of the country in the light of COVID-19. This also further provides an insight into my internal changes and realizations that I had in my journey of discovering and witnessing new realities in the wake of the current pandemic. Lastly some new ways of relating to clients as a changed therapist post COVID-19. Fresh beginnings, novel virus and skepticism The year 2020 began with new resolutions and plans. I chalked out my quarterly plan, half yearly and year-end targets that I planned to achieve in terms of research, conferences to attend, papers to be read there, new books to read, places to travel, new skills to learn and so on. The first quarter of the year seemed quite booked providing a sort of motivation and a boost to selfesteem. I had ticked a few boxes already by the end of January, 2020 and the world seemed to move at its usual pace, and me, faster. While rushing through my busy days at the hospital, I swiftly turned the pages of the newspaper one morning when I learnt of the first case of a novel coronavirus positive patient in Kerala (WHO, 2020). I thought to myself, well viruses have come and gone, we as a country have fought Ebola, Polio, H1N1 and so on. This also seems to be one of those with a different name and well, Kerala is far from Delhi. Being in my self-created world full of plans, I got a notice from the Health ministry that I will be posted in a quarantine camp set up at Indo-Tibetan Border Police 155

(ITBP) facility nearly 30 kilometers away from where I reside. I thought to myself, “But what about my plans? I am an organizing member for a national level conference in February 2020, have to present papers, manage my clinical work, and have to let my clients know that I will meet them more frequently for a few weeks since I will be busier and unavailable for some time later.” This had come unplanned as per my schedule. With a little resentment and stress to manage this unexpected duty in an unfamiliar zone, I went ahead for the duty carrying my laptop, deciding that I will sit in a corner and continue working on my tasks. After all, what could be the need for a clinical psychologist in a quarantine camp! Quarantine! A word that I was getting acquainted with and would be making friends with in the coming months! Quarantine camp: an eye-opener I drove through unfamiliar roads on the first day of the camp. As I entered the ITBP facility I saw soldiers wearing masks and holding their guns. As I reported to the chief medical officer, I got acquainted with the team. I learnt that there were doctors from All India Institute of Medical Sciences (AIIMS), ITBP forces, and virologists, scientists from National Centre for Disease Control (NCDC) all these institutes in Delhi. I was skeptical about my role. Nobody had a clue as to what my duty entailed since the whole team was busy preparing the facility as per the needs of the people and newly formed protocols. For now, I was curious to meet new people, interact and know more. After all, it was a break from my usual clinical duties and away from hospital! The ITBP in-charge of the facility showed me a building away from where we were standing which was cordoned off by tents around, guarded by soldiers. He told me that the building has 406 people from Wuhan who had returned home and were quarantined there. Till that time I didn’t know much about the virus and its mechanism and the NCDC people were helping us make protocols for everyone and the people inside. A wave of reality hit me suddenly when I saw the building and I wondered how people are “held” there with the knowledge that it’s for their safety. It’s human tendency that we tend to question the decisions made by others or even us, when it comes to questioning our freedom that we think we deserve. I wondered how so many people would be “okay” with staying in a closed unfamiliar place for 2 weeks with a possible threat of a 156

COVID-19: Challenges and Responses of Psychologists from India

! harmful virus? My past resentment to deal with something unplanned in my schedule slowly faded away and I slowly came to my senses to the present reality. As clinical psychologists, we are also social scientists, which help us to predict intuitively due to innate skills which we develop over time by keenly observing human behavior. The quest of discovering this new human phenomenon began with curiosity and fear and I dropped all my guard. This intuition, influenced by all the social psychological theories, made me have questions like, what is the general environment like in a place where hundreds of people are confined in view of a threat to life. What are the psychological bearings on the minds of these people in view of a biological threat? How would a human mind react to an unfamiliar place and uncertainty? And after all what could be the role of a clinical psychologist here, when the real threat is purely biological in nature? And then began a journey where I wanted to investigate these as a researcher and a social scientist. Curiosity replaces skepticism On my second day I decided to talk to as many people as possible who were working closely and had seen it unfold from day one, to gather as much knowledge as possible. It was clear by now that I had to carve my own role and nobody had any clue as to how to use my services there. I got excited at the possibility of creating my own place here and doing my bit in creating awareness amongst these people who were providing “essential services” to them. A kind microbiologist from NCDC introduced me to PPE (Personal Protective Equipment) and trained me how to wear it. Interestingly I got to know that a lot of infections happened due to improper donning and doffing of the suit. Here was my first piece of knowledge that this virus will not harm a person who plays safe and takes all precautions. He took me to the facility and asked me if I was willing to take rounds on all the floors or talk to people with speakers stationed on each floor. By this time I wanted to know more. So I decided to go to each floor and meet as many people as possible to see what their living conditions were and how they were coping. As we went he explained the do’s and don’ts which reduced my apprehensions. I saw mostly young people who were staying in a dorm-type facility. To get a sense of possible 157

psychological issues I interviewed a few people and observed others. Most people were experiencing anxiety being in an unfamiliar situation, unpreparedness on the individual’s part, apprehensions about COVID-19, sudden displacement from work or academics, being away from family, or loss of economic life. These situations were enough for the people to experience a range of mental health challenges depending upon one's vulnerabilities and the capacity to cope in a difficult situation. The human mind is designed to plan, predict and control future events with intelligence and previous knowledge, but being in an uncertain situation like this which they are not prepared for, is enough to create anxiety, experience destabilization and depletion of emotional resources. Quarantine psychology In the month of February in India, we did not have much news from other states about what the situation is likely to be in the immediate future. People who were managing the facility believed that these are the only potential carriers and if it is contained here then we are well managed. Since the situation did not seem out of hand at that time we felt that if we focus on this group and manage this, then we would have done a good job. The thought that if it becomes huge in the future, it would surely turn out to be a huge mental health crisis, did cross my mind often. However, the present scenario didn't make mental health seem like a priority. Nonetheless, I felt gratitude that I was present there to witness all that and offer help the moment it arises. It was not a surprise that I started getting calls from people for help. It was a social experiment of sorts which had started to play negatively on people’s minds. One person complained of getting over with his stock of cigarettes. On interviewing him I found that he has been a chronic smoker since 35 years and by no means was he willing to quit smoking which was helping him manage his stress. I was caught in a moral dilemma and I recalled the memoirs of Auschwitz prisoners who exchanged tokens which they had earned working on building railways, for cigarettes. Though it was an extreme analogy and no way comparable since these people were not prisoners, but they were prisoners in the hands of uncertain times and an unfamiliar place. I saw him getting more agitated each day and feeling the lack of freedom but I could not source cigarettes or write in his notes to 158

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! allow him to smoke. My ethics were in question here. I tried doing behavioral intervention for urge surfing with him, but he was completely closed and only wanted the cigarettes. It was just a matter of days that demand for alcohol, cakes and non-vegetarian food started coming in from others. It was as if they were trying to trade off their anxiety and fear by getting these demands fulfilled. By this time, people started getting agitated and fighting within small groups. I started visiting these people almost daily. It was challenging to wear that suffocating PPE and not just talk to people, but to also form a sort of therapeutic alliance so that they could start opening up to my suggestions. All the non-verbal cues and soft skills of therapy like maintaining eye contact, sitting in proximity, using silence, or other micro skills were not of any use here. I had to be as verbal and clear as I could be. Most of the time it was diffusing the agitation and helping them calm down in my presence. Slowly the nursing staff, doctors on duty, and the mess staff started recognizing my efforts and need for psychological management. They would call me inside the building whenever the staff was not clear about how to handle and what to say to the people, especially the more agitated ones. I started briefing the staff on how to handle and what communication skills to use in order to calm their anxieties. By the end of two weeks of my quarantine stay I had challenged my boundaries and gained a lifetime experience. I had gratitude, prayer and compassion in my heart. I had grown from my own small self to a more open and kind person. So had my qualities that I needed to nourish as a clinical psychologist. I stood with the whole team on the fifteenth day when everyone was sent back to their homes in different states. I also happened to exchange some thoughts with the Health minister of the state and shared with him the fact that I was skeptical of the need for my services here initially, but that, at the end of the camp I had realized that mental health needed to be addressed along with the physical health and I thanked him to have thought about it as equally essential. When pandemic teaches lessons A month had passed and as I watched the news about the growing cases of COVID-19, I often wondered in utter dismay as to when and how it had turned into a national crisis. By this time 159

the information was reaching at the speed of light and all of us helplessly witnessed the collapse of an ongoing system around the world. Gradually the cases picked up in India as they did the world over and COVID-19 was declared a pandemic. There were no other discussions happening within families, with friends and colleagues. We all started to adjust with the new situations each day, at home as well as work. ‘Pandemic’ and ‘epidemic’ became the most searched words on Google. Travel plans were shelved. Schools were shut. And a new reality that no one is immune to this threat had started to dawn upon the world. On 22nd March, 2020 a nationwide “Lockdown” was implemented. A new word was added to the day-to-day vocabulary and it became a topic of household conversations. With newer words in our vocabulary and so much more information, I began the second phase of my duty at a different quarantine center. Despite my earlier experience, this time was not any easier. My previous knowledge did not make me feel confident, in fact it made me more apprehensive. We were all living a real and inevitable threat on the rise. It was my first day on the road after the lockdown and I found myself alone on one of the busiest highways in the country. I could not understand how to process it, it seemed like a scene from an apocalypse movie where the only sight was that of policemen barricading the roads with masks and gloves. As I entered the facility, I realized that the population was at a high risk since they were all elderly with medical co- morbidities and had come from abroad. There were 90 people in total and I decided to meet everyone and let them know that they can seek help anytime they need. As I started meeting them, I realized there were as many stories as there were people there. I met a family of 3 who were returning from abroad after completing the last rites of their young son who had died. They were bringing his ashes back to India. Then there was another lady who lived all alone in a small town in Haryana and was visiting her only daughter in another country. She had no one waiting for her at home after she was done with her quarantine stay. Each story had something different, something sensitive to make you feel small as a human. The stories were drenched with personal histories of trauma, displacement and uncertainty in the background of their age and vulnerabilities. This time was different for me since I learnt that there was a huge shortage of PPE and I could not afford to visit them every day. I offered my share of PPEs 160

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! to the visiting doctors and nurses who needed it more and I offered my help telephonically. Every morning I drove on the lonely and quiet roads and I would sit at the reception waiting for my phone to ring in case anyone needed to talk. It was one of the loneliest times I had spent in my life. Each day I was learning about new, not so happy developments in the country. The system that holds everything together seemed to crumble in front of my eyes. Shortage of equipment became huge, doctors were seen exhausted, kits were not available to test frequently and lockdown had started to play on everyone’s psyche. I feared coming back home to a small kid and elderly parents. A few days later, when I was trying to fit into the new normal for me, I saw hundreds of men, women and children walking on the highway. I wondered what could be the reason for this mobility. I stopped my car in curiosity and asked them where they were going? And they answered “home” . It just struck me that the migrant labour force had waited long enough and when things seemed hopeless for them they decided to go back to their original homes in search of safety. I realized this virus had not only threatened us biologically but seeped into the political, economic and social systems of nations, where marginalized people were bound to feel even more isolated and targeted. It was just a matter of days that the migrant crisis was known to all of us and some of us were moved to hear stories of hunger, homelessness and desperation. As clinical psychologists it’s imperative that we understand an individual’s life story woven by cultural, political, social, economical, and religious threads, to name a few. Genesis of any mental illness lies deep in these aspects of life. All these aspects give us a unique identity and history that we identify with and relate to vis-à-vis others. When the system fails, the poor of the country are hit the most since they are more vulnerable. The mental health knowledge around migration and culture, displacement, trauma that I gathered over the years came to surface and compelled me to identify in reality around me. The mental health crisis is here, I thought to myself. This crisis is not confined to the fear and apprehension around COVID-19 but the repercussions it has on the 161

social systems of the country. Pandemic has caused another pandemic! And as the theories of altruism and bystander’s phenomenon are conceptualized in books that I recalled from my masters, I witnessed there were people who came forward to help them, stepping out of their safety zones while for some it was pure apathy. Our personalities often behave differently in crisis and that is what happens if we notice individual responses around us. One day, as I stepped inside the facility I got an SOS call from the staff that a guest from the US, living in the hotel had harmed himself badly and they had no clue how to help him out. Since they knew I was stationed at that hotel for quarantined people they reached out to me and asked me if I could attend someone out of the way of my duty. I quickly responded without thinking if I am stepping out of my jurisdiction and role to help him out. But in that moment it was all irrelevant and as I went up to his room I found him in a pool of blood. The hotel staff had provided him first-aid and was in talks with the embassy to manage him, since no hospital was ready to take him for admission on account of self-harm and being a foreign national in times of the COVID-19 threat. What followed between him and me is confidential, but I cannot help but mention here that an existential crisis can cause extreme anxiety, hopelessness and meaninglessness in life. A situation like this COVID-19 pandemic could trigger all past traumas and vulnerabilities that lie buried in many, at different points of life. Uncertain times like these have a huge potential to destabilize the system within us which tricks into believing that “all is well” because we as social beings are busy with work, family, travel, shopping, consuming and spending, and that starts defining and giving us a meaning in life. When everything is paused we don’t know what to do with our lives, our time and how to identify ourselves, hence the existential crisis. Processing of an existential crisis When Viktor Frankl (1984) was confined in concentration camps he observed that people who have found meaning in any form would be more resilient to face the tragedy because their immunities supported them to fight and look on the other side of the suffering. And as he said “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s 162

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! attitude in any given set of circumstances, to choose one’s own way.” The people who chose hope in the deepest pain and something to hold on to; survive. The situation that we find ourselves in may be unique to us and no one could be empathetic enough to know exactly how it feels to be “me” but, we may choose to “Live as if you were living a second time, and as though you had acted wrongly the first time” Frankl, (1984). We find ourselves discovering some real hidden potential that propels us to survive calamities or tragedies. According to trauma therapists, trauma is not something that happens to us but our ability to exceed our coping resources especially in absence of an empathetic witness. While we see people responding to this who find coping through cooking, cleaning, meditating, finding new hobbies and attending more webinars, we also need to be mindful of the people who are struggling in their own unique way, responding to the challenges in the most primal ways they know. While we are careful of our correct processing of the whole situation, it is important that we provide empathy to others in order to reduce their trauma as well. By making such a stringent system where India witnesses tight lockdown in the country it is important that we are mindful of not creating stigma for those who are stepping out to care for us, and even for those who are infected. I cannot help but contemplate the reasons why a COVID-19 positive person commits suicide. There have been lots of such cases reported in the news across the country. Though it needs much deliberation and action, I could think of stigma, ostracism, uncertainty, isolation, disclosure of identity by police or authorities in their neighborhood that could cause shame and anxiety leading to suicide. It’s a flight response in the wake of intense trauma. Self-reflections As I am writing this and hear the news of “unlock 1” announced by the Government of India, I wonder where we go from here. Do we hold on to our old values or reframe new ones? Do we learn to hold space for others and be their ally even if it is by maintaining physical distancing? Do we become more mindful of how we live our lives and the choices we make? And above all do 163

we move ahead processing this collective trauma by cultivating kindness, humility and valuing quality over toxic productivity. As Frankl (1984) said, “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom”. As a therapist, I am learning to explore beyond my four-walled clinic where people come to me. I am learning new ethics on how to connect with people by making technology my ally rather than going by the traditional way of therapy (Manickam, 2020). I am learning to appreciate the contextual importance of a life story. I am learning to gain more skills on trauma informed therapy and incorporate it in my practice henceforth and above all as I am witnessing this in real time I am careful to process it with self-compassion and humility so I have the tools to teach my future clients as well as my child how to deal with uncertainties. Suggestions for my fellow psychologists The collective trauma that we have witnessed as humanity will claim a huge space in the collective unconsciousness. We will be talking about it to our future generations. There will be lessons learnt at individual, societal, national and universal level. There is no way we are going back to the same life as we knew it. We are discovering new ways of relating with ourselves and the world. We are going to make different choices hopefully which are more responsible as if we got healed through a trauma. Life changing events like this pandemic or Amphan cyclone or bush fires of Australia, or racial attacks in the USA or the current political climate of India in the recent past have lifelong bearings on the human psyche. They may pass as events, but the memory of the same is powerful enough to trigger the vulnerabilities in us. As clinical psychologists or citizens of the world we need to feel the responsibility and our role in these changes and realize the interconnectedness of human life. Only then can we understand a life story of a client in the post pandemic era from the viewpoint of all the psycho social systems. I will never forget that I share the same history of this pandemic with all my future clients. This interconnectedness and relatedness will take us from a trauma history to a healing future.

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! References: Frankl, V. E. (1984). Man's search for meaning: An introduction to logo therapy. New York: Simon & Schuster. Manickam, L.S.S. (2020). COVID-19 Pandemic: A time for prudent and ethical action. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.218-228). Thiruvananthapuram: The Editor. WHO (2020). India Situation Report. https://archive.org/details/whocovid19-indiareport1.

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18 CONTRIBUTIONS AND CHALLENGES OF PSYCHOLOGISTS IN PRIVATE PRACTICE IN INDIA AND THEIR RESPONSES TO COVID-19 DR. DHERANDRA KUMAR Consultant Clinical & Child Psychologist Founder, Psyindia & LRS World College Consultant, Apollo Hospitals, Noida & IIT, Delhi

Pandemics are testing times for all, including mental health professionals. The very fact that mental health professionals have to provide the services while dealing with the same challenges at the personal level which society is facing en masse, compounds the challenges. In the wake of the COVID-19 pandemic, mental health professionals have extended their unconditional support to the people in need, and most of it has been voluntary without any financial burden to the help seekers. Mental health professionals in private practice moved in first to respond to the psychological distress caused by the spread, the impact of novel coronavirus infections and to the subsequent lockdown. Many private practitioners informed their patients that they were reachable over the phone. They took to social media to make themselves available to the public at large without any fee and mentioned their time slots. Later, they formed small groups with rosters to make mental health services accessible for longer hours, and some groups even started to run 24X7 helplines. It is vital to note the altruistic behaviour of private practitioners as they shut their source of earning by running the free helplines. After this phase, government institutes, private medical colleges, and different associations started their helpline. Private practitioners formed a large chunk of the helplines run by IACP, RCI, IAHP, TNACP and other similar organizations. In addition to these helplines, private practitioners ran public awareness and 166

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! educational webinars for the general public, fellow professionals, and corporates. They participated in several shows related to mental health and wellbeing in radio and TV and reached out to a large section of the population to allay their fears and provide tools to handle their distress in a simpler language. The following types of problems were seen by private practitioners while working in helplines, telephonic consultations, and video consultations1.! Anxiety related to COVID 19: how harmful is it, will we be able to control it, feelings of uneasiness, vulnerability and similar concerns. 2.! Emotional and Behavioural manifestations related to the lockdown: feeling down, feeling trapped, disconnected, disoriented, irritability, anger, aggressive behaviour, etc. 3.! An aggravation of physical and mental health problems as a result of reduced physical activity. 4.! Relationship issues came to the front, and there were significantly increased instances of abuse and harm as members of the family had to spend most of the time together. 5.! In children, feelings of boredom, longing for open spaces, troubling parents as there were almost no channels of releasing the energy. 6.! Some home makers were quite frustrated as they were not getting personal time. For work from home parents, it was not easy to maintain a work-life balance as children were at home all the time. COVID 19 threw many challenges at private practitioners, and some of them are as follows1.! For many professionals. working in helplines was a new experience - as in telephonic counselling/support, many sources of information were missing, e.g., eye contact, facial expressions, body language, etc. Many times, it was difficult to infer the tone because of network issues resulting in poor call quality. There were challenges related to call drop, also. 2.! The shift from offline to online practice was not smooth, especially for the not so tech-savvy professionals. It posed challenges even for tech-savvy professionals as they were 167

3.!

4.!

5.!

6.!

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not exposed to the intricacies of online practice. Adopting this new mode posed challenges for behavioural adaptation and adaptation with technology. Many private practitioners were not familiar with the software interfaces and had poor knowledge of hardware requirements. It demanded new learning related to the hardware and software for service delivery. Even these modes of telephonic and video consultations resulted in higher analysis and reflection on the skill set that these professionals already had. It resulted in sharpening their skill sets even for offline interventions. Thus, it resulted in the self-growth of these professionals. Counselling young children is a significant challenge in telephonic and video consultations, and the therapist has to rely on the parents mostly, and the therapist has to take into account both the child and parental factors. Most of the practitioners were not well aware of the ethical and legal issues of online practice. The working solution was found as following the best practices of offline or face to face work and the laws for the same. There is no separate legal framework for online practice in India. In many cases, a blend of telephonic and video-based interventions had to be used, and there was a switch between telephonic and video-based modes of intervention. It was mainly because of the low internet bandwidth issues. Dilemmas about recording or not recording the sessions was a common theme in government and as well as private practice. As per the Tele-counselling instructions and NIMHANS tele-therapy practice guidelines, it was resolved in favour of not recording the sessions. It helped many private practitioners in making the decision. Many clients (old and new both) were hesitant in trying the online mode, and some of them rejected it outright. The exploration of the beliefs related to this showed that they thought- online sessions are not worth the money, these are not as intimate as offline ones, there are issues in using the technology, the sessions will not be effective, etc. In some cases, the clients were adamant to see the therapist in person despite the strict lockdown and the risk of being infected. In the case where assessments were needed, there were concerns related to the reliability and validity of these in 168

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! online or offsite settings. Another concern was the high cost of the online versions in the Indian scenario, and its limits in its accessibility for the masses. 9.! IACP and NIMHANS conducted webinars to guide professionals on different aspects of online practice. The NIMHANS webinars were primarily based on NIMHANS Tele-therapy practice guidelines, and these guidelines were framed with a multi-disciplinary government set-up in mind, and these helped private practitioners to some extent. Private practitioners have to balance the service, its delivery, and the consumer aspect. Most of the government hospitals do not take the consumer angle into account, and the same is reflected in the NIMHANS guidelines. IACP has formed a committee on ‘Tele-counselling Practice Guidelines’ with Dr. Dherandra Kumar as the chairperson, and the report is expected to come within the next two months. These guidelines will also cover aspects related to private practice. 10.! There has been a mushrooming of online counselling platforms, and entrepreneurs are investing money into these, and they are trying to disrupt the market. They are offering online counselling for meagre charges, and they are not much bothered about the level of training of the counsellors onboard. Their motto is to initially offer the services at a little cost to capture the market. In addition to it, they are not bothered about the ethics in marketing the mental health services as they see it like any other consumer business. It has increased the financial challenges of private practitioners further. 11.! Last but not least, there is a lack of support system for private practitioners, which is highly needed in the current world of disruption. Thus, we see that private practitioners rose to the occasion in the wake of COVID 19 and have played a significant role. They have faced significant challenges, and some of them they have addressed, and some remain to be tackled. Now, they have to address the mental health aspects of the continuing pandemic as it puts a considerable amount of stress on the society at large. 169

19 TELEPSYCHOTHERAPY: THE BRIDGE TO CONTINUITY IN CARE AND MENTAL HEALTH SERVICES IN COVID-19 AND POST COVID ERA SMRITI JOSHI Lead Psychologist, Wysa.io Researchers Murray and Lopez had shared projections in 1996 which suggested that the health burden due to mental disorders will record a 15% increase by 2020 (Murray and Lopez 1996). The pandemic that has now brought our world to a standstill in 2020, was not even imagined or its repercussions included in these projections or predictions made till date. Almost 2.6 billion people are in a state of enforced lockdown across the globe (Van Hoof, 2020). Following WHO (2020) guidelines around social isolation, which is being looked at as one of the key ways to prevent the spread of this deadly virus, people have lost access to many services, activities and even medical facilities as outpatient departments have been shut down or restricted to only emergencies. People with existing mental health conditions and those struggling with psychological distress arising from fear and anxiety of their loved ones or themselves being infected by COVID19, feel lost and helpless. The need for social distancing has also led healthcare providers including mental health service providers like psychologists and counsellors to suffer economic losses and feel guilty about not being able to assist their clients as they would have done in pre-COVID-19 times. There already exists a huge gap between service providers and end users in India, as 70% of the population live in rural areas with limited access to mental health services (Murthy & Ramaprasad, 2010). It seems like people across the globe are grieving for losing how we were living just before COVID-19 struck. The uncertainty and lack of a road map is keeping people in a hyper vigilant mode, constantly scanning for threat and losing their “here and now”. 170

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! Some themes that stood out in conversations with Wysa, an emotionally intelligent chat box and with therapists on their online therapy platform, were feelings of collective grief: a sense of invisible loss, loss of safety, loss of routine/connection with outside world/loss of not being able to do things that gave them joy, because of quarantine or other restrictions, loss of job or fear of it, losing a loved one to COVID-19 or because their loved one is a frontline COVID-19 worker.( Becky et. al, 2020). It is being called the world's largest psychological experiment and everyone is in the experimental group (Van Hoof, 2020). Various Indian organisations that provide mental health services and training like the National Institute of Mental Health and Neuro Sciences (NIMHANS) and the professional body for clinical psychologists- Indian Association of Clinical Psychologists (IACP) and their various state chapters, in coordination with government-run mental health programmes, are trying their best to provide crisis intervention helplines for general public. To make sure that these crisis helplines are able to offer the intended support, these organisations have also framed guidelines and are providing online training via webinars to help the fraternity members make this shift from in-person sessions to be volunteers for these telecounselling helplines. But most of this shift has been triggered by the COVID-19 and there still are concerns about how to deliver telecounselling or telepsychotherapy in an ethically and legally safe way. The purpose of this article is to highlight the need for telepsychotherapy not just as a bridge to continue providing mental health support during these times of social distancing and lockdowns but also as an independent field for delivering mental health services. This paper also takes a courageous attempt at suggesting national level recommendations to help this field deepen its roots in our country and discuss ethical challenges and solutions to these challenges that will not only help in delivering tele psychotherapy legally and ethically in these times of the pandemic, but even beyond.

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Telepsychotherapy- Why now? The concern is not limited to only COVID-19, but the pandemic is a public mental health crisis as well. Considering the barriers posed by the need for social (read, physical) distancing, tele-psychotherapy seems like a viable option to not only manage the mental health impact of the pandemic and economic crisis, but also offer preventative solutions that help with building resilience skills, especially in view of the Pre-COVID-19 research which already indicated that by 2030 depression will be the leading cause of disease burden globally (Becky et.al, 2020). According to Inter Agency Standing Committee report (IASC,2020), the current need is to not only cater to those already suffering from mental health disorders or those at high risk due to (a) a history of previous emotional problems, and (b) exposure to severe stressors during the pandemic, but to also prepare oneself to meet the second wave of mental health problems one may see in the latter half of 2020. This may also include people with stressors like severe life-threatening illnesses, death of loved ones, severe financial hardships and economic losses (e.g., due to social distancing), stressful experiences during quarantine (e.g. severe symptoms combined with absence of contact with friends or loved ones) and burn-out from caregiving, especially healthcare providers or members of our own fraternity. To meet these needs, we need to assess cost-and-time saving, easily available resources with both clients and mental health service providers so that both parties are able to reach out and be available for psychotherapy/counselling sessions. Mobile phones or other electronic devices and the internet then becomes the most common and reliable resource to form this bridge between the mental health service providers and the clients. This is where Telepsychotherapy or telecounselling service comes in as a great alternative to in-person sessions. Lee (1998), president of American Counselling Association said in one of his speeches, “…to think that clients in the new century would not expect to access Internet counselling services is probably foolish and short-sighted on our part”. Telepsychotherapy or telecounselling is defined as, ‘the process of interacting with a licensed psychotherapist/qualified counsellor online in ongoing 172

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! conversations over time when the client and therapist are in separate or remote locations and utilize electronic means to communicate with each other’ (Bloom 1998). The electronic means of communication could be text-based chat, audio, or video, both for scheduling sessions and for provision of psychotherapy and also used in a blended way. Online therapy/counselling services could be delivered to and received by individuals or as a group (Amulya, 2020). Modalities for offering these services can be differentiated in terms of Time of service delivery—whether an intervention is delivered in ‘‘real-time’’ (synchronously) like live video or audio or text-based chat, or is delayed (asynchronously) like email or web- based self-help programmes. Online counselling or therapy, can be the first step for many in their journey towards mental health services for clients previously unwilling to seek treatment (Heinlen, Welfel, Richmond & Rak, 2003; Rummell & Joyce, 2010). These online services can offer additional support for existing in-person therapy (Wodarski & Frimpong, 2013). This pandemic has now brought up new realisations around helpfulness of offering mental health service, especially bringing teletherapy and telecounselling to the forefront as this is one way to provide crisis support, especially when most states in India are still under enforced lock down or people who have tested positive are in self-quarantine. There has been a rise in demand for online therapy/counselling since the past 2-3 months. Wysa has witnessed a 77% increase in new users during February to March 2020, as compared to the same period in 2019. Also, the number of clients who referred to the term COVID-19 during Wysa Coach/Therapist sessions increased week-on-week during March 2020, from 5% in the first week to 60% in the fourth week (Becky et.al 2020). Perspectives on Support for Growth of Telepsychotherapy in India One cannot emphasise enough on the role that government and policy makers play in managing any disaster - man made or natural or a health crisis like COVID-19. Any number of hotlines or 173

outreach work may not have the desired impact, as social distancing may be a barrier, especially in reaching out to those in remote areas or containment zones. Conventional telemedicine is offered in India for quite a few years by ISRO and the Apollo Telemedicine Networking Foundation, which have served more than 100 hospitals, provided training and have also helped set up telemedicine delivery centres in disaster/crisis locations during catastrophic times (Ganapathy & Ravindra, 2009). We can try to replicate similar models of telepsychotherapy/ counselling services during these critical times. Video conferencing seems to be a suitable modality to deliver mental health services to rural areas in our country as it can easily help bridge geographical distances and break educational and technical literacy barriers assumed to be present in the rural population (Joshi, 2017). Allocation of funds for bringing in telepsychotherapy health facilities within existing clinical settings like primary healthcare centres or private healthcare providers in remote areas is one way to reach the maximum people during this public mental health crisis (Manickam, 2020). Insurance providers should be encouraged to provide insurance support to clients accessing mental health support via telepsychotherapy facilities to encourage providers and clients to use these platforms. Steps to ensure smooth transition: Potential Challenges and Solutions Imagine sitting in one’s own office or a room in one’s house, using one’s phone or laptop to connect with a client who is seeking therapy for a mental health concern. It may seem like a mockery of what one has learnt about the relevance of the physical setting of a therapy room. It does challenge the traditional way of providing or receiving empathetic therapeutic support in the presence of one’s therapist or counsellor, where the therapist can observe verbal and non-verbal cues and offer appropriate tools/strategies to the client. How does one ensure that the standards of care and ethics that are followed in in-person sessions are followed even when client and therapist are not in the same room? Will the therapeutic alliance be as effective as in-person therapy? Research studying efficacy and therapeutic alliance on various online modalities like audio and video based sessions revealed that clients reported experiencing 174

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! good working alliance and close contact with the therapist and also felt that therapy received was more customised suiting their needs, helping them improve the understanding of their condition (Egede et al., 2016). Poletti et.al., (2020) reviewed 18 studies on telepsychotherapy and results revealed that even though therapists and general public may be skeptical about providing or receiving therapy via video-based sessions, it has been found to be a trustworthy alternative and efficient in treating mental health disorders like anxiety, depression and post-traumatic stress disorder. With such research backing telepsychotherapy, these services are quickly gaining popularity in India as well, and currently, even the most sceptic providers have to make this shift catalysed by COVID-19, as it seems to be the only alternative available. To help with a smooth transition it would help to go over these challenges listed below and potential solutions to these challenges. 1.! Client suitability Providers and clients may find it hard to adjust to this sudden, almost forced shift towards adopting this new way of providing or receiving services. For some therapists the novelty and perceived ease in offering service via these modalities can make them reach most of their clients. Assessing client suitability is based on a.! Severity of pathology or crisis the client is facing. b.! Technological literacy and accessibility to the internet and devices supporting the modality via which you wish to offer telepsychotherapy sessions. c.! A safe space, especially for the client to help them feel safe and reassured, is important to avoid turning this experience into an unpleasant, uncomfortable one for both sides. d.! It is best to first offer this to those clients with whom a good therapeutic alliance has already been formed to facilitate a smooth transition. Any gaps noticed in one’s work with these clients can then be filled in during work 175

with new clients- so plan this transition in a phased manner. 2.! Informed Consent and Record keeping Informed consent and documentation of professional work as well as session records, records of financial transactions, and crisis scenarios and steps taken is as essential for telepsychotherapy/telecounselling practice as it is for in-person sessions. It is important to communicate with the client in writing, about the modality and process of interaction, the potential benefits and risks of online therapy (e.g. specific confidentiality issues, data security), crisis management process etc., fee for different modalities and what would happen in case of missed sessions from either side related to telepsychotherapy must be understood by the client. If telepsychotherapy sessions are being offered as a temporary measure to clients (e.g. during the COVID-19 pandemic or any other scenario), then this must be explicitly stated and discussed with the client and consent obtained for the same. 3.! Competence As psychologists prepare themselves to make this shift, they should: a)! Remember to provide these services within the boundaries of their skills learnt from their training and supervised work experience and what is defined in their scope of work by their professional or licensing body (Chenneville & Schwartz-Mette, 2020, Manickam, 2020). b)! Share available evidence of one’s competence or skills advertised on a website or any other space, say social media. This could include proof of identity, qualifications, relevant experience (including experience in providing online services) and membership in any official registers/licensing boards and any relevant statutory body. c)! In India, as of now, telepsychotherapy is not a part of any post graduate curriculum. Even though a lot of basic competencies and skills for offering psychotherapy via telemodalities would remain the same, there are some unique skills and knowledge needed to offer services via this 176

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! modality. For example, it is mandatory that psychologists train themselves in skills to foster a good working alliance in the absence of visual cues, or learn how to deal with communication breakdown if the session gets disrupted. Professional consultation/supervision with experts in emental health and undertaking continuing professional development courses targeted towards such skills is recommended. Some institutions offering courses in telecounselling/telepsychotherapy are: a.! Tele Behavioural Health Institute https://telehealth.org/ b.! Online therapy Institute https://www.onlinetherapyinstitute.com/ c.! https://www.zurinstitute.com/course/certificatein-telemental-health/ 4.! Crisis Management: Discuss crisis management procedures during the intake process itself- like, what if a client reaches out to the provider/helpline during off-hours and if during a crisis the therapist may break the confidentiality clause to fulfil the duty of informing authorities to provide appropriate help. a.! Collaborate with clients to help them build a local support network. b.! Misunderstanding can happen due to technical glitches or reading too much or too little from cues available about the client via tele-modalities. Make sure you have discussed ways to deal with these potential misunderstandings to ensure a good therapeutic alliance. c.! Monitor all clients throughout telepsychotherapy to see if they need to be referred for in-person work or emergency services. d.! Establish in-person clinical support for clients in their geographic location. e.! Have relevant emergency phone numbers on hand during each session. f.! Last, but not the least, maintain your session notes, share them with clients and also record all 177

communication around any crisis event/plan made and referrals made and ensure that this data is safe and protected in your devices. 5.! Need for Guidelines/Regulating body: Absence of clear policies and guidelines about the delivery of telepsychotherapy can be one of the major challenges that can make clients or therapists feel wary of using this modality. NIMHANS (2020) and IACP (2020) guidelines for telepsychology and telecounselling were framed just in time to help professionals feel comfortable and confident in initiating telepsychotherapy practice. Remember, the key is to maintain the same ethics and professional standards of care and practice that are required in an in-person practice. Reach out to your supervisors/professional bodies for clarity in times of doubt and keep referring to any relevant acts like the mental health act or data privacy act applicable in your jurisdiction. 6.! Burn out Being in a helping profession can make a therapist or counsellor vulnerable to vicarious trauma and compassion fatigue, in addition to facing one’s own fears or anxieties about this pandemic. As a result, therapists might struggle to accomplish adequately their professional duties towards telepsychotherapy. Seeking supervision from a designated supervisor or one’s peers to discuss not just difficult cases but also emotional challenges that one would be feeling as an occupational hazard due to exposure to other people’s pain or from self-doubt about one’s ability to help people in the best way, would be a very helpful strategy to manage burnt out. Referring clients to other mental health professionals, for instance, those clients whose concerns lie outside your professional boundaries, or, if you feel there’s a client who might benefit more from speaking to a counselling psychologist or psychiatric social worker, would be very helpful in managing one’s case load. Having time for self-care plus selfreflection on a daily basis could help a lot with managing feelings of fatigue and burn out.

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! Conclusion The benefits of telepsychotherapy surpass its limitations, especially during the current pandemic. Studies on telepsychotherapy reveal the advantage as: increased care access, enhanced efficiency, reduced stigma, ability to bypass diagnosis-specific obstacles to treatment such as when social anxiety prevents a patient from leaving the house (Aboujaoude, Salame & Naim, 2015). Tele-psychotherapy practice and research investigating objective and subjective experiences of illness, suffering, altruism, dedication, what is working or not working in terms of treatments and treatment modalities would be precious to help both psychologists and the clients to sail through these difficult times together. There is a need to closely monitor this upcoming field and treat the current guidelines as working guidelines and update them to include any specific steps to take when addressing our multicultural and diverse population. It is also important that telepsychotherapy or telecounselling is offered as a specialization or a part of the post graduate courses in psychology/counselling as this indeed is one of the specialised fields and an early exposure to it will help with well-researched, improved list of skills and competencies specifically required for offering psychotherapy via various tele modalities. References Aboujaoude, E., Salame, W., & Naim, L. (2015). Telemental health: A status update. World psychiatry: official journal of the World Psychiatric Association (WPA), 14(2), 223–230. https://doi.org/10.1002/wps.20218 Amulya, D. S. L. (2020). An experiment with online group counseling during COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp. 182-197). Thiruvananthapuram: The Editor. Becky, et al. (2020). Early warning signs of a mental health tsunami: Initial data insights from digital services providers during COVID-19 (Preprint). 10.2196/preprints.19903. 179

Bloom, J. W. (1998). The ethical practice of Web Counseling. British journal of guidance and counselling, 26(1), 53-59. Chenneville, T., & Schwartz-Mette, R. (2020, May 21). Ethical Considerations for Psychologists in the Time of COVID-19. American psychologist. Advance online publication. http://dx.doi.org/10.1037/amp0000661 Egede, L. E., Acierno, R., Knapp, R. G., Walker, R. J., Payne, E. H., & Frueh, B. C. (2016). Psychotherapy for Depression in Older Veterans Via Telemedicine: Effect on Quality of Life, Satisfaction, Treatment Credibility, and Service Delivery Perception. The Journal of clinical psychiatry, 77(12), 1704-1711. Elke, H. V. (2020). This is the psychological side of the COVID-19 pandemic we were ignoring. Retrieved from https://www.weforum.org/agenda/2020/04/this-is-thepsychological-side-of-the-COVID-19-pandemic-that-wereignoring Ganapathy, K. & Ravindra, A. (2009). Telemedicine in India: The Apollo story. Telemedicine Journal of E Health, 15(6):576"585. doi:10.1089/tmj.2009.0066. Indian Association of Clinical Psychologists. (2020). Telecounselling Instructions during COVID 19 for volunteers. Retrieved from http://iacp.in/wpcontent/uploads/2020/04/Tele- counselling-InstructionsApril-7.pdf Inter-Agency Standing Committee. (2020, March 4). Interim briefing note addressing mental health and psychosocial aspects of COVID-19 outbreak (developed by the IASC's reference group on mental health and psychosocial support). https://www.who.int/docs/defaultsource/searo/whe/coronavirus19/iasc-interim-briefing-noteon-COVID-19-outbreak-sl-e.pdf?sfvrsn=a5bbbab4_0 Joshi, S. (2017). Online Psychotherapy: Current Status and Future Prospects. In A. Shukla & A. Dubey (Eds.) Mental Health: 180

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! Psycho-Social Perspectives (Volume:4 Therapeutic Applications) (pp 164-192). Delhi: Concept publication. Lee, C. (1998). Counseling and cyberspace. Counseling Today, 40(10).

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Murray, C. J., Lopez, A. D., & World Health Organization. (1996). The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020: summary. World Health Organization. Manickam, L.S.S. (2020). COVID-19 Pandemic: A time for prudent and ethical action. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.218-228). Thiruvananthapuram: The Editor. Murthy, S. K., & Ramaprasad, D. (2010). Family Burden and Rehabilitation Need of Beneficiaries of a Rural Mental Health Camp in a Southern State of India. International Journal of Psychosocial Rehabilitation, 15(2). 5–1. National Institute of Mental Health and Neuro-Sciences. (2020). Guidelines for tele-psychotherapy services. Retrieved from http://nimhans.ac.in/wpcontent/uploads/2020/04/Guidelines-for-TelepsychotherapyServices-17.4.2020.pdf Poletti, B., Tagini, S., Brugnera, A., Parolin, L., Pievani, L., Ferrucci, R., ... & Silani, V. (2020). Telepsychotherapy: a leaflet for psychotherapists in the age of COVID-19. A review of the evidence. Counselling Psychology Quarterly, 1-16. Wodarski, J.S., & Frimpong, J. (2013). Application of E-Therapy Programs to the Social Work Practice. Journal of Human Behavior in the Social Environment. 23 (1), 29-36. Doi: 10.1080/10911359.2013.737290. WHO. (2020, April 29). https://www.who.int/emergencies/diseases/novelcoronavirus-2019/advice-for-public 181

20 AN EXPERIMENT WITH ONLINE GROUP COUNSELING DURING COVID-19 D. S. L. AMULYA

Counseling Psychologist, Bengaluru Introduction The COVID-19 pandemic has necessitated that the majority of work and interactions be moved online. This has impacted the field of counseling and psychotherapy as well. There are numerous options currently for individual counseling online. The unique psychosocial challenges of the COVID-19 crisis provide good reason for creating group therapy spaces online too. Group counseling is a distinct format of mental health support and intervention wherein people gather to work together on wellness goals, as the group is facilitated by one or more mental health practitioners. The facilitator of the group is called the ‘group leader’ and the clients or participants in the group are referred to as ‘group members’ (Whittingham & Martin, 2020). Group counselling has unique advantages. Members in a counseling group discuss similar issues within the sessions and benefit from having shared experiences, building relationships, and receiving support from one another (Veder & Beaudoin, 2016). The group becomes a therapeutic space where people can discover commonalities in their experiences and not feel alone in what they go through. Amidst the ongoing COVID-19 crisis, there have been drastic changes that demand adjustment, and a difficulty or failure in adjustment can bring about emotional disturbances. A glaring concern that people are encountering at present is the strain of social distancing. Nearly everyone is in some form of distancing or isolation right now, and each person experiences the enormity of this situation in different ways (Epley, 2020). The basic need for connection is compromised for a lot of people during the lockdown. Deprivation of social connection during times of stress and illness can aggravate the stress and illness (Kanter & Kuczynski, 2020). Hence there is great promise in coming together in these times through regular meetings where people can set goals for 182

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! themselves and support each other in reaching them (Inverso, 2020). Since face-to-face group sessions are not feasible at this point, such spaces can be created online, to make them available and accessible for people who may benefit from group support. Online counseling groups can provide the necessary opportunities for connection, a sense of community and togetherness. The potential of online group counseling as a novel therapeutic medium is just beginning to be explored (Bellafiore, et al., 2019). Online support groups, counseling groups and psychotherapy groups are gradually evolving. This paper outlines the rationale and process of providing group counseling online, through a detailed account of an online counseling group held in the month of May 2020. This group was an initiative to create a safe and supportive space for clients to work together on self-care goals. In addition to this, the paper also includes perspectives gathered from interviews of professionals currently running online groups for mental healthcare. This paper records observations and relevant inferences drawn about the potential of creating such therapeutic groups online in response to the ongoing pandemic crisis. Rationale for Online Groups Some of the general hassles a client might encounter while looking for group counseling services are, finding a suitable group in an accessible location and one that functions at convenient timings. Since a counseling group extends for a continued period of a few weeks to months, clients also have to consider whether or not they can make that kind of continued commitment to a particular group. Online groups resolve such issues. The group can be accessed from the comfort of one’s own home and offers the convenience of not having to commute or travel to a specific place, making it more economical as well. Moreover, there is the advantage of richness of diversity and variety of experience that comes with people joining from different and distant locations. Online therapy can be delivered through modalities that are synchronous (chat, audio and video conferencing) or asynchronous and this classification is based on the immediacy of communication 183

and exchange of information (Joshi, 2017). This provokes a thought on what kind of modality might be more suitable for group counseling, especially considering approaches where here-andnow processing of what comes up alive in the moment is important for group therapy work in general. The Role of Technology At times like these, when the prescription of the government is to distance oneself and stay indoors, contact with people who stay away has become primarily virtual and over online media. People have been required to make a rather drastic shift to the digital world, for the purposes of work, meetings (official and personal) and just to stay connected. Technology undoubtedly plays a vital role in this process. Mental health professionals are embracing technology by transferring workshops, webinars and therapy sessions online. Progressively more mental health providers are banking on telehealth services to connect with patients for online counseling. Online counseling broadly refers to professional mental health services provided via the internet through chat, audio and video sessions. It is a great way to avail professional therapeutic support when it is not possible to be physically present for sessions. In response to the pandemic crisis, there has been a surge in private and public helplines that people could reach out to for support. It comes with additional benefits of anonymity, easy access, saving on commute time and expense, and the possibility of reaching service providers located remotely or far away. Having such options can help people assuage the sense of loneliness, lack of control, anxiety and isolation that the crisis creates. Online counseling services also need to adhere to the ethical and professional standards of practice that are required when providing in-person psychological services (APA, 2013). Mindful use of appropriate technology becomes especially critical for the purpose of defining a safe and reliable meeting space for therapy online. A thorough exploration of suitable online platforms can be helpful, while shifting counseling services online. Interviews - Online Group Ventures in India After an exploration over social media platforms and discussion with contacts about existing online group initiatives 184

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! within the country, two mental health professionals - Anando Chatterji and Shivangi Lakhlani - who have ventured into online group work for mental healthcare with diverse approaches, were identified and interviewed. The interviews were unstructured, tele interviews, with the primary purpose of gathering perspectives about online group work and its implications. Anando Chatterji, the CEO of Hank Nunn Institute, Bengaluru, is a psychotherapist who works with individuals and groups. His work is primarily driven by the approaches of group analysis and therapeutic communities. He mentioned the term “Scree’lational Psychotherapy” to refer to therapeutic relationships that are developed and processed over a screen. He suggested that adequate planning and preparation to work through challenges and anxieties can ease the shift to online work. (Chatterji, 2020a). Ethical issues such as informed consent and regular supervision become all the more relevant as therapists shift to online work (Chatterji, 2020b; Joshi, 2020). Shivangi Lakhlani, founder of the social start-up “Her Move-Meant”, is a contemporary dance choreographer with training in expressive arts therapy. She conducted two of her online groups over social media platforms like Whatsapp and Instagram. These projects created virtual communities of sorts, where people could gather and experience a sense of togetherness. Currently she is co-leading a support group with the expressive arts approach. In face-to-face groups, one can provide art resources but in the online group setup, there is a limitation of having to work with what clients can access around them (Lakhlani, 2020). Both the interviewees expressed concerns about technological glitches, privacy and safety issues, connectivity problems and the loss of personal connection and energy (that faceto-face meetings can foster). On a positive note, people from distant locations were accessing the online groups and some of the clients shared more over the online groups than in the face-to-face meetings.

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Online Group Counselling for Self Care Background During the lockdown following COVID-19 pandemic, friends and their family members shared about challenges they were facing in looking after themselves and engaging in healthpromoting behaviours. Some people expressed difficulty in implementing and adhering to self-care goals, although they had plans in place for the same. In response to this, the counseling group was planned as a safe space online that people could access to work with others on achieving their self-care goals. After a rigorous exploration of various web-conferencing platforms, ‘Zoom’ (meetings version) was chosen and finalised as the appropriate platform for conducting this counseling group. The rationale for this included, some essential features that the Zoom application provides, including gallery view of all members (so that all members can see one another at the same time), options to share screens (to share and discuss relevant content), and option of a ‘waiting room’ to selectively allow entry of members (to ensure a check on privacy and security). Moreover, the application is widely accessible. The procedure to join meetings is convenient, requiring a simple download of the application on one’s device (laptop or mobile phone). Emails with detailed instructions about joining the meetings, and usage of the platform were shared with the group members before the group began. The theoretical approach for the group was primarily behavioral and action-oriented. The group process was planned to involve the stages of rapport building, goal setting, planning for action, acting on goals while tracking progress, feedback, summarization and termination. Launching of the Online Group The online counselling group was announced on 27th April 2020 and it was facilitated by the author in the month of May 2020, to respond to the self-care needs and goals of people. The counseling group was designed as a closed group, with space for eight members. The group was conducted for 8 sessions, across a span of four weeks. Two sessions were held every week with a duration of two hours for every session. Innovative methods were applied to explain the idea of a counseling group as well as the purpose, its potential benefits and limitations. The registration 186

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! process and intake was hassle-free and was made through the use of suitable technology and online applications. The first group session was conducted on 6th May 2020 and the last session was on 29th May 2020. As the group was launched, pre-group interviews were conducted over a phone call, before finalising the registration of each member. The objective of the interviews was to explain and clarify the purpose of the group to the potential client/member, explore their interest and check for alignment between their goals and the goals that the group is designed to serve. Accordingly, the person was either taken in to the group, or guided to other relevant sources of support. The first session involved particular focus on gathering informed consent of the members participating in the online counseling group. Time was set aside in the first session to intentionally discuss and address members’ feelings about connecting online for counseling. A brief orientation was done in the session, to familiarize them with the platform. Potential issues that might occur in online meetings and possible options of addressing them were noted. This discussion becomes relevant, especially considering how the group process would involve sharing and responding to one another, and any technical issues obstructing that process could cause inconvenience and may create misunderstandings. The group then proceeded along the lines of a structured plan. The objectives of the group were made explicit to all, and it was designed for working on self-care goals that members choose for themselves. The emphasis was on behavioural change along with the facilitative interpersonal forces of the group. Facilitative Forces in the Online Group Members expressed a sense of togetherness in their experiences and a relief in knowing that they are not alone. Relating to others’ experiences also elicited empathetic responses and altruism from individual members as they acknowledged each other's struggles and conveyed support. Members had the opportunity to connect within the group as they shared information and modelled helpful behaviours. For instance, one of 187

the members defined her goal as communicating her emotions without feeling guilty. This inspired another member to think about how it was relevant for him as well, and he chose that as one of his goals for the future. Members experienced significant emotional and interpersonal dynamics during the course of the group. For example, after the first session when one of the members expressed his desire to discontinue the group and wanted to proceed with individual therapy, the rest of the group responded with immense care and understanding. Each of them conveyed to him what his presence meant and expressed their wish to have him continue with the group. The love, support and acceptance that the group communicated eventually influenced his decision and he continued in the group. This was a very powerful and heartwarming instance of the therapeutic interpersonal forces of a group. It was enlightening to witness how this was possible in the online group as well, despite people connecting from places apart. Over the course of the eight sessions, the group displayed the capacity to listen actively, convey acceptance of each-others’ pace and position, positively affirm one another, and also internalize some of the nurturing messages for oneself. They were able to form a bond that was powerful as well as influential, so much so that in the final session, at the very end, none of the members wanted to exit the meeting and they stayed on despite the session ending. The group leader addressed the same and the group requested the leader to end the meeting, as they were not able to. One of the members also highlighted this as an experience of a strong bond, which made the exit difficult at that moment. Hence, it wouldn’t be groundless to say that the facilitative principles of the group process can very much be created and experienced in online groups as well. Role of the Group Leader Similar to face-to-face groups, the leader’s role in online group counseling involved preparing a plan for the eight sessions and outlining the structure of the same. The leader played an active and mindful role in encouraging members to share, listen and offer support to each other. The leader spent adequate time on introducing members to the platform (Zoom), and discussing the 188

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! procedure and implications of using it. In the first session one of the members was not able to access some of the features of the platform. Separate time was allotted by the group leader, outside of the sessions, to explore and fix the issue so that the member could join in comfortably for the remaining sessions. Conducting the session as per the time and plan, while ensuring that every member had an opportunity to be heard and supported with their experiences was a challenge. When the audio or video was unclear and members had to repeat what they shared, it disturbed the session flow. Besides, disruptions in internet connectivity created hindrances. In some instances, a member would begin speaking and all of a sudden they would exit the meeting due to network disturbances. The leader would collaboratively decide along with the members about how to proceed in such situations. Accordingly, the group would move on to another member’s sharing or wait together for the member to join back. Despite the possibility of such disturbances being addressed initially, they nevertheless brought abrupt pauses and discomfort within the group. The leader managed the same by checking and encouraging members to talk about their feelings in the moment. Punctuality and attendance were repeatedly emphasised along with explaining the rationale and when some members joined in late or did not attend a session, it was handled mindfully by the leader. Members who attended regularly and punctually were acknowledged with verbal reinforcements and had the opportunity of sharing first or choosing the direction of an activity. Tools and Techniques Ice breakers and other activities were planned and developed for the group, to suit the online sessions. Members shared during the course of the group that they found the activities relevant and engaging. Psychoeducation and sharing of content happened during the sessions through the “screen share” feature in Zoom. Outside of sessions, a google group was created as a space for members to share content and communicate with one another as necessary. The messages and posts on the group were moderated by the group leader. 189

After action plans were finalized, members were paired with one another as ‘buddies’, to support each other in their attempts at action. Progress was tracked through the use of ‘google sheets’. Discussion of members’ experiences and progress was done with reference to the sheet, and supplementary questions. The group actively participated in the feedback process and moved towards termination. While outlining the ethical considerations surrounding the termination process, Chenneville & Schwartz-Mette (2020) suggested that psychologists must ensure to process termination fully and adequately in online sessions just as in face-to-face sessions. Further, they need to provide appropriate referrals for clients who need continued support. Keeping such essential considerations in mind, adequate time was spent on the termination process, to address members’ feelings and allow space for communicating messages before closing. In the final session, an activity involving the shared “whiteboard” over Zoom was used to invite members to create a piece of art to depict their feelings and experiences. This feature allows all members to ‘annotate’ on the same board. Each member chose a colour and drew on the board. This activity was fun and allowed members to bond and playfully engage with each other before sessions came to a closure. Working through Challenges As anticipated, there were some challenges due to internet connectivity issues and technical glitches which caused interruptions in the flow of sessions. The preparation for the same in the very first session made it easier to address and work through them. During the course of the group, there were occasions when some members were not able to switch on their videos due to low internet bandwidth and hence knowing the attendance of a member in the ‘meeting’ was a challenge. The options of keeping videos on or off during the session creates an additional possibility where a member is technically logged into the meeting, but can physically be away by keeping the video off. It might be helpful to factor in this “present-but-absent” scenario as a possibility in online groups, and to find ways to address the same. Calling out to them and checking from time-to-time became necessary to ascertain their presence and this also disrupted the flow of the sessions. Keeping these aspects in mind, members were requested to keep their 190

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! videos on to the extent possible, at least at times when they would speak. Members were understanding and cooperative. A downside noticed with members connecting from home, was the greater chances of distractions and interruptions. Such issues would not arise in face-to-face sessions where the group would meet in a separate physical location that already sets a definite boundary. Confidentiality and privacy were addressed within the scope of these distractions coming up in the online sessions. Preparation also involved noting and addressing the potential issue of “zoom fatigue”. Zoom fatigue is a novel term used to refer to feelings of fatigue and burnout while video conferencing, due to audio/video disturbances and just the idea of having to stare into a screen for extended durations to communicate and process information (Fosslien & Duffy, 2020). Keeping this potential issue in mind, sufficient breaks were included in each session so that members could ‘switch off’ and look away from the screen for a few minutes. Outcomes of the Group The group smoothly proceeded through the stages of forming, norming, performing and closure. Members’ attendance in sessions was recorded. It can be noted from Table 1 that four of the eight members (50%) attended all the eight sessions in full. Table 1. Attendance of members in the 8 sessions Membe Number of sessions r attended In full In part M1 8 M2 4 1 M3 4 1 M4 8 M5 4 1 M6 8 M7 8 M8 5 1 Note. Members’ names are coded as M1, M2...M8 in alphabetical order of their names. 191

The remaining members have fully attended at least 50% of all the sessions. The reasons for the absence (in part or full) included unavoidable personal reasons and lack of internet connectivity. When some of the members had such emergencies, they were able to attend at least a part of the session instead of having to miss the whole session. Flexibility was possible as members could connect remotely for sessions, without the need to travel/commute to the session location. A specific instance of hassle-free adjustments was when a member (coded as M2) joined in late for one of the earlier sessions. The reason was that the lockdown was lifted in his area and his new work timings interfered with the schedule of the group counseling sessions. The group members were invited to respond to the same, and it was mutually decided by all the members that the timings be accordingly revised, to accommodate member M2’s circumstances. In terms of progress with goals, seven out of eight clients were able to initiate healthy behavioral changes. One of the members (coded as M5) struggled to make the changes she had planned, which was also one of the reasons she was not able to attend some sessions. Upon encouragement, she was able to use the group space to share her concerns and eventually identify the kind of support she needed. This was an instance of how acceptance from the group encouraged the member to trust and share about one’s unique experiences without feeling excluded or judged. Members were able to help one another through goal setting, tracking progress and communicating feedback constructively. There was space for sufficient summarization and the group was terminated with closure. Feedback from Members After the closure of the group, members were invited to share feedback about their experience, by responding to a ‘google feedback form (available with the author) to get responses anonymously and 5 of the 8 members gave their responses. While 60% of the group had responded, it also raises a question as to why the remaining members did not. This might indicate that even though the members expressed positive feedback within the group, they might have had some inexplicable concerns that they were not able to voice out. Some earlier studies on online 192

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! group counseling have identified themes in members’ negative experiences such as superficial engagement, feeling disconnected from one another or other general risks and disadvantages of connecting online (Kozlowski & Holmes, 2014; Barak et al., 2008). The reasons for not sharing feedback could hence be multifold - in terms of dissatisfactory experiences in the group or some unrelated personal reasons. Diversifying the means of eliciting honest feedback might be helpful in this regard. The feedback from the 5 members showed that they found the experience of the group to be good or great. All the 5 members have given positive feedback for the group structure and process (content, plan and activities), leader’s approach (style and support), safety and freedom of sharing in the group (no privacy concerns or judgments experienced) and convenience of the platform (Zoom). Another aspect that was checked was members’ preferences for online or face-to-face meetings for sessions. Studies have generally shown an inclination of members towards face-to-face group sessions than meeting online (Kozlowski & Holmes, 2015; Kit et al., 2014). Majority (60%) of the members shared that both (online and face-to-face meetings) have their pros and cons and that they do not prefer any one over the other. The remaining 40% mentioned that face-to-face meetings are better. The concerns shared by members included internet issues, disappointment due to the absence of other members in some sessions and inconvenience with some sessions not starting on time (when someone joined in late). One of the members shared that they would have liked the group to extend for longer. Interestingly, all 5 of them (100%) reported that they would be interested in participating in such online group spaces in the future. Conclusion The information gathered from the interviews on conducting online group counselling and the online counseling group for self-care initiated by the author seem to have certain parallels. The challenges include the lack of personal connection as in a face-to-face meeting, internet connectivity issues and special 193

attention needed to ensure ethical practice. The advantages are noted to be convenience and accessibility to spaces for connection, support relational growth and wellness. Considering the therapeutic benefits that group counseling offers in general, the kind of difference that online group spaces could make especially during such times of mandatory distancing and restricted travel cannot be emphasised enough. The observations from the documented group process, though not technically sufficient for generalization, still affirm the boundless budding potential for conducting online group work successfully by the psychologists in our country. The unique advantages that group counseling offers in mental health care, beyond and different from individual counseling, have been widely documented. Creating such space online makes it possible to transcend geographical and time boundaries, allowing an opportunity for people to access supportive and connected space amidst such ongoing uncertainty. Psychologists in India can make use of the online platforms (ethically and appropriately) for creating therapeutic group space (Manickam, 2020). Psychologists in India who choose to venture into online group work, need to document their considerations, experiences and outcomes of online counseling/therapy groups in order to generate evidence base. In the wake of this unprecedented crisis of COVID-19, online group counseling is expected to gain higher traction as we cope with the emerging “new normal”. Acknowledgments Special thanks to Mr. Anando Chatterji and Ms. Shivangi Lakhlani for participating in the interviews and contributing relevant perspectives to the content of this paper. References APA. (2013). Guidelines for the Practice of Telepsychology. Retrieved from American Psychological Association: https://www.apa.org/practice/guidelines/telepsychology

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! Barak, Azy, Boniel-Nissim, M. & Suler, J. (2008, September). Fostering empowerment in online support groups. Computers in Human Behavior, 24(5), 1867-1883. Bellafiore, D. R., Colón, Y., & Rosenberg, P. (2019). Online Counseling Groups. Retrieved from APA Psynet: https://psycnet.apa.org/record/2004-00189-010 Chatterji, A. (2020, May 25). Personal interview about online groups for mental health. Chatterji, A. (2020, March). Scree'lational Psychotherapy. Retrieved from www.prezi.com: https://prezi.com/nbeej71xrih/screelational-psychotherapy/ Chenneville, T., & Schwartz-Mette, R. (2020). Ethical considerations for psychologists in the time of COVID19. American Psychologist. Advance online publication. http://dx.doi.org/10.1037/amp0000661 Epley, N. (2020, April 23). The power of social connection in the age of social distancing. Retrieved May 18, 2020, from Chicago Booth Review: https://review.chicagobooth.edu/behavioralscience/2020/video/power-social-connection-age-socialdistancing Fosslien, L. & Duffy, M.W. (2020, April 29). How to combat zoom fatigue. Retrieved from Harvard Business Review: https://hbr.org/2020/04/how-to-combat-zoom-fatigue Holmes, C.M. & Kozlowski, K.A. (2015) A Preliminary Comparison of Online and Face-to-Face Process Groups, Journal of Technology in Human Services, 33:3, 241262, doi: 10.1080/15228835.2015.1038376 Inverso, E. (2020, March 28). Connection, Belonging, and Purpose in the World of Social Distancing. Retrieved May 18, 2020, from Beck Institute for Cognitive Behavior Therapy: 195

https://beckinstitute.org/connection-belonging-and-purposein-the-world-of-social-distancing/ Joshi, S. (2017). Online Psychotherapy: Current Status and Future Prospects. In A. S. Anubhuti Dubey, Mental Health: PsychoSocial Perspectives (Volume:4 Therapeutic Applications) (Vol. 4). India. Joshi, S. (2020). Telepsychotherapy: The bridge to continuity in care and mental health services in COVID-19 and post Covid era. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.170-181). Thiruvananthapuram: The Editor. Kanter, J., & Kuczynski, A. (2020, March 16). Social distancing comes with social side effects – here’s how to stay connected. (M. Ketchell, Editor) Retrieved May 16, 2020, from The Conversation: https://theconversation.com/social-distancing-comes-withsocial-side-effects-heres-how-to-stay-connected-133677 Kit, L.P., Wong, S.S., D’Rozario, V. & Teo, C.T. (2014) Exploratory Findings on Novice Group Counselors’ Initial Co-facilitating Experiences in In-Class Support Groups With Adjunct Online Support Groups, The Journal for Specialists in Group Work, 39:4, 316-344, doi: 10.1080/01933922.2014.954737 Kozlowski, K.A. & Holmes, C.M. (2014) Experiences in Online Process Groups: A Qualitative Study, The Journal for Specialists in Group Work, 39:4, 276-300, doi: 10.1080/01933922.2014.948235 Lakhlani, S. (2020, May 27). Personal interview about online groups for mental health. Manickam, L.S.S. (2020). COVID-19 Pandemic: A time for prudent and ethical action. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.218-228). Thiruvananthapuram: The Editor. Veder, B., & Beaudoin, K. (2016, April) Launching Online Group Counseling. The Journal of Employee Assistance. Retrieved 196

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! from EAPA: https://www.eapassn.org/Launching-OnlineGroup-Counseling. Whittingham, Martyn & Martin, Jennifer (2020, April 10). How to do group therapy using telehealth. Retrieved from apaservices.org: https://www.apaservices.org/practice/legal/technology/gro up-therapy-telehealth-covid-19?

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21 INDIAN ACADEMY OF APPLIED PSYCHOLOGY (IAAP): VOCAL VOICE ON LOCAL TO GLOBAL PERSPECTIVES OF PSYCHOLOGICAL SERVICES. DR. NOVRATTAN SHARMA Professor of Psychology M D University, Rohtak and Secretary IAAP. Indian Academy of Applied Psychology (IAAP) is the largest body of Psychologists in India which is continuously active since its inception in 1962 at the Presidency College, Chennai. It has been serving the society through various academic, professional and extension activities across the country. The important objectives of IAAP (2020) are: a)! To promote the advancement and diffusion of knowledge of Psychology and to promote the efficiency and usefulness of its members by setting up a high standard of professional education and knowledge. b)! To arrange, provide for, or join in arranging and providing for the holding of conference, regional, national (or international), exhibitions, meetings, lectures, classes and discussions on subjects of general and special interests in Psychology, and also for the exhibition of any new, improved, or other apparatus for Psychological Research. c)! To cooperate with academic, professional and other bodies in the advancement of Psychology and other sciences. d)! To prepare, edit, print, publish, issue and circulate gratuitously or otherwise and to sell, lend, issue and distribute gratuitously or otherwise any papers, treatises, books, pamphlets, leaflets or communications made to the academy or documents relating to psychology and any reports of the proceedings and accounts of the academy, and for this purpose to cause translations to be made of any such papers, treatises or communications as shall be in a foreign language and to illustrate any of the publications as the 198

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!

e)! f)!

g)!

h)!

academy may thing expedient in connection with the objects of the academy or any of them. To undertake research projects and publish independently of and/in co-operations with other official and non-official organizations devoted to national development. To obtain, collect and receive money and funds by way of contributions, donations, subscriptions, legacies, grants or any other lawful methods, and (subject to the provision of the said section) to accept and receive gifts of property of any description (whether subject to any special trusts or not) for or towards the objects of the academy or any of them, and to administer such funds and property. To keep a register of members, their qualifications and appointments. Divisions under this academy may be organized to represent major scientific and professional interests that lie within the academy. To do all such other things as may be incidental or conducive to the appointment of the subjects.

To respond to COVID-19 in India, IAAP has identified the following issues of concern: 1. Physical and Mental Wellbeing of Corona Warriors: From doctors to nurses to police personnel to other essential service providers have been experiencing physical as well as mental strain. Identified problems among them are fear of getting the infection and infecting their loved ones, working overtime and working with inadequate protection measures. Psychologically they have increased experience of negative emotions, frustration, insomnia, depression, stress, post-traumatic stress disorder, denial, anger, fear and exhaustion. These problems are in turn affecting their attention, work productivity and decision making capacity. 2. Psychological Wellbeing of Close Relatives of Corona Warriors: Family members of corona warriors experience stress, anxiety, depression, stigma and discrimination in society due to their possible exposure to COVID-19. They also have worries about their family members providing essential services getting infected with the virus. 199

3. Mental Health Problems Faced by Population in General: People in general are also experiencing physical as well as psychological problems. The following were identified as reasons for experiencing the same: lack of adequate information, fake news, miscommunication through social media, low Socio Economic Status (SES), interpersonal conflicts, excess use of social media, lack of social support, unemployment. Increased instances of anxiety, substance abuse, loneliness, domestic violence and child abuse has been found. Excess use of internet/ gaming/social media during lockdown was observed that can lead to restricted physical activity, cyber bullying and may also cause internet addiction disorder. 4. Problems Faced by Vulnerable Population: Vulnerable population include old people, children, women, and migrant population. IAAP is committed to working on the problems faced by the vulnerable population and promoting their mental health. 5. Mental Health of COVID-19 Patients: Higher prevalence of mental health problems among COVID-19 patients like depression, anxiety, PTSD, insomnia, tension, suicidal thoughts are experienced. Even after recovery from infection, they have reported experience of stigmatization and rejection by the people in the neighbourhood. IAAP is extensively working on the applicable solutions to the identified issues: 1.! Organizing webinars: IAAP has been conducting webinars for knowledge dissemination and expert opinions are being shared to young psychologists. 2.! Innovative use of online platforms: IAAP proposes to use online platforms like social media to reach out to the people. COVID-19 awareness generation events can be organized on social media to enhance their reach. Also, free content can be provided online like videos (educating children about protective health care measures during COVID-19) and scholarly articles on topics like hardiness, mind-body relationship, effect of breathing and relaxation on body, how to make work from home, more productive and establishing work-life balance. Self-help manuals can be provided online on a dedicated website/platform for dealing with psychological problems faced by people. 200

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!

3.!

4.!

5.!

6.!

7.!

8.!

However, the authenticity and quality need to be assured and they need to be regulated by experts as per the ethical guidelines. Widespread publicity of psychological services: IAAP recognizes this to be a critical factor as it would increase accessibility to psychological services and will also help remove the stigma of mental health problems. Creating an online platform to acknowledge problems/queries and promoting action-based research on them: A dedicated online platform can be created where people can report problems faced by them and a committee can be assigned to respond to those problems. Hence, IAAP proposes action-based research/fundamental research. Broadcasting real life experiences of people: Broadcasting real life experiences of people who overcame mental health problems can be done with their consent. It can be used for observational learning. Need for more empirical evidence: More empirical evidence on impact of COVID-19 are needed. Moreover, collaborative research efforts and knowledge sharing is the need of the hour. IAAP finds it important to develop psychological tools especially designed to assess mental health problems during pandemic as the validity of tools designed in normal times is questionable. Resource centre for psychological tests: Different universities and institutions develop and standardize psychological tests but they usually do not get shared and sometimes are not even known. Hence, IAAP proposes establishment of Resource Centre for Psychological Tests where all these newly developed tests can be submitted and after quality check by a dedicated committee those can be popularized nationally as well as internationally. National Institute of Importance in Psychology: Just like other national important science institutes, there is a felt need of establishing an institute of psychology which is of national importance (Manickam, 2016a). Young psychologists can be imparted with skills and specialized training can be provided. In addition, research on 201

psychosocial issues prevalent in India can be taken up which can help the government in policy making. 9.! Formation of FIPA (Federation of Indian Psychological Associations): It is the need of the hour which can serve as an apex association regulating and supervising the work of other psychological associations in India. Three major associations namely - Indian Association of Clinical Psychologists (IACP), National Academy of Psychologists (NAOP) and IAAP have come together on several occasions in the past few years to work out the modalities on FIPA (Manickam, 2016b). A coordination committee of the office bearers of the three organisations was constituted to further work on the agenda. This will help to collaboratively respond to COVID-19 by providing psychological services to the larger population, reaching out to the grass root level, integrated research and knowledge and experience sharing platforms of various associations. 10.! Psychological Council of India (PCI) - PCI may be constituted by the Government of India on the pattern of RCI helping psychologists in India to get legal standing through registration. 11.! National disaster management authority (NMDA) has prepared disaster management guidelines but psychosocial support is yet to be given priority by them. Hence, IAAP proposes to give due priority for psychosocial support and service during disaster management. 12.! Community based Psychological First Aid to reduce fear, anxiety, worries and trauma due to any pandemic like COVID 19 may be taken up by the existing departments of psychology in various colleges and universities across the country. 13.! A special journal issue on COVID-19 is planned and we have solicited articles for our journal, Indian Journal of Applied Psychology. 14.! IAAP is gearing up at all its fronts to identify local/ regional issues with the scientific assessment of global standards by raising the voice in a very vocal manner at appropriate academic, professional, scientific, constitutional, political platforms for seeking and ensuring the well-deserved 202

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! positive status of Psychology in teaching, research and applications. References: Indian Academy of Applied Psychology (2020) Current News https://www.iaap.org.in/ Manickam, L. S. S. (2016a). Challenges of professionalizing psychology in India: Where do we go from here? Indian Journal of Psychology, Centennial issue. 243-252. Manickam, L. S. S. (2016b). Towards formation of Indian Federation of Psychology Associations: Let us wake up for our causes. Journal of the Indian Academy of Applied Psychology, 42,1, 40-52.

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22 TAMIL NADU ASSOCIATION OF CLINICAL PSYCHOLOGISTS (TNACP) RESPONDING TO COVID-19 PANDEMIC DR. N. SURESH KUMAR Assistant Professor in Clinical Psychology, Madurai Medical College, Madurai SRINIVASAN JAYARAMAN Assistant Professor in Clinical Psychology, SRM University DR. K. RANGASWAMY Visiting Professor, Institute of Mental Health, Chennai

The Tamil Nadu Association of Clinical Psychologists has been in existence since 1970. After a brief hiatus, it was revived in 2014 and has been active since then. The Covid-19 pandemic has been another opportunity for the association to rally together and take action. The Context Even though the current situation has given us a lot of distress, it has also strengthened the unity among all the Clinical Psychologists across various parts of the state and nation as a whole to work as a team in maintaining and providing better mental health to the people in our respective communities. The Strategic Plan - The Mental Health Task Force When the pandemic began to spread in India, the Executive Committee of TNACP acted proactively and initiated multiple online meetings among the TNACP members to mobilize a plan for helping the public through tele-counselling service. All the members were consulted on their willingness and availability in volunteering to counsel the needy individuals. This paved the way to start the “TNACP Mental Health Task Force” group for COVID19 by getting formal permission from the State Mental Health 204

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! Authority, Secretary, Department of Health and Family Welfare and Commissioner of Social Defence, Tamil Nadu. The helpline list with the contact numbers of volunteers was circulated through television broadcasting in various channels across the state through news, advertisements, pamphlets and also by TNACP members through their personal social media accounts. The calls started coming in from within the state and also from other parts of India. We received calls from clients with symptoms of anxiety, depression, conflicting relationships, domestic violence and many more, including those who were seeking help to get to their home state during the initial period of lockdown when moving from one locality to another was restricted. Moreover, we also received calls from the general public about doubts and clarifications regarding the lockdown, transportation availability, helping stranded people near their locality, and so on. Our professionals not only acknowledged these calls but also provided them with the nearest possible helplines. The Service Provided and Observations The people who sought help were given initial counseling through telephone and if the therapist found the client’s symptom to be severe, they were asked to get help from the nearest Government Hospitals. The data regarding the details of the clients who contacted the professionals was recorded in a Google form by the respective therapist who took the call and further details were maintained confidentially by the secretary of TNACP. We are happy to mention that up to May 31, 2020, we were able to help around 200 clients, who had mental health issues, through our teleservices. Out of 200 distress callers, 63% were male and 37% were female, between ages 13 to 70 years, of which 53% were professionals, 24% were homemakers, 7% were businessmen, 5% were students and 11% were other professionals. Majority of distress callers (84%) were living with their family members and 16% were living alone. It has to be highlighted that 25% of the distress callers had a past history of psychiatric illness, 9% of callers had a history of substance abuse, 5% had family history of 205

psychiatric illness and 4% had suicidal ideas. There were people who sought our support on a continuing basis and around 10% of the callers were advised 3 to 5 follow up sessions. Majority of the distress calls (91%) were from those who were distressed and 9% were primary caregivers or significant family carers. The influence of social media in reaching out to the public was evident as 62% of distress callers got to know about our services through various social media. The remaining 20% knew about our services through television scrolling and 18 % of distress callers were informed about our services through their friends and significant family members. The common mental health problems observed was COVID-19 related anxiety, mild depression, stress and obsessivecompulsive symptoms, negative thoughts, stress, dullness, rumination, financial crisis, sleep disturbances, crying spells, aggression, loneliness, worry about spouses who were living abroad, fear that they may become a carrier of COVID-19, reduced work performance, doubt that an existing T.B and Asthma condition may lead to COVID-19, concern about using excessive cleaning materials and withdrawal symptoms related to substance abuse. Women, who were homemakers, reported increased stress and interpersonal difficulties, increased workload and lack of personal space. Children and students were worried about their academic challenges and anxiety about uncertainty related to their future academic pursuits. Some were restless and irritable and others felt lonely because of being stuck at home or lacked interest in academic activities. There were some who felt dependent on social media and cell phones and parental abuses were also reported. The commonly employed intervention strategies were psycho education, ventilation, reassurance, supportive psychotherapy, interpersonal psychotherapy, problem solving skills, Cognitive Behavioural Therapeutic Techniques and study skills.

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! Media Many working professionals in the hospital and academic sectors went beyond their regular work schedules in writing and publishing articles in newspapers, online blogs, and personal interviews in the mass media and also through conducting webinars to provide the public with a better understanding of the Psychological Mental Health in relation to the pandemic situation. Continuing Professional DevelopmentWe as professionals also had the zeal to make use of this lockdown period more productive, by learning and updating our skills through daily learning via webinars. To equip our members to provide telecounseling sessions, we collaborated with TISS Mumbai, iCALL team trained our members for telecounseling skills. The TNACP started conducting the webinar series from April 11th 2020 and successfully completed 50 webinars as on 20/06/2020. These programs were delivered by eminent speakers from all over India and included a wide range of trending topics in the field of clinical psychology and behavioural medicine. Until the month of May 2020, we had provision for accommodating only a maximum of 100 participants. Encouraged by the attendance and efficiency of these academic programs, the TNACP was prompted to continue the webinar series with increased provision to accommodate 500 participants, to include students and Clinical Psychologists from various institutions in India. We hope that the Rehabilitation Council of India will assign CRE points for the attendance of these webinars and further encourage the professionals to update themselves. Guiding Future Psychologists The most recent initiative of TNACP has been to organize a webinar for post graduate students of Psychology to orient them to the field of Clinical Psychology, to show them new avenues in this field, and to guide them in preparing for the M.Phil. Clinical Psychology entrance examination. A Webinar was conducted for this purpose with eminent clinical psychologists working in both 207

government and private sectors and in other countries, who interacted with the students. Lessons Learnt 1.! It was felt that a single helpline number would have been helpful in extending the telecounselling service to more people. 2.! It was also found that the number of calls was high during the week when the helpline numbers were scrolled on TV news channels and also whenever the members gave interviews or wrote articles in newspapers. This shows the power of mass media in reaching out to people. Harnessing this power is essential for a wider reach in the future. 3.! Establishing a standard Psychological Response Protocol (PRP) can ensure uniformity in providing service, as well as guide the members in the event of future pandemics or disasters. We hope to continue this work together as a team in the coming days to provide effective mental health services to the society.

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23 A PARADIGM SHIFT: CHANGES, CHALLENGES AND WAY FORWARD S. DIVYAPRABHA, N. GANESH, S. KALPANA, R. NANDINI, S. BHASKAR, R. SURYAKUMAR AND DR.T.R. UMA Chennai Counselors’ Foundation (CCF), Tamil Nadu. The Roman Emperor and philosopher Marcus Aurelius said, “Man’s life lies all within this present, as it were but a hair’s breadth of time; as for the rest, the past is gone; the future yet unseen!” How true! But alas, the human mind does not work in such a simple rational fashion. Ask Albert Ellis! Humans always ruminate about the past leading to a worthless sense of guilt in the present. They are unable to accept the uncertainty of the future and try to establish a homeostasis which becomes virtually impossible. This is the situation even in the best of times, isn’t it? Then what can we say about the current pandemic, the most feared COVID-19 which has shattered the myth of our perceived immortality. The virus has become the greatest threat to global public health in this century. The ephemeral nature of life and the certainty of death has been accentuated. We are reminded of our mortality on a constant basis now more than ever before, leading to increased levels of fear and anxiety. One of the primary causes for people experiencing such a threat is due to the uncertainty attached to it. COVID-19 has spread across the globe threatening lives and altering life experiences. It is being considered an indicator of inequity and deficiency of social advancement (Chakraborty and Maity, 2020). Universally, societies are divided on socio-economic / educational / regional / cultural/ gender / racial and age lines, though collectively they make up the social fabric. This social fabric is going through a major upheaval impacting the physical and psychological health of the people, economies and environment all over the world.

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Governments of countries globally have been tackling this crisis imposing measures like lockdown, developing herd immunity. Our Government has opted for a nationwide lockdown that continues till date. While the efficacy of this measure is a moot point, it has indisputably led to the stoppage of essential functions leading to financial crisis, job losses, shortage of essential commodities. People’s morale has taken a severe hit and they have sunk to levels of despair hitherto unseen. Other factors such as restrictions on socialising, travel, non-functioning of schools / colleges, sports activities have had a telling effect on the psychological health of people. Current scenario This pandemic has altered everyone’s lives in ways that we had not imagined. What we considered ‘normal’ now has ceased to be. A ‘New Normal’ seems to have emerged – as a forced and imposed response to the current crisis. Does such a paradigm shift in our daily lives overwhelm people? Of course, it does. Being at home unable to attend school or office for the best part of the day is a challenge. It is even more frustrating not to engage in your usual hobbies like taking a stroll along the beach or watching a movie at the theatre. And if you throw in the fact that you are stuck at home – which could be a small tenement for many – it can be a recipe for disaster. The absence of maids, cooks, drivers all add to the stress and sadly, if the family is dysfunctional, it leads to unpleasant consequences of domestic violence, sexual abuse etc. During the initial days of the pandemic, as a few cases started trickling in, people were curious. However, with a constant increase in numbers without any let up despite the lockdown, people started fearing the worst. Being prisoners in their homes without the usual activities, only exacerbated the stress levels. Work from Home (WFH), while looked as an attractive option initially, had its merits and its own challenges for many industries. The lack of social contact has made this option a debatable substitute. All these led people to experience heightened anxiety, panic, insomnia, eating disorders, financial worries etc. Children were also impacted with schools and colleges being closed. Exam schedules were disrupted. Students who had overseas admissions were in a quandary as they could not travel. People who were 210

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! visiting their home country got stuck. All these led to a manifold increase in anxiety levels. A fall out of all these perplexing issues was the surge in cases of watching pornography, addiction to internet, mobiles, alcohol dependence, substance abuse, and in some cases relapse of psychiatric illness or they developed comorbid disorders. With no definitive predictive models available, scientists are struggling to say for sure when this pandemic will be contained. The absence of a proven treatment or a vaccine, has only escalated people’s anxiety and fear. It is always said that every dark cloud has a silver lining! The current situation is no exception. With reduced road travel, pollution levels have come down significantly. The ban on air travel has not only helped reduction in pollution, but also directly impacted the much-touted global warming positively. Rare birds and animals seem to have come out of their habitats. Hospitals are less crowded as people refrain from visiting them for minor ailments. The deaths due to road accidents has come down significantly. We can hear rare birds chirping. Nature, they say, has taken this time out to heal itself. That is the good news amongst all this pandemonium. However, in the overall analysis, do these gains justify the fear, anxiety, pains, lives, and livelihoods lost? We don’t think so. Changes and challenges This pandemic has certainly had a severe impact on the physiological, psychological and behavioural aspects of people. These need to be addressed on an urgent basis. The physiological symptoms of COVID-19 are not that pronounced except in some cases. However, the psychosomatic impact is quite striking. Fear and anxiety cause several negative effects in our body namely increased heart rate, nervousness, sweating, fast or difficulty in breathing, increased blood pressure, headache, nausea, dizziness, changes in eating habits and insomnia. If there are pre-existing conditions like diabetes or asthma, these could get aggravated due to these symptoms. While immunity boosters are encouraged to protect us from this virus, it is important that psychological immunity is given attention to retain good health and wellbeing. 211

When psychological resilience is not practiced, the impact of the pandemic can be quite marked. Lack of concentration, lack of motivation, poor memory, paranoia, and confusion are seen quite often. People can also develop psychosomatic symptoms as listed earlier. The fear of getting infected, anxiety about losing one’s job, stress due to business loss, worries about outstanding loans and investments, and overall major concerns about the future may be fairly common issues, but they are capable of generating rumination of thoughts leading to cognitive distress and emotional turbulences. Uncertainty can cause immense anxiety, so much so, that people sometimes equate it to imminent danger. Facing uncertainty feels more distressing than even facing real pain! The physiological and psychological impact of the pandemic does have a conspicuous influence on the behaviour of people. Procrastination due to low drive, getting verbally and/or physically abusive, uncontrollable anger, frustration leading to harming self or others, feeling helpless and hopeless can result in a noticeable deterioration in general wellbeing. Couples who live in abusive relationships have higher chances of experiencing domestic violence, including physical, emotional, and sexual abuse. Addictive behaviours such as smoking, using alcohol and substance use may escalate leading to violent behaviours. Working women as well as home makers, who have additional responsibilities of home care and/or paediatric and geriatric care require the highest level of psychological resilience, the absence of which may lead to a nervous breakdown. A trauma like the COVID -19 pandemic may give rise to PTSD, especially survivors of COVID-19 (may remember the nearness to death while in the ICU), frontline workers (exposure to people dying before their eyes and the threat of contracting the disease). It is important for those to stay connected with family and friends, practise self-care (mindfulness, playing music, taking walks whenever possible). These are some strategies that can help people to cope in a more meaningful way. The help of the psychologist doesn’t end with the pandemic but even after the trauma, people may require the assistance of a psychologist in tackling the PTSD syndrome. 212

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! Way forward With the media frenzy, it is imperative not to believe in everything everyone says, but only follow and limit it to news updates from official sources. It is advisable to restrict oneself from news channels and reading articles on social media and the internet. Instead one needs to focus on the positive aspects with which one can start a new lifestyle which can - balance and ease out the negative impact listed above. Some of the positive spin offs like spending quality time with family, utilizing the commute time for learning new skills, building meaningful relationships, innovative ways to stay connected, focusing on building a better immune system, reassessing priorities in life etc., should be focused upon. Being strong, positive, resilient, and learning to accept and adapt must be the mantra. “Prevention is better than cure” goes the adage. The best way to tackle the physiological symptoms is to exercise precautions. This can be achieved to a large extent by following some of the good old practices of personal hygiene, hygiene in public places, wearing masks, gloves, using sanitizers wherever necessary and following certain basic etiquettes while coughing, sneezing, maintaining social distance etc. While this may sound novel to the current generation, these were age old practices that were being followed by our forefathers but that were given up in the name of ‘progress’ and dropping so called ‘conservative’ practices! The psychosomatic symptoms, however, need to be addressed and are covered in the next para. By changing our perspectives and seeing what is positive in the situation can be the game-changer. Cultivating a growth mind set and developing resilience will help. With these interventions anyone can combat this crisis successfully. Psychologists, as mental health professionals, play a very crucial role in helping the public to improve a sense of well"being and alleviate the feelings of distress during COVID-19. Whether it is restructuring cognitive distortions, or challenging irrational beliefs to recommending behaviour modifications, mental health professionals are required to rise to upgrading knowledge and competency to cater to the ever-changing needs of humans. 213

Like in every emergency, this virus has thrown up many challenges to almost everyone irrespective of class or creed, educated or illiterate, rich or poor, including front-line workers. Is the situation going to be like this forever? Absolutely not. The developments over the past two months followed the Kubler-Ross curve. Denial- initially assuming that it will not impact us; followed by anger at the lockdown; then bargain, perhaps, pleading for no quarantine or lockdown; then depression – feeling extremely stressed out about these developments and finally acceptance, inevitably learning to live with the pandemic. Those who are unable to move to stage 5 will be severely impacted by stress and the resultant anxiety. The resilient person, however, moves on confident that this too shall pass! Necessity is the mother of invention Steve Jobs once said, “Innovation is the ability to see change as an opportunity – not a threat.” So true. In the wake of this pandemic, one will be amazed and surprised that creativity and innovation has been the order of nature. It is heart-warming to note how human behaviour is transforming and redefining norms. The outstanding coping mechanisms of some, whether it be in their creativity of making masks, memes, posting videos or sharing beautiful pictures of nature, birds and animals is, quite frankly, incredible. People are today more in touch with their friends and extended families via resources like zoom, WhatsApp video calls and Facetime. They make time to catch up with immediate and long-lost family members, colleagues, clients, associates, and friends. Be it online studying for schools to post videos and conduct classes, many engage in MOOC (Massive Open Online Courses) platforms and get certified in courses that they always wanted to complete. From doing fun courses, signing up to dance, Zumba, yoga, meditation, chanting, cooking, baking, mass prayers – it is all just a click away! This has been a huge boon! Despite the boon, the challenges of mental health professionals are many and varied. They must equip themselves to be updated with skills due to the current needs. From the social context, there is still a stigma associated in approaching a therapist 214

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! or counsellor. Some people fail to follow social distancing in public places, and it causes increased irritability and impatience among those who follow it. Keeping in mind this non-compliance, it is imperative for mental health professionals to educate and empower one and all about individual responsibility. For the professionals to do that with conviction, they must first adhere to those “New Normal” and be a role model. Today, the boundaries of the “professional me” and the “personal me” are blurred and this can cause additional trauma and stress to any professional and it includes mental health professionals too. They must also be mindful that they too are at a high-risk of experiencing secondary trauma and burn-out in their profession. Teleconsulting is the order of the day – doctors, lawyers, business heads, training groups and organizations are conducting online courses with certifications, counselling and therapy, have for the first time moved to this platform too – private clients, patients, free helplines, conducting sessions online or over the phone. Need based webinars for clients across companies and corporates who want to keep their employees WFH engaged and mentally healthy are also on the rise. A lot more people are now willing to access help via online support groups for specific needs and reaching out to their peers for specific solutions, online – working has mostly moved today to a digital platform. Group work, for one, has been brilliant! Groups offer the advantage of normalizing the situation being discussed with the added advantage of group reflection and an interactive Q&A towards the end that sums up the intent of the session. It is not group therapy, but certainly a collective sharing that reduces apprehensions, and individual fears giving a sense of comfort that they are not alone in this battle. CCF’s initiatives during the COVID – 19 crises Chennai Counselors’ Foundation (CCF) is an association for mental health professionals registered under Tamil Nadu Societies Act. Since its inception in 2004 it is flourishing as an organization that can be globally recognized for its professional excellence and ethical practices. Their mission includes collaboration with the national and international associations for cross cultural learning. The Office bearers of CCF are the President, Secretary and 215

Treasurer who are elected once in two years through Annual General Body elections. The four co-opted members are selected both on nomination and self-joining. These seven members form the Executive Committee (EC) who manages the functions of CCF. EC then selects coordinators for its Training, Career & Guidance, Research and Youth wings. Case study Circle is a monthly feature facilitated by an experienced senior counsellor supported by a coordinator. All these professionals volunteer their time, energy, and effort for the growth of CCF, mental health professionals and the mental health profession. To learn more about CCF, log on to www.chennaicounselorsglobal.org. While individually, mental health professionals can be involved in the acclimatization of the paradigm shift, what can counsellors and psychologists’ associations do? Below you find some of CCF’s initiatives already implemented. We hope to continuously strive to work towards the best for our community and professionals. 1. Brochure on wellness tips: For a start, CCF prepared a brochure containing psychological wellness tips in English and Tamil to deal with COVID-19. It was circulated to over 160 members with a request for onward transmission to their friends, families and contacts. CCF also posted it on their website and FB page. Furthermore, the initiative was promoted widely through word of mouth, print, audio, visual and social media. 2. “Let’s talk”, a free telecounseling: CCF followed it up by offering “Let’s talk”, a free tele counseling pan India initiative, with the objective of reaching out to people facing psychological distress during the COVID-19 complete lockdown. We roped in a psychiatrist who is also our member for clinical intervention if required. People targeted were those in isolation, quarantined or suspected to be carriers and were home quarantined. About 20 counselors, a few of whom were polyglots, offered their time and expertise for the cause. During the first call, a mini Mental Status Examination was conducted to evaluate the depth of their wellness conditions. Depending upon the assessment, the tele callers were assigned to counselors based on the caller’s time and language preference. Counselors stated that they followed an eclectic approach based on the caller’s needs. Most applied Solution focused short term brief therapy. For any other future help, 216

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! appropriate referrals were made. Following the termination of the sessions, feedback was collected from the tele-callers regarding the efficacy of the counselling services. Receiving positive feedback has given a sense of satisfaction too. Some of them mentioned that they were better equipped with positive mind set and healthy coping skills after the session. 3. Parenting Manual for COVID-19 free e book (CCF, 2020): Another initiative by CCF during the lockdown was the launch of a free e-book on – ‘A short Parenting Manual for COVID-19.’ The book was authored by four psychologists who had given tips on parenting at different ages and stages of child development. The framework was based on famous psychologists like Bowlby, Maslow and Erikson. To reach a larger audience, the e-book was then translated in Tamil. To summarize, is there life after COVID-19? Well certainly there is, not after but with COVID-19! It is a fact of life and we need to embrace this paradigm shift and ease into the ‘New Normal’ way of living as it is! While the virus has shaken the very foundation of life, it has also made us aware and appreciative of what we have and be grateful for that. Many thanks to the Universe which keeps us afloat, the family time, bonding, sharing, trying out different treats and the housework, honing professional skills, learning new hobbies, developing new interests – are all in a day’s work! So yes, life certainly has changed and realigned itself for each of us. Staying safe and healthy as individuals, family and as a productive member of society is essential for survival and wellbeing. So, are we at the “acceptance” which is the 5th stage of the Kubler Ross model? Perhaps we are! References: CCF (2020). http://www.chennaicounselorsglobal.org/images/documentries /Talking_with_Children_pdf.pdf Chakraborty, I., & Maity, P. (2020). COVID-19 outbreak: Migration, effects on society, global environment, and prevention. Science of The Total Environment, 138882. 217

24 COVID -19 PANDEMIC: A TIME FOR PRUDENT AND ETHICAL ACTION L. S. S. MANICKAM Centre for Applied Psychological Studies Thiruvananthapuram, Kerala

Introduction The lockdown that was announced in our country on March 24, 2020 brought public life to a complete standstill barring health, police and essential services. The impact of the COVID-19 pandemic on people’s lives has reiterated the role of psychology and its significance across all walks of life. The psychologists from India have the responsibility to make strategic plans to address the issues that are coming up to ease the burden of the professional community in our country. In this paper, I present some of the national level strategies that are needed. The ethical concerns that come up to psychologists while working in different sectors are also briefly discussed. Lockdown- ‘World's biggest psychological experiment’ Van Hoof (2020), Professor of Health Psychology and Primary Care Psychology, Vrije University, Brussels, wrote that, 'Lockdown is the world's biggest psychological experiment - and we will pay the price'. Out of 7.8 billion people across 235 countries, a major percentage was going through 'some kind of lockdown' and he considered this as the 'largest psychological experiment ever'. The effects of the lockdown and COVID-19 on the people, it’s impact on the roles and responsibilities of professionals - the psychological fraternity in particular, are challenges that stare at the face of every psychologist in the country. Mobilizing a humongous population to learn to comply with physical distancing, helping individuals cope with their distress during isolation, and combating stigma towards those who tested positive, were some of the initial concerns. The health service providers and warriors in the frontline including police personnel were subjected 218

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! to tremendous stress, a situation that has not received much consideration in our country. To achieve Goal 3 of the sustainable development goals of UN, ‘Ensure healthy lives and promote well-being for all, at all ages by 2030’ (UN, 2015), there is an imperative need to make strategic plans for the next 6 months and perhaps for the next 5 years and beyond. Indian Council for Medical Research (ICMR, 2020) has already released documents on behavioral change expectations from people in order to contain the spread of the virus. Equally significant for psychologists is managing the fallout of this lockdown in terms of secondary epidemics of different phenomena including burnout and absenteeism and taking timely action to mitigate its adverse effects (Van Hoof, 2020). National strategy of psychologists in responding to COVID-19. The country of France had set up a 'psychological field' in response to the terrorist attacks and disasters in the 1990's. (Bernard-Brunel & Cholin, 2010) We need to develop a similar 'psychological battlefield' to win this battle and collectively put our ideas together to help draft a national policy. This cannot be achieved by a stand-alone approach. We need a collective effort and only the psychology associations in India can do this. Though coming together is not achievable, the associations independently have to define what each member needs to do, to clarify the role of the psychological science in responding to the COVID-19 pandemic. As scientists, one may have to take a strong stand on evidence-based methods in dealing with the situations. At the same time, one may have to encourage experiments that have not been tried out before, but have a research basis to proceed further. It is laudable that efforts were taken by individual psychologists in different parts of the country, but we do not have any compiled reports on the action strategies. Programs of individual psychologists are announced through social media at random and there is no common repository to record, store and archive the valuable information on the activities undertaken by psychologists in India, which could be of immense value for future research. Inadequate data and lack of proper documentation of 219

progress related to capacity building and delivery of service have affected the positioning of our psychologists in the international psychology forums. Innovative methods It is praiseworthy that some of the psychological associations at the national level and state level have taken the lead and have submitted their reports, which are added to this volume (Divyaprabha et al., 2020; Kumar, Jayaraman & Rangaswamy, 2020, Sharma, 2020). As we initiate new methods of coping with the current changes, it is important to keep watch on the activities from the ethical perspectives too. Ethical Guidelines in times of COVID-19 ICMR (2020, April) in their ethical guidelines has stipulated the following while addressing the needs of the vulnerable population. The first one is the persons who are tested positive for COVID-19. Psychosocial support needs to be given to them, their families and the health workers who are in contact with them. Equally important attention is required for the persons who are in isolation or quarantine as advised by the health advisors (ICMR, 2020, March 23). In view of the enormous stress and anxiety that the person may undergo, the document emphasizes the importance of showing, “… respect, empathy and compassion and not subject them to any kind of stigma or discrimination”. It is our responsibility as psychologists to develop a strategic plan to address the large population who are in need of our service. Who will streamline and enforce adherence to ethical guidelines in the practice of psychology? The ethical guidelines are in place for some psychology associations. However, I am yet to see any association taking a strong stand against any member or any office bearer for violation of ethical standards. Many practicing psychologists claim that they follow the guidelines. When asked about specifics, they retort, ‘You have been in practice for so long, so you should know which one we are using’. In the context of COVID-19, APA has brought out ethical considerations for psychologists (Chenneville & Schwartz-Mette, 2020, May 21) which may be a guideline that can be used by us. Salient features of the 220

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! guideline in reference to the standard guideline requires discussion. Standard 1: Resolving Ethical Issues These include ethical issues in relation to the workplace and one’s role. These have already been raised by several psychologists in our country especially the school psychologists who have been asked to ‘engage the class’ when regular teachers are not available, where the ethical issue of the role of the school psychologist and the organization’s interest come into play. The psychologists are assigned the tasks to benefit the organization rather than their assigned role. The ethical code suggests “Avoiding Harm” to the clients and in the COVID-19 pandemic, psychologists working in hospitals or other health care settings where access to personal protective equipment (PPE) is limited may be asked to see patients or clients without wearing PPE even after exposure to COVID-19 and one has to suggest other means to avoid ethical issues in relation to organizational conflicts. Standard 2: Competence In the current scenario, many psychologists have the feeling that ‘something is better than nothing’. But the code says that, “…psychologists do not extend themselves outside the realm of their own training, experience, and abilities”. In the social media, it has become very common for the ‘so called psychologists’ announcing different teaching programs, as well as services one intends to provide at this time and tend to exploit the public and the upcoming psychology students. The psychology associations and the trained psychologists have the ethical responsibility of safeguarding the profession by not letting incompetence creep into the profession. Standard 3: Human Relations While working with the CARCEALD population (Manickam, 2016a) in our country, the possibility of discrimination is quite high and one has to be aware of “Unfair Discrimination,”. This clause, prohibits psychologists from discriminating against people based on individual differences, like age, gender, faith, state of origin, disability, caste, and socio-economic status. It may not be 221

possible for the psychologists and clinical psychologists working in hospitals to screen clients for COVID-19. However, following the universal precaution protocols is the best way and using ‘physical distancing’ and reverting to tele-behavioural health could be other options to avoid discrimination. Standard 4: Privacy and Confidentiality It is unfortunate that in several forums, clients have written about the breach of confidentiality by Indian therapists. The ethical code demands psychologists to maintain confidentiality. Since many psychologists are shifting to work online, frank discussion on the limits of confidentiality need to be discussed as part of the informed consent process of clinical service and research. As we take consent to record the sessions, in case of recording, we also need to be aware that clients can also record the tele sessions. Many online help forums have come up and as a quick fix solution several agencies have issued helpline numbers and it is important for us psychologists, if involved, to help keep the privacy and confidentiality of those who seek help. Standard 5: Advertising and Other Public Statements The guideline is that even in emergency situations such as COVID-19, psychologists need to be honest in pronouncing the limitations of their professional competence. Care needs to be taken to not mislead our recipients who would benefit from our services in relation to our expertise and experience. Therefore, it is imperative to provide an opportunity to professionally upgrade one’s capacities. In the hurry to respond, it is likely that one may make statements in response to the questions asked by the media. It is true that it brings the profession of psychology to the limelight. One has to be careful to not make public statements that fall outside one’s ‘expertise or are inconsistent with the existing psychological literature’. Since we do not have research findings yet on the impact of COVID-19 on mental health, psychologists should not make definitive statements about the psychological impact of COVID-19. If the psychologist is familiar with the research findings, it may be appropriate for one to make general statements about the impact of social isolation on mental health.

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! Standard 6: Record Keeping and Fees Psychologists and clinical psychologists are offering free service (Divyaprabha et al., 2020; Kumar, Jayaraman & Rangaswamy, 2020, Sharma, 2020) in response to the COVID-19 lockdown situation. Some of the associations have stated that the sessions are free till a specific period of time. Unless it is made specific, the possibility of a number of people asking for free sessions even after the lockdown and the pandemic are likely to increase. Therefore, one has to be cautious about the same, especially when there are a large number of private practitioners of psychology in our country. It is important to document the calls and the session as one would do in the in-person sessions. This is important for clinicians who are trainers as well as for psychology teachers to document it as per institutional requirement. Standard 7: Education and Training The ease with which the psychology community incorporated innovative methods in responding to the current scenario in providing psychological services gives the hope that the current generation of psychologists is adept in using technology to overcome the barriers. Another concern which directly impacts the psychology fraternity is the sudden lockdown of teaching institutions, and with it the inability of students to access labs and internship programmes. Many psychologists have taken to online teaching, online interviewing for the intake of new admissions and online assessments. It is not yet confirmed how the trainees who are about to complete their training will carry out their data collection required for submission of research reports. Clinical training was depending heavily on in-person interaction and with the restrictions in contact, how the research projects as well as the supervised practicum experiences are to be directed for the current batches of trainees who are undergoing training is yet another challenge. Telehealth can be used, but it would be difficult for the clients to access the services like those staying in the wards and even those at home, where privacy issues also become a concern and require standard guidelines.

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Standard 8: Research and Publication Telepsychotherapy and online counseling using both video and telephone have come into prominence and may be facilitated more through the apps that are being developed by individuals and organizations. Institutional approvals have become a norm with the research proposals being approved by a registered institutional review board (IRB). The completion of research through a different mode would require a modification by the IRB and ICMR (2020, April) as per the latest guidelines provided to the ethical committees. There are reports of Psychologists initiating research without experience and supervision need to be checked to prevent human rights violations. which can be considered as a bold step. Though many of our psychology departments are yet to constitute IRB, the future of research in psychology, especially when it comes to publication in indexed journals will get affected if one does not produce the certificate from the IRB. Practicing psychologists and others who intend to conduct research may be encouraged to get affiliated with institutes where IRB’s are in place in order to facilitate more scientific research in psychological science. Standard 9: Assessment How far will the clinician be able to effectively administer cognitive function assessments and projective tests while maintaining ‘physical distance’ and how the use of PPE would impact the rapport and therapeutic relationship, are questions that need to be answered. Using tele psychology tools to conduct assessments remotely also raises the issues of confidentiality which was mentioned earlier. Administering tools online may also pose several challenges including that of copyright issues. As Chenneville and Schwartz-Mette (2020) observed, “When transitioning to remote assessment, psychologists must carefully examine their existing tools and procedures for various referral questions to determine whether they can translate these directly online”. Since many of the norms have not been prepared for conducting tests using telepsychology, care has to be taken while interpreting the results and informing the clients about the results. This becomes complicated when it comes to assessments of children, less motivated clients and those who are not proficient with any form of formal assessments. 224

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! Standard 10: Therapy As we use more of these platforms, we need to keep a watch on privacy, boundary and ethical practice. We need to discuss with the clients about the limits of confidentiality, and be realistic in communicating about the potential risks and the probable benefits. With many practicing psychologists shifting to work online, the clinician needs to be aware of the service providers at the locality of the client. The location of the client and therapist, and in case of trainee and novice therapist, the location of the supervisor should also be disclosed and discussed in order to take care of risks that the clients may experience. It is timely that Indian Association of Clinical Psychologists has formed a task force to develop practice guidelines on Telecounseling and Telepsychotherapy (Kumar, 2020). Capacity building and Training of the Responders Globally, psychologists are realising that psychological damage requires emergency care, just as physical damage does. (Van Hoof, 2020). The health emergencies programme of WHO (October, 2018) had developed a learning strategy to prepare the workforce of excellence. It highlights that the learning and training need to be coherent, high quality, coordinated and standardized. National level psychology associations in collaboration with Governmental agencies will be able to create a workforce of excellence for health emergency work at the national level. Even when locally initiated, adopting this framework in the learning strategy will help develop sustainable programs. We are yet to think of responding to those who are in quarantine, their relatives, people who are in isolation and relatives of those who are in isolation. People from different states of our country are living abroad and some of them are unable to return home (Thomas, 2020). The situation is similar in relation to people who are living in other states within our country, other than their home state which causes added stress. The increasing number of suicides of people who are COVID-19 positive is also of great concern. It is possible that we can develop a standardized, high quality and coherent strategy with the coordination of all the psychology 225

associations (Manickam, 2016a) solely for responding to the pandemic. Psychological field to take on To conclude, the challenges for the psychologists in India are far higher than many other countries. The psychology associations need to come together, communicate, develop a consensus in responding to COVID-19 and collectively work to tide through this pandemic. It is for the psychologists in India to take a lead in creating a psychological field, mobilize the entire community of psychologists in our country, liaise with our Governments, initiate a dialogue with the policy makers and create the psychological field to combat the present and future adversities. References: American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. Retrieved from https://www.apa.org/ ethics/code/ Bernard-Brunel, L., & Cholin, N. (2010). Immediate intervention of medico-psychological emergency units. Soins Psychiatrie, (269), 16-19. Chenneville, T., & Schwartz-Mette, R. (2020, May 21). Ethical Considerations for Psychologists in the Time of COVID-19. American Psychologist. Advance online publication. http://dx.doi.org/10.1037/amp0000661 Divyaprabha, S., Nerur, G., Suryakumar, K., Raman, N., Bhaskar, S., Suryakumar, R., & Uma, T.R. (2020). A paradigm shift: Changes, challenges and way forward. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.209-217). Thiruvananthapuram: The Editor. ICMR (2020, March 23) Home quarantine of symptomatics will flatten the curve: Mathematical modeling by ICMR. https://www.icmr.gov.in/pdf/covid/techdoc/Model_summa ry_V3.pdf 226

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! ICMR (2020, April 4) Appeal to the General Public : Not to consume and spit Smokeless Tobacco in Public https://www.icmr.gov.in/pdf/covid/techdoc/Appeal_to_the _General_Public.pdf ICMR. (2020, April). National Guidelines for Ethics Committees Reviewing Biomedical and Health Research During COVID-19 Pandemic https://www.icmr.gov.in/pdf/covid/techdoc/EC_Guidance_ COVID19_06052020.pdf India Today. (2020, January 31). Kerala reports first confirmed coronavirus case in India. https://www.indiatoday.in/india/story/kerala-reports-firstconfirmed-novel-coronavirus-case-in-india-1641593-2020-01-30 Kumar, D. (2020). Contributions and challenges of psychologists in private practice in India and their responses to COVID-19. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.166-169). Thiruvananthapuram: The Editor. Kumar, N.S., Jayaraman, S., & Rangaswamy, K. (2020). Tamil Nadu Association of Clinical Psychologists (TNACP) responding to COVID-19 pandemic. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.204-208). Thiruvananthapuram: The Editor. Manickam, L. S. S. (2016a). Towards Formation of Indian Federation of Psychology Associations: Let us Wake up for our Causes. Journal of the Indian Academy of Applied Psychology, 42(1), 40-52. Sharma, N. R. (2020). Indian Academy of Applied Psychology (IAAP): Vocal voice on local to global perspectives of psychological services. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.198-203). Thiruvananthapuram: The Editor. 227

Thomas, R. (2020). Psychologists’ mind on missing beats of an expatriate life. In L. S. S. Manickam (Ed.), COVID-19 pandemic: Challenges and responses of psychologists from India (pp.101-104). Thiruvananthapuram: The Editor. UN General Assembly. (2015) Resolution A/RES/70/1— Transforming our world: The 2030 agenda for sustainable development. New York, NY: United Nations. Van Hoof, E. (2020, April 9). Lockdown is the world’s biggest psychological experiment-and we will pay the price. In World Economic Forum (Vol. 9). https://www.weforum.org/agenda/2020/04/this-is-thepsychological-side-of-the-covid-19-pandemic-that-wereignoring/ WHO. (2018, October). WHE Learning Strategy: A learning strategy to create a ready, willing and able workforce – a workforce of excellence – for health emergency work. https://www.who.int/emergencies/training WHO. (2020, March 18). Mental health and psychosocial considerations during the COVID-19 outbreak.https://www.who.int/docs/defaultsource/coronaviruse/mental-healthconsiderations.pdf?sfvrsn=6d3578af_2 WHO. (2020, April 12). https://www.who.int/docs/defaultsource/coronaviruse/covid-19-sprp-unct-guidelines.pdf

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ABOUT THE EDITOR

Leister Sam Sudheer Manickam hails from the state of Kerala, India received his Masters in Psychology from University of Kerala, Clinical Psychology training (M.Phil.) from the National Institute of Mental Health And Neuro Sciences, Bengaluru and PhD from Columbia Pacific University, USA. He is the Professor of Clinical Psychology and Hon. Founder Director of Centre for Applied Psychological Studies, Thiruvananthapuram, India and also serves as Director of Training and Research, Mhat, Calicut, India. He was formerly Professor of clinical psychology, JSS Academy of Higher Education and Research, Mysuru, India and had taught at the Department of Psychiatry, Christian Medical College, Vellore and CSI Medical College Karakkonam. He served as Professor and Head of the Department of Clinical Psychology at Sri Ramachandra Academy of Higher Education and Research, Chennai. He was visiting fellow at the University of Birmingham, UK., had undergone training in different forms of therapy abroad and is an integrative gestalt therapy trainer. He is the Fellow of several psychology associations in India, former General Secretary of the Indian Association of Clinical Psychologists and initiator of the Indian Psychologists Virtual Network. He had published more than 60 research papers and several book chapters. He is the author of the book, ‘Integrative Psychotherapy: Indian Perspective’. He was awarded with Excellence in International Scholarship by Division 17 of American Psychology Association, USA.