Cabin fever: mental health and the pandemic podcast

Transcript

Cabin fever: mental health and the pandemic

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Daniel Ridge: The term "cabin fever" is taking on new meaning through the global pandemic and many of us have struggled through what has become the greatest confinement of people in their homes in history. How have you adapted? What have you done to cope? Today I'm talking with Paul Crawford to discuss his new book Cabin Fever: Surviving Lockdown in the Coronavirus Pandemic. Paul is Professor of Health Humanities at the University of Nottingham, and also editor of our series Arts for Health, which we'll also be discussing.

Well, thank you Paul so much for joining me today.

Paul Crawford: Good to join you too.

DR: Your book Cabin Fever is extremely topical at the moment considering that we've all been living through cabin fever over the last year. I'm curious about what inspired you to write this book.

PC: The idea for the book about cabin fever came from being isolated in lockdown. My wife was overseas at the time, and I found it quite challenging. Although I've got a nice-size house and the garden, I find it quite difficult to be in confinement. When I discussed the isolation with my eldest son who was also in lockdown on the Ottawa River in Canada, we got to think about, you know, that whole Tom Hanks experience in Castaway. I knew from that film Tom Hanks took some comfort creating a character, Wilson, from an American football. I did the same here actually, except it was a cushion and I had my wife's face printed onto the cushion.

DR: Oh, that’s funny!

PC: Yeah, yeah, I know [chuckles] I had the daytime face and the night-time face. So, I’d move this cushion around the house, and it helped a lot. But when I was in conversation with my son about the challenges of isolation, we chatted a little bit about cabin fever and I said, “wouldn't it be funny to write a book about that?” When we looked into it, we found that there was very little out there that had been written on this topic.

DR: Where does the term “cabin fever” come from?

PC: That was the first thing that we found interesting, and tricky. The first published reference is by Edward Cave, who was writing as Silvanus Urban in the Gentleman's Magazine in 1820. He linked the term to the experience of typhus infection. Ordinarily, people think of cabin fever in terms of the sea life and being in the cabin at sea but, in fact, our research showed that the notion cabin fever, actually was driven by the experience of the poor accommodation in Ireland.

The poor of Ireland were living in cabins and they were also subject to typhus infections, because of the close living in a single room. And that was, if you like, intensified during the Great Famine in the middle of the 19th century. And afterwards, of course, many of the Irish at that time left for North America. By doing so, they brought typhus to North America, and they also brought something else which was cabin building. And, as the Irish took part in a lot of the pioneering of North America, and the whole expansion into remote locations, the cabins went with them and there was a shift from the physical side of typhus infection – the physical symptoms. Gradually there was a shift to the notion of the psychological affliction of living in confined situations in remote locations that was experienced in, you know, North America.

DR: In the first chapter of your book you point out the double-edged sword of confinement, that is, a very real danger from the threats outside of the home, but then there are also threats that come from, from that confinement itself, whether it's, you know, isolation alone or with members of the family, what we tend to call “cabin fever”. Can you tell us about the threat of both the interior and the exterior?

PC: From an interior perspective, we have the whole business of isolation, or being overcrowded, particularly in small built environments, small spaces, and the limited resources of confinement in interior settings so that can be access to a variety of resources, but also impacts on relationships, the balance between home and work, and the division there. Also, indoors, we're lacking sunlight, and we're also more limited in terms of exercise and activity space. We are cut off to some extent, not entirely, but we’re cut off to some extent, particularly in urban environments, from perhaps more beneficial access to nature. The sedentary quality of indoor life, and the easy access to food intake, and excessive screen time, and over reliance on social media – all of those can play in as threats to health and well-being.

And then outside you've got, in the pandemic, of course, you've got the outside environments for threat in terms of infection and outside of the pandemic context you might be thinking of extreme weather conditions in terms of air and space, lack of oxygen, if you talk about air and space flight, and you've got types of sea locations, of course, extreme sea conditions. Those are two components that are working diversely there.

DR: How do these threats take a toll on our mental health?

PC: That's huge, Daniel. Clearly, if you can't go outside, the increased stress levels, from a number of directions, come into play so the increased stress levels from lack of access to resources that you need – social connectivity, employment – so that may be adversely affected. So, if you can't work from home, that can impact on your sense of purpose and goals, which are important to good mental health, as is, you know, finance, income. Then we also have in that kind of intense indoor life, the threats to interpersonal relationships and the likelihood of conflict, literally getting into each other's hair in that sort of environment.

The stress levels, we're talking here increase cortisol, which we know has physical and mental health impacts, which are damaging. If you can't go outside for long periods, you don't enjoy the benefits of sunlight, and we know that sunlight is key for increased serotonin happy chemical and also vitamin D production, which is also key to serotonin, and we don't get to enjoy the comfort of nature, fresh air, exercise outdoors, all those things come in.

But one of the key things is the sheer boredom, the indoor life, the potential lack of stimulation from a restricted environment. Also, from the indoors perspective, of course, and that confinement, we need to think about the whole business of what we know from the research in terms of how confinement, particularly solitary confinement, can lead to profound mental health distress. In addition, we have, and have seen this in the lockdown experiences, increased abuse and domestic violence, which itself can massively impact on the mental health of victims, and these intensified in lockdown.

DR: In your book you have a lot of historical context; for example, you talked about Florence Nightingale in history of solitary confinement. What lessons about isolation and confinement can we learn from history?

PC: One of the big lessons we can learn from history, is that when you are confined to indoors for prolonged periods, whether you're in a prison, or in other contexts, you're going to be subject to increased anxiety and depression, generally. You become more irritable, potentially more aggressive, your sleep will tend to be disturbed in either direction, you can become hypersomnic or suffer from insomnia, and you can have changes in your thinking about yourself about the world around you, the limited world around you, and you may also end up self-harming and committing suicide.

But in terms of the question about the history side, there's a lot to look at there from penal history and the history of solitary confinement to other contexts such as prisoner, prisoner of war experiences and hostage history. And then perhaps more, typically if you're thinking about the pandemic, you might be looking at plague history; for example, the Great Plague of London, which Daniel Defoe covered, really shows that kind of social disruption, being in lockdown and aggression and violence to those trying to prevent people leaving their homes during the plague. And then we get a little bit broader into the whole history of pioneering and adventure on land, sea, in the air and in space. The history of science comes in, in terms of the whole business of practising, if you like, for trips to Mars through analogue stations, and how people have managed on the International Space Station and in other spaceships. And then we come to, you know, cultural diversity in terms of cabin fever with different cultures establishing or presenting different accounts of the experience of confinement or isolation in remote territories.

And finally, you mentioned Florence, of course, last year was the bicentenary of Florence Nightingale and, in our other book Florence Nightingale is Home, we showed that Florence Nightingale was subject to cabin fever in a very real sense, because most of her life, or much of her life after she returned from the Crimean War was as a housebound invalid. She suffered from depression, quite possibly intensified, or increased, by her experience of confinement.

DR: You also talk about the diversity of the lockdown and confinement experience. Can you tell us about this?

PC: I think this is a key point actually, Daniel, because you use that word “lockdown” as if it's a one size fits all, that's what everybody experiences, but of course, over 4 billion people, over half the world's population experienced some form of lockdown in the last year. That's the greatest confinement in history; however, what that confinement amounted to, the kinds of lockdown, would have been quite diverse.

So, for some people, they would have been in isolation from family and friends, maybe for long periods; for others, they may have been in lockdown with their families or even strangers, as in the case perhaps of university students in halls of residence. Others could well have been in nursing homes or other kinds of group homes and with diverse physical and mental health status. And then, quite aside from that, if we think about people's homes: homes are very diverse in terms of size, space, location, resources and so on – the facilities within the homes. And, indeed, a lot of differences in terms of being info rich or info poor, access to technologies, access to Netflix or not, you know, so all the different resources that people have mitigated for lockdown with that can be very different.

And some people have worked seamlessly from home; they've adjusted very quickly to go in on Teams or Zoom or whatever, and the types of work they do, hasn't really been, you know, hugely affected or impacted by the lockdown. Whereas others, of course, have lost their jobs or through furloughing schemes they've lost their job activity, which may have impacted on their overall experience. Yeah, so that's just some of the parameters, and there are many, many more.

DR: You dedicate an entire chapter to antidotes to cabin fever. What are some of these antidotes you found?

PC: The research that we did around penal environments, showed how important it is to have sufficient interest and stimulation to deal with prolonged confinements and isolation and to have purpose and goals. So that's a key factor, also, in mitigating for cabin fever in the lockdown is to have purpose and goals during the day and, psychologically, it's been important in terms of how you view home environments as providing a sanctuary, as opposed to a prison. It's very easy to get into that kind of mindset where you view your home as a prison; you're being stopped from, prevented from, going outside, you know, you've got to live inside. It's almost like being under house arrest. And so, adapting and adopting a mentality around sanctuary helps to mitigate for that.

Adjusting to the new normal is clearly something we all have to do when we're posed with quite a momentous change in terms of our life and how we’re living it, but some of the, I guess, traditional things come in around managing your body health. Particularly important is exercise when you're housebound. I actually invested in a treadmill (which I must say was quite interesting a couple of times because I kind of ended up doing a backflip onto the sofa in the room), nutrition and hydration. And, of course, getting quality sleep. All those things, perhaps, you'd say “oh yes, well, they're important and they mitigate for this”, and they do. The other one is, again, perhaps a little bit more obvious, access to nature, and actually making the most of outdoors. Now that's been easier when the weather and the conditions have allowed for that, but of course, as with people experiencing cabin fever in places like the Arctic and so on, going outdoors isn't always easy, and in a harsh winter, as we've had a difficult winter with long dark days as it were, then getting out into nature is more reduced.

One of the key surprises for me, Daniel, has been just how important the creative arts have shown themselves to be in mitigating cabin fever, and we know this too, actually, from the penal context where there's increasing research showing how involvement in the creative arts in penal environments can really mitigate against the mental health impacts of confinements and isolation. We've seen that in this last year with the lockdown; we've seen people turning to the arts and humanities, both in terms of activities, or simply receiving the arts and humanities through reading or watching films, and so on. And we know from the evidence that the creative arts are like a shadow health service, and they are something we don't need to have them prescribed to us, but we should take them as readily as some of us are taking medications.

DR: Yeah, I wanted to ask you about that. You’re editing Emerald’s Arts for Health series, and you cover in the series a lot of diverse subjects: theatre, music, drawing, reading, dance. Is there any of that research that surprised you from the different books or different contributors that might have been more engaging that you were not expecting?

PC: Not really, I think what surprised me in that series was that it took so long to find a way to have a series of books that were geared towards the public, and geared towards what I call creative public health. In other words, we've had lots of research papers, we've had lots of academic books about the value of the arts to human health, but what we've not seen, until this series, actually, is books which are showing the general reader the particular benefits of singing, drawing, painting, dancing, theatre, and just laying it out, how these arts activities or arts environments even, can enhance physical and mental health.

DR: I think it's interesting that there's almost a human need for creating art; do you think people need to be told: “Okay, you need to set time aside to do the arts”?

PC: I don't think the public need to be told. The creative arts have been a core feature of humanity and society. And what's happened over the last 150 years is that health has become something which we locate as a matter for the doctor; we go to see the doctor about our health, we go to hospitals for health, we go to the clinic, and so on. The public health side of things has been more on matters like epidemics and sanitation, etc, etc. Curiously, the health benefits of the creative arts has [sic] been, if you like, under-emphasised. It's as if all our theatres, our music, our reading and so on, are simply entertainments. Yet, can we imagine a world without music, films, dancing, singing? I think we'd struggle to have any sense of what it means to be physically and mentally well if that were the case.

So, when lockdown happened, I think there was a deep resonant turn towards those comforts and those interactions that we know make us feel better. And that may be singing, it may be drawing, maybe painting. I run my own solo disco in my kitchen for the first six months of lockdown. And I can tell you now, I benefitted not just from the exercise, but I've benefitted from being able to just dance my own way to the songs I wanted to listen to.

DR: Well, your series focuses, not only on the arts, but on how different approaches to creative activities can be utilized in different places, like care homes and hospitals. Can you talk a bit about how these approaches differ?

PC: Well they can be both similar and they can differ. So, in terms of access to the arts, within reason, everyone can have some access to various kinds of arts in their day-to-day life, and that goes for people in hospitals or in care homes, as much as in their own private homes. Of course, the resources available in those spaces may be different. And, also you may have to adjust your engagement with the creative arts because maybe you're with other people who, you know, have different expectations of the use of space, and so on.

In terms of hospitals and clinics, of course, a lot of the business of those places and spaces is a particular kind of recovery, in terms of health and well-being, we need that. But I've been trying to emphasize the importance for clinicians and hospital managers and people who provide those services to really consider how the environments for healing, the environments that people come to recover their physical and mental health can be enriched through feasible creative arts and practices and access to those resources. Some of that may be therapeutic directly and specifically for particular conditions, and that may require personnel who are trained for that, for example, using creative approaches in recovery after strokes, or in other conditions such as dementia. However, there are also many creative resources that can be brought to bear, not just for patients in hospitals, but also hard-pressed and, you know, burdened staff, and family visitors to perhaps offer some respite on the corridor, or through other community events to reduce stress levels.

DR: How can our listeners use dance, drawing, film, reading, etc, to care for themselves as we emerge from the pandemic and ease back into, you know, prior versions of ourselves?

PC: I would strongly recommend that they think about the creative arts as a non-prescription kind of medication for the future, in terms of reducing stress levels and increasing positivity, as we're all let out of this horrible lockdown experience. I think for some people, they may have learned new habits of creativity while they've been in lockdown. Others may have missed the opportunity during lockdown to think about the benefits of the creative arts and I would really encourage those who've missed that experience to consider what we've learned from lockdown in terms of how this can mitigate for loneliness and isolation, loss of purpose and, you know, regardless of the pandemic, just treat the arts as the kind of doctor that you don't need an appointment for.

DR: Surprisingly, it seems that there have been benefits to confinement, what has the research shown us?

PC: Now this is really interesting, Daniel, because, okay, cabin fever, you know, mental health impacts – there's no doubt there's been a lot of mental health impacts from lockdown; we've seen numerous government reports, health reports, on increased levels of depression self-harm, abuse, anxiety levels. Young people have struggled in particular with loss of access to education and their peer groups and so forth, but there are also positives that come out of this. We've seen that people have been, I guess, in an involuntary way, they've been given more reflection time in this kind of situation of lockdown and thinking about, you know, new ways of working. That was a pretty instant thing for those who were in employment was, “how do I work from home if I can?” and so on. And that provocation has led to some interesting developments in terms of how we work from home and some of the benefits there.

Some people have found that the extra family time that's come from lockdown has benefitted them, and they felt that they've been able to adjust to new perspectives and priorities around being amongst and among their family. The other thing that's sprung up is an awareness and a reliance on community. So, this may have come quite simply as people have required or asked neighbours if they could deliver food to them and so forth, and going outside and singing, or other social exercises of community and solidarity that have happened. The other aspect which, perhaps, we need to take with us as a message really after lockdown is the permission to chill, the permission to do nothing, or what I think of as “chronic pyjama wearing”; letting one’s self off the treadmill that we often find ourselves in, the home–work split.

DR: That's true, that's one of the things that I found hard was just learning to relax and be okay with “today I didn't do anything”, you know?

PC: Yeah, well, you know, that's probably a common experience, Daniel, in terms of how we're all wired up to, to get busy and do stuff in a very, you know, competitive society, perfectionistic society, driven, pushing ourselves. So that's, I think, a key gain. The other thing is, for some people, they've saved money from being blocked from needless spending on useless objects. Perhaps other people haven't saved money, so it's probably a diverse experience there, perhaps people have been really hitting it hard on Amazon and deliveries of things they never thought they needed.

But, the change in our behaviours around shopping, and, you know, shopping deliveries and perhaps the time saving there, certainly reduced travel commutes and so on, I think that's had a number of benefits, at least perhaps green or climate benefits as well. How far these benefits go for individuals will, of course, be different, but the change in noise levels I noticed during, during the lockdown in terms of being able to hear nature more the whole soundscapes changing, and the air just seeming so much cleaner. I don't know if that was true or not but that's how it felt. And, a bit like what you said about kind of stepping off the hamster wheel a bit and chilling, I think the lockdown has pushed us to stop and look a bit more at simple things; stop and look at the flowers. I watched my apple tree gradually deliver apples across the year and it was, it was almost like a slow-motion experience, actually seeing that every day, and looking, looking at the apple tree every day. I'd never done that before.

DR: Yeah, well, as you wrote your book you were conscious of these things and exploring it, and I'm wondering, for you, personally, do you think there are lessons that you're going to be taking out of this that may last the rest of your life?

PC: I didn't need this lesson, but I was in the classroom for it. And that was, I miss my children so much, because my eldest son and my, my daughter and my youngest son, have been outside of my arms for the best part of 14, 15 months. And, like many people, I think, who’ve been separated from, from not just their children, but their loved ones as well. It's a lesson you shouldn't need, but I was in the classroom, and I was listening.

DR: I think, really, for me it's getting off that hamster wheel and slowing down and kind of being okay just not doing anything.

PC: Maybe that's what we'll all be doing when we get out of lockdown is thinking and feeling a bit more, and hopefully being able to be more compassionate both to ourselves and to those around us.

DR: That's really nice. Well, thank you so much for joining me.

PC: It's been a pleasure and I wish everybody well as they get out of their cabins and experience a new, new normal.

DR: Thank you for listening to today's episode. You can find a transcript of my conversation with Paul Crawford on our website, as well as more information about Paul's book and the series, Arts for Health. I'd like to thank Charlotte Maiorana for her help with today's episode and Alex Jungius of This is Distorted.

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