Dr Mark Cross

Kia ora educators of New Zealand.

In this time of Covid-19, anxiety and stress are ever-present. As you head into your new school term, so different from how you would usually, it is important to look after your own health. In this crisis time, it is vital that we adapt and stay mentally fit and healthy – as well as maintain our common humanity, compassion and care for each other.

I could not have chosen a more compelling time to release a book on anxiety. It was both serendipitous and eerily well-timed.

By definition, anxiety is “fear of the future” and that covers what we are all feeling, to some extent. The difference between chronic anxiety, where you can get an anxiety or panic attack out of the blue, and anxiety in this time of Covid-19, is that this anxiety is linked to the tenacious bug.  

As with many people I know and treat, I have gone through phases with my own anxiety. When I was younger, I ran away from acknowledging I had an issue. In my 30s, I worked on my acceptance but was loathe to go for treatment. Since my 40s, I have tackled it head-on and worked on being kinder to myself.

As a doctor, I find it easier to discuss my sexuality (which has been very hard) than the fact I have what is essentially a mental health condition. Self-stigma is something I implore everyone I treat to work on; I have to as well. I have had anxiety, that I recognise as such, from age four or five. It is so much a part of me, and has spurred me on at times, that I can’t file for full divorce from it. Separated under the same roof, perhaps – much more manageable. 

In this time of Covid-19, there are positive aspects, such as having a leader who is decisive, clear in her messaging and comes across as caring for her people. I wish I could say the same for us across the pond, where the mixed messaging and resultant confusion has made even the Marx Brothers appear sagely clear. In a time of global crisis, Jacinda Ardern has certainly taken a leaf from your didactic almanacs. She could teach those leaders who have minimised this pandemic to the detriment of their peoples a thing or twenty.

Another positive by-product, much closer to your hearts, is that it has finally dawned on everyone how hard your job is.

Another positive by-product, much closer to your hearts, is that it has finally dawned on everyone how hard your job is. Educators are now absolutely respected by parents the world over, frazzled by children at home full-time, wishing that they had been nicer to you all pre-Covid.

I have strong connections with New Zealand, including family and great friends, and we love visiting your land. I proudly wear my pounamu, gifted to me by elders and my wonderful friend, whom I call my Māori sister, Phyllis Tangitu, head of Māori Health in the Lakes DHB in Rotorua. My sister is a primary school teacher, married to a Kiwi South African.

When John and I emigrated from London to Australia in 2005 as I turned 40, mid-life angst a main drive, I was struck by three major differences between New Zealand and Australia. You had a female Prime Minister, LGBTQ rights were advanced and the Indigenous voice appeared proud and present.

As a psychiatrist, I have always advocated that I can’t just prescribe someone a pill for their anxiety or other mental health condition, and ignore societal stressors.

Why do I spend so much time talking about social and cultural issues in a piece about anxiety, you may ask? As a psychiatrist, I have always advocated that I can’t just prescribe someone a pill for their anxiety or other mental health condition, and ignore societal stressors. These factors are so intertwined in causes as well as management of anxiety disorders. Stigma and discrimination are phrases much touted. They are powerful words, often leading to hateful and hurtful actions – with significant, negative mental health outcomes for those who are on the receiving end.

I have been asked how I and my family are dealing with the current crisis.

I have been sharing funny memes with my community: family, friends, my patients and their carers, my neighbours, SANE Australia colleagues (I am on the board), Rainbow families community, which we are members of, my workmates and my acquaintances. If you laugh, you breathe deeper, which helps anxiety. Laughing together, not at someone, is a great tonic in these uncertain times. We all have communities we belong to, we can invite those who are on their own into ours. Community is key; yours include the young in your care and their carers.

If you laugh, you breathe deeper, which helps anxiety. Laughing together, not at someone, is a great tonic in these uncertain times.

We go for walks, check on our elderly neighbours and those who live on their own, from a healthy distance, of course. I have issue with the term “social distancing”; it is healthy distancing to prevent infection, not to counter social contamination. It is so important right now to give a virtual hug to friends or family not living with you. We have the internet; it is a wondrous thing. Social media has been kinder lately and can be a wonderful way to stay in touch, as can video calling. So is dressing up to take out the rubbish or go for a walk down the road.

Mateship and humour will keep us going. Mindful use of alcohol and chocolate will too. We are being asked to go to couch, not to war. The dark side of alcohol misuse, though, is an increase in domestic violence, drinking alone in isolation, and other social and health issues. There are online mental health forums, telephone support services and internet-assisted meeting hubs. Talk to someone, don’t feel more alone in a time where we are connected via the web.

I was feeling more stressed thinking about my family and my own health, accepting that I am 55 this year and more at risk than when younger. The cognitive dissonance is powerful. On the one hand, I want to isolate at home; on the other, I am a doctor, with a duty of care to others. We now have options to work from home via telehealth, but I still have to see my inpatients face-to-face. When I speak to my patients with anxiety they are fearful, finding it hard to cope at present. However, when we talk it through, most of them are introverts (I’m an extroverted introvert), who like nothing more than being at home. Having obsessive-compulsive traits is useful when organising your home against infection.  

I am often asked what we should say to our kids, how we can help them with their anxiety. I have two sons, ages nine and seven. We are lucky in that we have four parents to share the load. My respect and admiration go to all of you who help with others’ kids, as well as coping with your own, especially single parents. And those without kids, who make the lives of parents so much easier.

We made the decision to take our children out of school over four weeks ago, when our leaders were dithering as to whether to close schools or not. I am the lucky parent: I get to go to work, chat on radio and TV, and swan in for dinner – so I have been told. Don’t lie to your kids, lack of knowledge worsens anxiety. Make hand-washing fun, and a natural occurrence. They understand that we are all in this together. That we are all doing this, so that when we all get back together, there aren’t any of our loved ones missing.

The big advantage I think younger people have, is that using the internet is second nature to them.

Young people will pick up anxiety and stress from adults, so it is always best to be open with them. The big advantage I think younger people have, is that using the internet is second nature to them. They chat, socialise and play on the web. It is hard not being able to see family and friends, but at the moment we can at least walk outside. I haven’t seen so many families out walking with kids and dogs, as I have in the past few weeks, since the 1970s.

As you prepare for the online term, remember to maintain structure and routine, especially sleep. If you’re feeling okay, you look after others better. Don’t hit the snooze button. Get up, do some stretches with some deep breathing, and think about positive things in your life you are grateful for. Don’t focus on news cycles. Mindfulness helps – concentrate on what you are doing, in the moment. Avoid thinking about future issues, work on day-to-day functioning, and maintain social contact.

You can reach out to each student, privately, via a personal message. It is useful to ask, “Are you okay?” Schools should have resources such as counsellors, as well as others who have been trained in mental health. If you don’t have such training available, demand it. Those of you who have personal experience of mental health issues, your lived experience is invaluable in terms of the common sense and compassion you can show to others. It is also good to ask parents how they are doing. Set up a video chat or messaging service to check in with your charges and their families during the term. This may seem like more work, but not commuting allows for morning walks and more mindful preparation for the day.

Those of you who have personal experience of mental health issues, your lived experience is invaluable in terms of the common sense and compassion you can show to others.

I do think that structure and time management is easier when you don’t have to rush to work, attend too many meetings, or have to worry about what outfit you’re wearing. I had a great week chatting to my patients from home, with a nice shirt on – and tracky pants. I feel lighter as I am not rushing around to meetings, conferences or flying abroad. I am spending quality time with my family and chatting to so many friends and colleagues.

I am trying to follow my own recommendations. I don’t drink too much wine, but we have had a couple of video chats and drinks with friends, which was great. I do have a thing for chips (both crisps and hot chips) and chocolate right now, but am working on a healthier me after Easter. When in bed, my husband will chide me as I scroll through scary news, rather than sleep. We all need support – and caring nudges – to shift behaviours at times.

But you know, what I have noted lately, despite those I have seen described as “Covidiots” ignoring rules, is that people are being kinder. They are making the most of spending time with family. I really didn’t know that so many of my friends liked to bake! We have mateship in Australia and New Zealand, a sense of community, as well as a great sense of humour. We can get through this.

We have mateship in Australia and New Zealand, a sense of community, as well as a great sense of humour. We can get through this.

Post-Covid-19, I am hopeful that people understand and empathise about mental health issues, linked to the greater amount of stress and anxiety this year has wrought. Mental health issues are increasing, especially linked to threats to our environment and climate, as well as the increasing poverty, loneliness and isolation so many face. There is growing awareness that these are symptoms that people with mental health issues have, at all times of the year, Covid-19 or no.

If we as a human race do not learn from this, and change positively post-crisis, existential angst and despair will certainly grip me. We have to care for each other, have courage and be kind – or we descend into selfishness, and our earth is further bled, for profit for the few. I want to look my children in the eyes, and say that I have done my bit for my fellow humans and their future. We have to look after the mental health and well-being of all humans and animals. Reading books is really good for us (hint intended)!

The long-term effects of this year of Covid-19 will be that young people will want us to take more care of the environment. We’ll discover they are more resilient than we think, but they’re fearful of their future planet.

Thanks for reading this article. Stay safe and connected; our health, sense of belonging, family and wellbeing are important.

He aha te mea nui o te ao. He tāngata, he tāngata, he tāngata. What is the most important thing in the world? It is people, it is people, it is people.

Good luck with your new school term, may the streaming force be with you, and your anxiety eased.

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Dr Mark Cross is an Australian psychiatrist specialising in treating young people, complex PTSD, women’s mental health and anxiety disorders. He is a senior lecturer at the University of NSW and a conjoint lecturer at Western Sydney University. In 2015, he received the Royal Australian and New Zealand College of Psychiatrists NSW Branch Meritorious Service Award for his significant contribution to psychiatry. His latest book is Anxiety: Expert Advice from a Neurotic Shrink Who’s Lived with Anxiety All His Life (ABC Book/HarperCollins, 2020).