Given that it is important for us all to remain mentally well in the coming weeks and months ahead we have decided to provide a transcript of Eamonn’s conversation from yesterday ‘Coronavirus Podcast – Ep2’ with Consultant Psychiatrist Dr. Philip McGarry on the mental war against Covid-19:
(Please note the transcript is supplied by Transcription & Stenography Services NI)
MR MALLIE: Good afternoon, I am Eammon Mallie and you are very welcome to this very special podcast for Eammonmallie.com. My guest this afternoon is Philip McGarry, a distinguished psychiatrist who has been working in Northern Ireland for many many years, who worked throughout the Troubles, and has lived with the psychiatric problems, et cetera, of the community of Northern Ireland. He is joining me this afternoon so walk us through the circumstances, the extraordinary circumstances in which we find ourselves right now because of COVID‑19. The reality is that myself and my wife Detta, we are self‑isolating in south Belfast. We are in good health, we are very accustomed to the internet, we don’t drink really, we don’t smoke and we have no suppressed immune problems, so I suppose in a sense that we are privileged. But what I am trying to establish, Philip, from you is to try and find out if there are any parallels, or anything from war time, which we can learn to help us in these circumstances currently to try and get us through these extraordinary circumstances?
DR McGARRY: Well, there is to doubt, Eamonn, that there are some parallels, although the big element today of course is that most people are probably entirely accepting of the Government imposing these restrictions. But we do know that when people are kept confined for long periods of time it can have a very significant impact upon their overall mental wellbeing. But one of the big protective factors in that situation is well recognised to be social cohesion. It is quite interesting, if you looked at some work on the prisons in Northern Ireland during the Troubles, those members of paramilitary organisations who remain well were those who continued to be part of the organisation, to feel loyal to it, to be committed to it, and they often found that those who got referred for psychiatric help in fact were those who had in some way fallen out with the organisation, they were in this prison environment, but yet the advantage of social cohesion of the others was lost to them. And I think that one of the lessons, and that goes back really over a century back to, I mean at that time the great Swiss sociologist is that the advantage in life is having a strong network, people where viewed as an individual, a big part of a group which would be conviviate, that is an inevitably important asset in a situation, particularly in this almost unprecedented situation in which we find ourselves today.
MR MALLIE: Philip, Philip, of course, that brings us to the critical point of the family and being locked down, sharing the same house, bedrooms, et cetera. Now, can you take us through that, the implications could be immense. For example, some people are habitual drinkers at home, smokers, some people have mental problems, all of these issues. I would like you to address them and to see if we can make any sense or give any advice, any direction to people in the given circumstances in which they find themselves?
DR McGARRY: I think it is quite likely that in the short‑term things actually could be very, quite good from a psychological point of view, in the initial almost honeymoon phase, it is almost like a bit of a phoney war, isn’t it, at the present time, because everybody realises that we have this terrible thing outside and we know that we have to band together for protection, and I think in the short‑term we will find probably a movement in mental health. It is quite interesting, talking to my colleagues in the emergency departments, the number of people turning up now with acute psychiatric distress, with suicidal ideation has dropped away dramatically, dramatically and that perhaps ‑‑
MR MALLIE: Is that explainable?
DR McGARRY: Yes, well, there was a paper I produced with my colleague, Peter Curran, many years ago when we looked at suicide in Northern Ireland during the 70s and 80s and in fact the suicide rate dropped in the 1970s as the Troubles got worse and then as the Troubles began to improve the suicide rate went back up again. And the theory, and that fits in with the reduction in suicide during World War I, during World War 2, even a slight drop in suicide during the Falklands war, and the theory seems to be, the hypothesis is that at a time when there is a huge external threat when any of us could be taken away, the fact that ‘my wife and I aren’t getting on terribly well’, ‘I am a bit worried about how I am getting on at work’ seems totally trivial and the broader context can in fact bring us through. So I think in the short‑term initially when there is a great fear that all of us have, and we find that is the case, and that is a reasonable fear, that actually might be quite protective and in fact the normal hassles and problems of life might hopefully in the short‑term recede into the background. But, obviously as time goes on, and as someone said this isn’t a sprint, this is a marathon and the concerns would be that as the weeks go by and people are still locked up effectively then that, then the issues you describe of maybe of difficulties in relationships, people with significant financial problems, other issues like that, that could become more problematic.
MR MALLIE: Paul, I want you to go further into the family, right into the heart of some families. One of my GP friends tells me one of the big problems nowadays is particularly when one partner dies, the other partner sends out for the drink and just sits drinking habitually at home on his/her own. Now, is there any support, any help for that type of person who feels very isolated and might feel the drink is the only solution?
DR McGARRY: I know, and I have heard anecdotally already that there are some individuals who do seem to be taking more alcohol than they should be, and indeed in the early phase, I mentioned earlier about it is almost like a kind of a holiday phase, people can think ‘this is very nice, well, what do I do on holidays? I drink’. But it is very important that very quickly people realise we need to get into a routine at home and what this is, this is not a party, this is not a holiday. I noticed that AA, Alcoholics Anonymous, are trying to set up online meetings and that is good and I know that what’s happening, I mean right across the piece a lot of groups are setting up neighbourhood groups, and in my own street, for example, and like you I live in a very, in a very well off part of south Belfast, there actually is a Whatsapp group and in one sense, sadly, I probably know more about my neighbours now than I have at any point in the last 25 years, and I regret why didn’t I engage more with them before? So there is a lot of that happening at the local level and when you see that families and groups of friends are getting together and supporting them in this initial phase we do set up mechanisms to provide support. And generally it will be friends and family and people like that. And, having said that, I mean there are a lot of online, or sorry, telephone resources available, we know of the Samaritans, we know of Lifeline, and if you go online for support groups there is a lot of telephone online help available and there are ‑‑
MR MALLIE: I want to take your statement you have made there, Philip, I just wanted to come in there, Philip, because I am conscious that in an awful lot of homes, quite a few homes you will have child abuse, you will have domestic abuse by husbands and wives, partners, et cetera; would you be worried that there might be an escalation, that people might think there is a greater cover now to behave like that and is there any remedy, apart from those phone lines and how long will it take for a response to come?
DR McGARRY: Well, one can only hope, Eamonn, that if we lock things down now such that we can get on top of this virus that we will not be in a situation where it becomes, as I say, more like a marathon than a sprint. And I think if people can see it is relatively short lived then that will be easier. However, I would share your concerns that if this lockdown does have to go on for a very significant period, then some of the things you mention are going to be, become more problematic, and in essence all I would be saying to people is even though we can’t go out of the house, in essence we can ‑‑ unlike 50 years ago or 100 years, we can contact people easily on the internet with all of these new mechanisms, and we have got Facebook and Zoom and we have this new thing it is called Home Party, there are so many many opportunities there for people to use that way of communicating with others ‑‑
MR MALLIE: Yes, but again ‑‑
DR McGARRY: ‑‑ but it is true, but we must use other sort of IT possibilities to make up for that.
MR MALLIE: People ‑‑ Philip, yes, that is fine in theory for the younger generation, but you will understand that the older generation, they are not necessarily internet friendly, they are not necessarily knowledgeable of how to work the internet and to find entertainment on the internet, et cetera. Isn’t that something of a concern or should the Government or the authorities be doing something about accessing that type of facility to people who are locked in their homes?
DR McGARRY: Absolutely. And obviously for many older people who have a family and others of a younger generation they are getting a lot of help in that, and of course many older people nowadays actually are becoming very internet savvy, but you are absolutely right, in this period of physical, social isolation, all of us, family, friends, local authorities and Government have a duty to do everything they can to make sure that there can be social connection indirectly outside the physical contact, and I would encourage Government and local Councils to support families in every way they can to then, to do that kind of activity, yes.
MR MALLIE: Thank you, Philip. I am calling you Philip this time, I apologise for calling you Paul earlier. Philip, there is another question I want to put to you: What about the generation of entitlement? That young generation, the upwardly mobile group of people in their 30s, well‑financed and resourced now, and they have always felt, certainly in recent times, it appears that they felt that they were entitled to everything. Now, is this a dangerous period for such young people who will not have access to all the recreation, the gyms, the fast line, the fast life, et cetera, at this point in time; would that concern you?
DR McGARRY: Well, quite interestingly I know that my daughter, who of course is a very sort of a very kind and generous and not entitled person but, and yesterday she had herself, my wife and myself, we were in our living room and we had a sort of Joe Wicks exercise video on and had us really ‘you must do your 15 minutes once a day’. So they are adjusting, and I know a lot of personal trainers are now doing stuff online. They are used to living online and that is helpful, but you have a valid point indeed, this, I mean the word “unprecedented” is used far too often in life but we truly are in an unprecedented situation. And I do think that when this all finishes there will be questions about the way we live our lives. If many people will be able to work pretty well from home for at least part of the week, although of course that is more for those in the upper earning half of the population, as you know, if they can do that, well is it that we should be doing more anyway? And in fact do we need to fly as much as we did before? I think that, and also there will be questions of maybe, of broader political questions about the importance of the role of the State because after all the key workers, dare I say, are not the financiers and the hedge fund managers, the key workers are the ones who will come and deliver food to your door, it is people who will be care workers who will keep going, the porters in the hospitals, as well the other hospital staff, I really do think there will be an awful lot of new thinking coming out of this, and I think in a year’s time, I think all of us, young and old, politicians and the rest of the population, will actually be looking back on this as an opportunity maybe to recap a bit what we are doing. Maybe in the way that Greta Thunberg could never do on her own, but perhaps what has happened and she will make a real change to how we live our lives.
MR MALLIE: Philip, let me finally ask you this question: I heard a very robust challenging, or challenge to the Health Secretary this morning, Matt Hancock, by Piers Morgan. And Piers Morgan was prosecuting the thesis: ‘Lock up, why aren’t you locking up, you know the problems, why aren’t you locking up. Complete lockdown. You saw what happened at the weekend, the beaches, the parks, the young people, congregating, rubbing shoulders, not, not observing the social distancing’. What would you do if you were Boris Johnson?
DR McGARRY: One is always a bit wary in a liberal democratic society of handing Government coercive powers, it is easier for the Government to be given powers not to then later give those powers up. I think I know that, again 19 year old daughter was telling me last week that some of the pubs that opened on St Patrick’s Day got terrible stick online and the feeling by young people that is not acceptable. I agree we had wonderful weather at the weekend and that that had a bad effect, I do think we need to keep giving very very strong warnings and it is much better but if society as a whole feels this is the right thing to do, I am going to ‑‑ social shame is probably better than the actual coercive powers of the police. But I think we do need to be saying the population as a whole, you must indeed stay indoors unless you need to go out and have the issue of the police rather, as a potential big stick in the background rather than immediately introducing excessive powers. Because if we can do it voluntarily on the basis of social cohesion, that is much better for everybody and will cause less resentment about those of people having to stay inside.
MR MALLIE: Well, Philip, the reality is that people are not, younger people are not observing this social distancing and they are not staying in and in those circumstances, given that we are told contact is the potential killer, the transmitter of it, is it not just to seek to persuade people to lockdown?
DR McGARRY: I think we will have to see what happens over the next few days, but we know the weather is going to remain dry and there are opportunities to go out for those who wish to do so. I think I would, I personally would prefer that we go in for strong persuasion and indeed Mallie Media is part of that and all the media emphasising that. Yes, if all else fails then we may have to do something more draconian, but I think we really should use the power of social cohesion and potential social embarrassment, and I think young people do respond. And a lot of the psychological evidence, that people do respond to the sense of being, of embarrassment and social shame, but in a good way hopefully as opposed to coercion. But I agree coercion must be used there in the background as a potential big stick and if next weekend is like last weekend, well then yes, I think we may have to go down that line.
MR MALLIE: I hope that the horse won’t have bolted at that stage, Philip. But, in conclusion, what tips would you give to people at this point in time from a psychiatric point of view to try and guard themselves, to protect themselves from all the potential preoccupations which might be visited upon them, finding themselves in these awful circumstances?
DR McGARRY: Well, I think one of the big things coming out from the guidelines that I am hearing from colleagues, that first of all it is establishing a routine is vitally important: Get up more or less at your normal time, go to bed more or less at the normal time, try and eat your meals at the time you normally would and even try and have a regular time, if you are going to ring somebody on a regular basis, a family member, try and keep it to a certain kind of time of the day. If you are going to do a bit of exercise at home, again try and do that at a certain time of the day. Keeping to a routine is really really important, this has got to be not like a holiday ‘well, I’ll lie in bed ’til lunchtime and see what happens’, you have got to treat it almost as work, even though you are at home, and the work might just be ‑‑ and spending time online doing a new course in something or other. There are a lot of people I know whose houses are tidier than they have ever been any time in the last five ‑‑ I know my daughter and I did our shed at the weekend and in a better state than it’s been for a long time, but having a regular routine, trying to find interests, and again the good old internet, and this, while it does come into its own, there are so many possibilities to do things you have never wanted to do, keep in touch with friends and family, but you may find new friends and family members engaging much more with them than you ever have before; this could be a time of opportunity. I mean, let’s be honest, if somebody had said to us six months ago ‘you have two weeks of doing nothing’ and if you are lucky enough to be in a job where you are paid to be at home, that’s fantastic. Well, try and keep up that kind of spirit, but it is important that we are getting out of bed, meals at the normal time, and again by the way don’t be on the internet all night because we do know that your body clock does respond to too much light at night time, and particularly blue light coming from devices, so do more of your internet activities during the day and try and wind down, try and wind down to sleep at the normal time, you have to get up ‑‑
MR MALLIE: We will leave it there. Thank you very much indeed for your time and for your wisdom, and you have seen a lot in your lifetime, like myself. With the help of God we will continue travelling in hope. Philip McGarry, thank you very much indeed for being my guest.
DR McGARRY: Thank you.
MR MALLIE: Good afternoon.
DR McGARRY: My pleasure.