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Psychiatrist talks mental health in a time of pandemic

In scary times it is important to actively take your mind off the news and coronavirus. THEO PANAYIDES meets a psychiatrist who says the pandemic is making vivid what was previously obscured and not dwelt on by busy people

It’s all so awkward at the moment. I meet Dr George Mikellides at the door of his Nicosia office (this is before the lockdown measures announced last Tuesday); we’re face to face, but still social-distancing. He reflexively offers his hand for me to shake, I panic and freeze for a second – just long enough to make him self-conscious, so he withdraws his hand just as I think about extending mine. This Covid-19 business is playing havoc with social graces.

This is not just an idle observation – because George is becoming quite a well-known voice on all things coronavirus, frequently appearing on TV not to downplay the pandemic (perish the thought) but to wonder what effects the necessary measures might have, and how best to cope with them. The virologists and epidemiologists have had their say – but London-trained George is a consultant psychiatrist and that too is relevant, especially as we all hunker down with only the steady drip-drip of death rates and new infections for company.

The media emphasis on bad news adds to the fear. Globalisation plays a part too, bringing the mayhem in Wuhan and Milan to our doorstep. Above all, there’s the uncertainty, both because we know so little about the virus (is it in the air? will it recede when the weather gets warmer?) and because it’s such a sneaky virus in general; people can appear healthy – even feel healthy – yet still be infected, and infectious. In a way, fear of Covid is a lot like our fear of death generally, another muddy uncertainty gnawing away at our wellbeing. Fear of death is always with us, agrees George, “but when these things happen, like this pandemic, it’s like having death in your face, let’s say. Which makes things much more complicated – for everyone, even for doctors”.

Mental anxiety, depression, even psychosis; these are his subjects, his stock-in-trade. He knows them like a craftsman knows his tools, or a Michelin chef knows his sorrel and rosemary. George is very pleasant company, a fluent talker (as you might expect from a TV pundit) with horn-rimmed glasses, thick curly hair, a beard flecked with grey – though he’s only 38 – and an affable manner, yet the affable manner hides some pretty intense life experiences. “I’ve seen people in shock,” he tells me. “I’ve seen people being psychotic. I’ve seen people self-harming. I’ve seen people running around naked in the street, I’ve seen people running around naked on psychiatric wards.” He’s seen people hallucinating while they were high on drugs, he’s worked in prisons and listened to horrifying tales of abusive childhoods, he’s come across patients who tried to kill themselves. “It’s quite shocking when you see people who jumped from a motorway bridge, or from a fifth floor. We even had a patient who jumped from the eighth floor, and survived.”

All this was mostly in London – though he also worked at Nicosia Central Prison for almost a year – where he spent eight years after finishing a medical degree in Prague. He’s been back in Cyprus for about five years, and has been one of the few on the island offering rTMS, Repetitive Transcranial Magnetic Stimulation (more on this later), for the last three. George is happy to vouchsafe this information; anything more personal, however, tends to get deflected. It’s fair to say I don’t get much on his own fears, if indeed he has any.

Partly it’s because he seems to be a genuinely stable character, without much of an edge; “I believe I have good self-control,” he muses. “I’m able to rationalise things, put things in perspective.” Partly, too, it’s a kind of professional reflex – because a psychiatrist isn’t supposed to reveal themselves. ‘So, Doc, are you married?’ he recalls a patient’s father recently asking, in the usual conversational Cypriot way; in the UK, notes George, that might be considered a highly inappropriate question. It has nothing to do with being secretive, it’s about being able to do his job effectively. He needs to be neutral, so that patients will open up to him; the more he reveals of himself, the more he might alienate those who (mistakenly) assume he won’t be able to relate to their own experience. The inmates at Pentonville Prison in north London might’ve held back, for instance, had they known they were talking to a dentist’s son from Larnaca; instead they saw only a health professional, a good listener, and a fellow Londoner whose story might plausibly resemble their own. “I remember patients sometimes saying ‘You have a cockney accent’,” he chuckles. “Which I didn’t. I didn’t even know what a cockney accent meant!”

I do get some personal info. He played tennis seriously in his teens, and even played against Marcos Baghdatis in a tournament final when George was 12 and Baghdatis around nine (Marcos won). He briefly thought about becoming a pilot, before settling on medicine. He and his partner Marianna have a three-year-old daughter – a major reason why he’ll probably have to reduce his working hours soon. He works a lot, usually working straight through with only a snack at lunchtime, seeing 15 or 20 patients a day – and many, or most, of those patients come with mental disorders, a sky-high stack of emotional baggage which he has to share then discard, for the sake of his own mental health. “You need to be able to put things aside,” confirms George. “You need a break. That’s why you need to have a good night’s sleep, have dinner, see family for a bit – and then the next day the same routine, patients, patients, patients.”

In a way, what Dr George Mikellides does on a daily basis is what we all have to do, in our Covid-related ‘new normal’: engage with the burden of others’ distress and suffering – the scary stories, the steadily rising numbers – without allowing it to overwhelm us. “My advice to people is obviously to keep updated with the news, that’s quite crucial,” he tells me. “But, on the other hand, we don’t need a 24-hour update – whether we have a new incident in Cyprus, or if the incidents went from seven to eight, or if someone has been hospitalised.

“It comes to a point where you wonder how important it is to be bombarded 24/7 with this kind of information. The only thing it can actually cause is panic, agitation, fear of death, and people will actually get isolated even more – and I don’t just mean isolation by physical barriers, [but] by their own self. They might spend a lot of time, a lot of hours, in their bedrooms, which is not healthy. They need to use the bedroom just for sleep – some might say for sleep and sex!” he adds waggishly – “rather than lying in bed awake, on your tablet, on your phone, for hours and hours. This will have a huge impact on your sleep, you won’t be able to have good-quality sleep…

“So I’d recommend to people to get out and about. Not to have personal contact with others, but they can go for a walk without having contact with other people. Just to breathe a little fresh air, and see the sun.”

‘But what about lockdowns?’ I ask, anticipating the measure that was indeed put into place a few days after our conversation.

“I know,” he replies soberly. “I believe that, if there is a 100 per cent lockdown, it will have a huge impact on mental health. Meaning people will become agitated, people will become depressed. I’m not saying these things to scare people, that’s the last thing I want to do. I just want to give them a warning that it’s good to just – go for a walk.”

Look, says George with a kind of expansive shrug, “It’s not like this pandemic is bringing death [i.e. for the first time]. Death is there, death is in our lives. This is just like a reminder – a constant reminder, especially if you watch the news and how the news are presented”. Headlines don’t help, wallowing in bad news when they could be reassuring people that all appropriate measures are being taken; still, he repeats, all the virus is really doing is making vivid what was previously obscured. “What we tend to do in our lives, is we tend to get distracted – by doing hobbies, by going to work, by seeing our family, we tend to kind of ‘forget’ death. Unconsciously, I think, we never forget death”. It’s just become much more visible, all of a sudden.

Does he know any tricks to manage this anxiety?

“‘Tricks’, that’s a good way of putting it!” Well, he replies, meditation can help; even if it’s just 10 minutes a day, it provides perspective and improves self-awareness. “I will advocate for meditation.” There are other tools, even on lockdown. “We can still exercise at home, it will bring some relief. We can still read self-help books… Some people also – which is evidence-based – use aromatherapy”. A few drops of lavender oil, sprinkled on your pillows or couch, can induce a “calming sensation”. God can help, too. “Believing in God gives you a reassurance that there is something after death… In a way, we trick ourselves – [but] others would say that you need to have faith to be healthier. Which is true, if you do have faith you feel more reassured, and you don’t tend to worry too much about it”. Is he religious? “That’s quite complicated,” he replies with a laugh, once again opting not to reveal too much.

It’s a vast subject, really: the life of the mind, the tricks we employ to maintain mental health, the way we’re all finally – frighteningly – prisoners of our often-deranged inner selves. The mind gets stuck in irrational fear, like a drug, and the rest of us follows obediently. This may be a good time to recall rTMS, the non-invasive technique he offers which involves placing an insulated coil over the scalp and stimulating the brain with short magnetic fields (more details at cyprusrtms.com).

The treatment is relatively new (it was FDA-approved in the States in 2008), yet it’s already being suggested for migraines, depression, OCD, bipolar depression, and could even help with dementia. George has tried it himself, he tells me, “it feels like a tapping on the scalp” – but the more intriguing fact is that rTMS has also been used to help people quit smoking, alcohol dependency, even gambling. The diplomas on his office wall include one from Harvard Medical School, where he took an intensive course on the subject – and during the course, he recalls, “they showed us a picture from a Chinese prison”, addicts lined up beside a dozen machines and rTMS provided by the prison authorities, to reduce their cravings.

It’s fascinating – and a little scary – how easy we are to manipulate, even as we sit at home potentially freaking out at the thought of a virus coming closer and closer. Will governments of the future simply equip each household with an rTMS-like device, with instructions to self-apply if life starts becoming too unmanageable? “It’s not as simple as that,” laughs George. “It won’t change your personality!” He shakes his head wryly: “We are prisoners of our minds, and that’s a true fact. But we can always think about escaping from that prison.”

How to do it? Clinical intervention helps, to be sure – rTMS, or just psychotherapy – but also perhaps through our own devices: taking exercise, listening to music, learning a new language, “enhancing our spirituality” – anything, says Dr Mikellides, that’ll release dopamine and other neurotransmitters, that powerful sense of enjoyment that makes life worth living. And what of George himself? Does he also have an irrational fear of death? “I don’t have an irrational fear, in general,” he replies affably, “about anything”. We say goodbye – and this time we do shake hands, with an embarrassed chuckle as if doing something quite daring, then rub them with hand sanitiser immediately afterwards. Crazy times.



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