Western experts weigh in on mental health and pandemic

On Wednesday, May 6, Western professors Dr. Chandlee Dickey and Barb MacQuarrie took part in a webcast to answer questions from the community including prioritizing mental health during the pandemic, increased risks of harm and vulnerability of abused women and children in isolation, strategies to cope with domestic violence and child abuse, and more. The event was hosted by Sarah Dawson, Western Alumni Career Coach.

*   *   *

Sarah Dawson: Good afternoon, everybody. I’m Sarah Dawson, from Western Alumni and I’d like to welcome you to today’s special Q&A webcast. We are focusing our questions primarily on the idea of maintaining mental health during this pandemic and making that a priority.

We have two of Western’s leading expert researchers with us today: Dr. Chandlee Dickey and Barb MacQuarrie. And thank you to those who have sent in questions through social media, and if you’re joining us on Zoom or Facebook, we welcome you to send us your questions and we’ll get to as many as we can.

A quick introduction to our panelists today:

Dr. Chandlee Dickey is chair and chief of the Department of Psychiatry in the Schulich School of Medicine & Dentistry. Using neural imaging and behavioral tasks for research has greatly advanced our understanding of schizophrenia. An expert in psychiatric education, Chandlee moved to Western in 2018 after establishing herself as an internationally renowned thought leader at Harvard University. During the pandemic, she’s especially focused on mental health for all and effective ways to stay calm and manage your well-being during these uncertain times.

Our next panelist, Barb MacQuarrie, is the community director for the Centre for Research and Education on Violence Against Women and Children in Western’s Faculty of Education. Throughout her celebrated academic career, Barb has developed and promoted countless evidence-based education tools, gendered violence prevention initiatives for community and university-based partners. An expert on workplace harassment and sexual violence, Barb is currently studying the increased risks of harm and vulnerability for abused women and children in isolation and developing new strategies to cope with domestic violence and child abuse in this new normal.

Thank you both for joining us today. We have lots of questions to get to and I hope you both are doing well.

The first question I’ll toss out there to you is around social distancing. It’s helped us flatten the curve during this pandemic, but what are the potential impacts of distancing on people’s sense of well-being?

Chandlee Dickey: We talk about social distancing and it’s exactly not what we need right now. We really need social connection. People throughout history have had to come together in times of distress and in times of worry and this term has caused some cognitive dissonance for us because we know we have to maintain two-metre physical distancing, but the social connection is what we really need.

People got confused at first and some of our common social connections had to break down. We weren’t going to work; we weren’t seeing people in the hallway or in the elevator or in our apartment buildings. We miss seeing our students. We’ve all had to think of different and creative ways of maintaining that important connection while maintaining a distance and people have been unbelievably creative. They’ve been cooking online, where everyone’s cooking the same dish but in different spots or communicating across front porches. And that’s been very, very helpful to people’s sense of well-being.

Dawson: Have the recommendations for public health measures themselves created more vulnerabilities for people?

Barb MacQuarrie: For some groups of people, they have. Certainly, the people that I’m most concerned about.

There’s been a real vulnerability created through social distancing. For women who are in abusive relationships, isolation is already a primary dynamic of that relationship. They’re already being limited in terms of who they can interact with – family members, friends, co-workers – and it’s like our public-health measures have handed a new tool to abusive partners where they can reinforce that power of saying ‘you are not allowed to be in contact with other people.’ In the hands of an abusive person, those directives to maintain distance, they almost become a weapon that is used to isolate people those who are experiencing abuse even more.

Dawson: Are we learning anything that will help us improve our prevention efforts and respond to domestic violence in the future?

MacQuarrie: We’re learning a lot, but we’re in the middle of it so I don’t want to be premature. What we’re seeing here is that the pandemic is exposing vulnerabilities that always existed, it brings them to the surface where we can’t ignore them any longer. Those dynamics of isolation that were already there, we have not done enough to address them.

One of the campaigns that I work on is called Neighbors, Friends and Families, and it’s simply giving ordinary people, people who have no expertise in domestic violence, the tools to be able to recognize warning signs, to be able to understand when situations become more dangerous. That that work is important because, even without a pandemic, the number of people experiencing abuse who reach out to professional services is relatively low. The people who know that something is wrong are our social circles, our friends, neighbours families and co-workers.

So, we have to empower everybody to be able to say, ‘Look, something’s wrong. I’m worried about you. Do know that help is available, and you can go here?’ It’s very simple.

Dawson: People seem to be getting anxious from the constant barrage of stories about COVID-19. Is this normal?

Dickey: Well, it is normal. I mean how can we not be anxious; we don’t know what’s coming down the pike. We don’t know if we’re going to be having a second surge in the fall; we don’t know when we’re going to be able to return to work or how our kids are going to get through school, or to Barb’s point, whether or not we’re even safe in our homes.

So, of course, people are going to be anxious. I’ve been anxious from time to time. The key is how we frame it. If we see ourselves as victims of the pandemic, as opposed to us being agents for sort of controlling our lives, we’re not going to do as well.

What if we see this as an opportunity? An opportunity to get the word out about domestic abuse and child abuse, an opportunity to get the word out about mental health issues, opportunities to take on new hobbies, opportunities to connect with family members in a different kind of way.

If we see ourselves as empowered and agents, then we’ll fare better.

Dawson: Do either of you have some strategies on how to mitigate the anxiety that comes with uncertainty?

MacQuarrie: The best thing we can do is to connect by the means that we have available to us. A lot of us have almost forgotten how to use a telephone but it’s a really good way to talk to somebody. The whole world learned how to Zoom in the last monthly or so. There’s lots of social media platforms and other sort of creative ways to connect like playing bridge online.

So, find ways to stay in touch – it’s never been more important.

Dawson: So, I’m hearing from both of you that we all need connection no matter where you are on the continuum of well-being, connection is central to maintaining and improving well-being.

Dickey: In addition, not everyone is connected. So, for those whose social network might be a little smaller, there are still lots of basic things that we can do. At times of stress, we often lose the basics like maintaining good healthy eating habits, maintaining exercise. And when people say, I can’t go out for my run, well you can run in place. Or you can do push-ups and sit-ups, as painful those may be. You could learn how to do a burpee. There are all sorts of things that you can do in your restricted space.

Also pay attention to sleep. Sleep is very important. It affects our well-being, our ability to pay attention, our optimism – so maintain a regular sleep routine.

And basic meditation – there are lots of free apps for guided meditations. It’s not that we must become this super Zen-like person, we just start where we are and do what we can to help us stay focused during these difficult days.

Dawson: A listener from social media asks, “Is it OK that I’m not as productive at work and are we supposed to be productive right now?”

MacQuarrie: We’re all struggling with those questions. And in my world, a lot of the work that we do is grant-funded, and there is a general awareness amongst funders that we’re facing our own challenges. I work with a young woman who’s doing an amazing job at continuing to work, but she’s got a 2-year-old she has to look after while she’s working, it’s not possible to do the same thing.

I had conferences and workshops planned for the next year and now, it just can’t happen. For me, it’s a bit of surrendering to the circumstances, letting go of some expectations, and trying to get myself into the space of rethinking how I might be able to do those things in the future but not getting too caught up in ‘business as usual,’ because it’s just not.

Dawson: People are starting to realize what their daily routines meant to them. And when those spaces are no longer filled, it’s left an empty feeling, and that causes anxiety and stress around feeling productive, about experiencing meaning. Are there any ideas around reframing that notion to help us?

Dickey: It’s a concept called self-compassion. It’s about giving oneself permission to be OK and accept where we are in our journey and not have these huge expectations that we’re going to be this amazing superstar when we’re looking after our two year old or we’re trying to figure out what the structure of our day should be.

In addition to practicing self-compassion, it’s about appreciating what we are, as individuals, contributing during this pandemic. We have asked millions of people to stay home. And that is a gift. It is a gift that we give one another. It’s a gift that we’re giving to our hospitals and our health care workers, that we’re staying home and not flooding the country with COVID-19 cases. It is a way of contributing.

So, if people can reframe things like ‘my job right now is to stay home and not get the disease and not pass on the disease. And that’s OK. And that’s where I am.’

That reframing in a positive way and seeing oneself again as an actor can be really helpful.

Dawson: I’ve been hearing a lot lately about self-care, but we see a lot of people we do not have the luxury of self-care. Is there a way of thinking about that differently as well?

MacQuarrie: Self-care is critical and to bring it back again to the group that I’m most worried about, people who are experiencing abuse, self-care is really important in that context and you can understand how difficult it could be. But to survive in those circumstances, you must find small ways to take care of yourself. It can be specific to each individual; it might be eating your favorite food, it might be finding that five minutes, just for you. It might be not blaming yourself for what’s happening. It might be wearing your favorite piece of jewelry. It might be finding a way to take a short walk. Self-care is important and can be difficult. But don’t forget about it.

Dawson: Barb, although we’ve never faced anything like COVID-19, can we draw on any past experiences to understand what the current situation might be like for those who are in abusive relationships?

MacQuarrie: We do have research of natural disasters, whether they’re floods, fires, earthquakes, or times of crisis, where normal routines are disrupted, where people aren’t able to connect the way they normally do. We know, in times of stress, that reports of domestic violence and violence against women and children increase significantly. After the 2008 financial crash, we experienced increased reports of violence and abuse.

We’re throwing all these factors together in the pandemic: economic stress, disruption of routines, inability to reach out as easily to helping and professional services, it’s all there. What I will say is that we won’t know until sometime after the pandemic has ended, actually how much violence and abuse has increased because there are many people who are in situations right now where it’s not safe to reach out and ask for help, or they’re just simply not able to because they’re being so closely surveyed.

Dawson: When we think about on the role that workplaces play in helping and supporting their workers and their co-workers, what responsibilities do they have regarding support in this remote environment?

MacQuarrie: Let’s go back to our Occupational Health and Safety framework that we all work under in Ontario. Employers have a general duty of care for their employees, but in Ontario, we were the first jurisdiction around the world to have specific duties to protect employees from harm, the results of domestic violence – very progressive legislation.

That duty does not end just because we’re in a pandemic and people are working from home. Now we must think of creative ways to be able to do that. And it goes back to what we were talking about earlier, the ability to check in with people, or co-workers, if we’re supervising people, we must try to be in touch with them. We must be aware of warning signs, of somebody who’s missing a lot of meetings, somebody who never turned on their video in a chat, somebody who seems more anxious or afraid than what the circumstances would merit.

And we know that there can be other reasons for all those warning signs so we want to know whether we can safely communicate with somebody. Can we ask them yes/no questions? Is it safe for you to talk? Are you OK? Do you need help?

And it’ll go from there.

One thing I will say about this is that it would be much easier for workplaces to support employees experiencing domestic violence, or potentially experiencing domestic violence, if we had prepared ahead of time. We have relations of trust in place, we have safety planning strategies in place that can be more easily adapted to these times, we can have things like specific code words set up between a supervisor and employee. It’s hard to do that in the middle of the pandemic.

And so, to return to your earlier question, are we going to need things now that can help us do better in the future? Yes. We really need to focus on how employers can support employees experiencing domestic violence.

Dawson: How do we help students cope with moving from a typical classroom experience to an online environment?

Dickey: We’re in the middle of a massive experiment and we don’t know how it’s all going to turn out. I think some children and adult learners are flourishing in this online environment, it’s perfect for them. They can figure out when they want to learn, how they want to learn, they can stay in their pajamas, they can be doing whatever they want while they learn, they have great internet connection, they know how to use all the technology, they’re great.

There’s another group that’s more socioeconomically disadvantaged, where they don’t have a stable internet connection, their parents are less tech savvy. Their parents are maybe a little less educated and really can’t help them through this homework problem or that problem. I think people are worried that that cohort of children and adult learners are going to fall further behind.

And then there are the middle who are probably doing OK. You know they miss the soccer games; they miss the exercise that comes with school, they miss being in the school play, they miss their trombone practice. But they know it’s going to end and they’re getting through.

The key is to see what of normal life we can preserve. Is there a way to have trombone practice online using zoom? If soccer is their thing, can we come up with creative ways that that team can still stay connected? Maybe they can’t kick a soccer ball around in their living room, probably not, but maybe the team can come together once a week to think about plays or to continue to grow together.

Frankly, we don’t know how our children are going to come out of this and I think the individual child’s baseline resiliency is going to be a major contributor to their outcome. I think teachers are very worried about their students and not being able to check in on their kids who they know are in a difficult home atmosphere. And they’re very worried. Are they creating the right educational tools to help these different kinds of learners? So not only are the kids challenged but so are their teachers and schools.

Dawson: Are we seeing an increase in calls across helplines throughout the province and across Canada?

Dickey: Yes, there has been a dramatic rise in calls to our local health lines and that’s good. Mental health and well-being are now topics that are on the table. We’re having this webinar; people are reaching out to helplines. People have been suffering from mental health issues and loneliness and anxiety and worry forever but now it’s OK to call, now it’s OK to talk about anxiety. So, this may be one of those COVID silver linings? That mental health, anxiety, domestic abuse, child abuse, it’s now out in the public. And we’re able to talk about it. And so, we’re encouraging people to continue calling, continuing to get the help that they need.

Dawson: What would your message be for people who are not reaching out, or not going to the hospital because they’re worried that they might contract the virus that way? Are the hospitals prepared to continue to provide service for people suffering in this way?

Dickey: We just had an editorial come out in the London Free Press over the weekend, I believe that Adam Dukelow and others prepared. We’re open for business. We are here to serve. We care about people. The helplines are here to serve, people’s family doctors still care about them, they still want them to come and reach out. So, we’re lucky that here in London, the number of cases of COVID-19 are manageable. And so yes, everyone’s still open for business and here to serve.

MacQuarrie: That is an important message for women who are experiencing abuse or anybody who’s experiencing abuse. That some have been afraid to reach out or they may have the impression that shelters are closed or that they’re over capacity. I want to really emphasize that shelters are innovating and they’re changing the way that they service people, as they’re having to respect social or physical distancing. It’s true, there are fewer beds actually available in shelters, but they have found beds, in communities largely and in hotels, for people.

Don’t hesitate to call the shelter. They are there, they are available, they’re open, they are operating. And they don’t just provide the roof over their head and the bed. They also provide safety planning strategies, they provide help navigating any system that you have to be involved with, whether it’s health care, whether it’s a child welfare, or whether it’s a family justice or criminal justice system, they help you with all of that. So please know that shelters are still open and spaces available.

Dawson: An attendee has mentioned that ho we frame the pandemic is important. Do you think that people are framing the pandemic as a monster and feel like they can’t beat it or win?

Dickey: It depends who we’re talking to and how we want to frame it. When we’re talking to small children, sometimes it’s good to make it external like a monster to battle. For other people, that kind of imagery or framing may create a sense of powerlessness and helplessness. It really depends who we’re talking to and what they need.

We must adapt how we frame things. The idea that ‘we’re all in this together,’ that kind of that distance framing, has been helpful in pulling people together. But if it makes people feel powerless, then don’t.

Dawson: Regarding work/life balance, do you have any recommendations on how to wear many hats simultaneously and maintain your well-being? What are the tricks?

MacQuarrie: The first thing to do is acknowledge and be open about what’s going on in your life. Don’t try to be the person that can manage everything and that doesn’t need to ask for any accommodations. Be honest and be open with your co-workers and your supervisors, about what you can do and what you can’t do. I work with another colleague, who acknowledges that she experiences anxiety, so if it’s a bad day and she can’t be online, that’s OK. We must make room for all our very diverse realities and not assume one person can carry it all.

Dawson: Are there any recommendations for mental health and well-being for elementary and secondary students?

Dickey: They need to maintain their exercise and that’s hard if they don’t have a yard and they can’t go on the local park jungle gym right now. Kids need exercise to be ready, effective learners. If their exercise diminishes, they’re not going to sleep as well which compounds the problem. So, work with the child and develop an exercise routine that they think is fun. Maybe it’s putting on a goofy song and dancing instead of doing that algebra problem. Keeping their body’s natural needs going is key.

Dawson: How do we make recommendations for our adolescents to balance isolation and social interaction with their peer groups? And considering how much time they’re spending on screens, where they’re getting information and how they’re sharing it, is there a balance? Is there a right direction to go?

Dickey: The key word is balance. Throughout this pandemic, it’s about trying to maintain balance and talking with our teams about how are they doing their homework, what are the challenges? How are they using social media, what are they hearing, what are they experiencing, are they worried about one of their friends, for example, being in a difficult position?

It’s about communicating and that’s hard if you have a child who is a little less communicative by nature. But then you try to reach out to the parents’ groups. Parents often form these informal networks, like soccer moms or I guess here in Canada it could be hockey moms. But reach out to the hockey moms and say ‘How’s Sally doing? How’s Sam doing? How’s Varage doing?’

The whole message today has been about connection. So, parents can strengthen their community networks and in talking with our children about what they’re experiencing.

Dawson: Are there any specific findings regarding Indigenous communities or youth on the streets during this pandemic? How are they being affected?

MacQuarrie: People and groups that are more vulnerable are going to be disproportionately impacted by this pandemic. And we’re in the middle of it so we don’t have research yet. But if you think about people who are already less well-resourced whether it’s mental health resources or whether it’s housing or whether you already had higher rates of family violence. You can see how all that’s going to play out in these situations where we’re all isolated, or we’re not in our normal routines, where we’ve got financial stressors. Yes, those groups are going to be disproportionately impacted. We just don’t have the research yet because it’s still happening.

Dawson: Do you know of any resources or initiatives that our communities might consider addressing some of these specialized issues that have already existed but might be exacerbated during this time?

MacQuarrie: OK, I’m going to put in a plug for my own center here, the Centre for Research and Education on Violence Against Women and Children. We have a lot of resources that specifically address the challenges of marginalized groups in our society.

My colleague, Peter Jaffe, has been doing a multi-year major initiative looking at the prevention of domestic homicides with vulnerable groups including Indigenous people, rural people, children, refugees, and immigrants. There are a lot of research briefs on the website, written in plain language. We also have the Learning Institute, which is run by my colleague, Amanda Baker, who takes research and puts it into very accessible formats for an easy, quick read.

Dawson: Chandlee, if you’re working with someone that you suspect is struggling but hasn’t brought forward their concern, what are some ways that you might check in on them while maintaining their individual boundaries and dealing with security in your workplace?

Dickey: It’d be two different answers. One is a preventive thing that can be done up front in organizations and that’s to create a buddy system. People have a buddy and they text each other each day: ‘Are you OK?’ When they text back, ‘Yeah I’m OK today,’ or ‘Feeling a little grumpy,’ or whatever it is, ‘How are you?’ Over time, you can see whether there’s been a shift in your partner’s responses.

I have a buddy with a member of my department, and it has been fantastic for me because he’s really funny, and I didn’t know him that well before this but he’s made me laugh on many days. So, creating a buddy system, and it’s not too late because we’re still in this, is one way for organizations to install a more formal of preventative measure. Let’s say you don’t have a buddy system or this person’s not your buddy but you noticed that you don’t see them, they’re not showing up or they’re not putting their video on, or they’re a little quieter, or more withdrawn – really watch for those who are more withdrawn – I’d love to encourage people to just reach out to and say hey how you doing? How are you managing? This COVID thing is kind of rough, don’t you think? And say, for me it’s making it hard to sleep or, I used to not drink any alcohol, now I am.

Invite people to share and be explicit even saying look, I noticed that you never have your video on or, or you’re usually really funny and I haven’t heard your jokes lately, I miss them, what’s happening? Name the observation and we can help invite the discussion.

It is important to reach out because some people may be just waiting for that first opportunity, that first invitation to say well, actually I’m not doing so well.

Dawson: How can we positively frame this time for someone who has terminal cancer? And they may be feeling like they’re really missing out and they have a limited amount of precious time left, how can we think about that and be supportive to that situation?

MacQuarrie: I’m going back to meditation, going inward and connecting with ourselves, which is important. I know end of life is a time when we really want to be surrounded by our loved ones, but it’s also maybe an important time to have that connection with ourselves. And the more we’re able to make that connection with ourselves, the more we’re able to connect well with others. If we can have a sense of sacredness and connection with self, and then using the less than ideal means that we have to connect with others will feel a little bit less painful, although I do want to say it’s really difficult.

Dickey: It is a difficult time – it always is – and how people cope with the end of their life really is very individualistic. And so, I would encourage the caller to connect with the person who is dying and ask how would they like the remaining time to unfold, what would be meaningful for them? And just being present. Sometimes we feel like we have to fix a problem. And right now, someone’s dying, we can’t fix that.

We can’t fix COVID-19. We can’t fix that we can’t give them a hug right now.

But we can still be present. And by that, I mean, maybe using technology just to sit with them and be at their bedside virtually and saying ‘Yes, here we are, can’t really change much. How is this for you? I think it’s awful, I’m miserable, I’m lonely already and you haven’t even gone yet but I’m already missing you and I’m already sad and grieving. But I’m here. Not happy that I’m here in this way but I’m here and I’m here with you.’

Just giving that gift of being present with another person and allowing them the space to explore their lives, explore the meanings of their lives, their regrets, their joys, retelling stories that have been important to them over time, being open to what their needs are. As they’re dying, they are going to have all sorts of different needs, emotional needs, physical needs and again, accepting where they are each and every day is the biggest gift we can ever give someone.

And then, there’s the old standby of just expressing love. I mean this time of COVID-19 is very stressful. It’s making us anxious; it’s making us feel unproductive on all sorts of things, but it also gives us the opportunity to be sure that we focus on expressing love for those that we care about. And then expressing it again.

Dawson: Can you comment on any measures that may be put in place to help patients see loved ones when they’re hospitalized?

Dickey: With the hospitals, we’ve restricted visitors again because we’re trying to embrace this physical distancing. We’re trying to keep our health care workers, who are on the front line, as distant from people who may have COVID-19 and are asymptomatic as possible so the reasons why we have these restrictions are important. Having said that, it must be unbelievably painful to be a family member, worried about the person we hold most dear, who’s in the hospital and, it’s going to make me cry but, I’ve heard stories of nurses and social workers, holding up iPads to help families communicate, to give the people that gift of that connection, that chance to express love and support.

We’re trying to roll out iPads as much as we possibly can, as quickly as we can, to allow people to have an appropriate level of connection during this difficult time. Is it perfect? No. No, nothing’s perfect right now. And know that we in the hospitals wish we could do more. And know that we’re doing pretty much the best that we possibly can make things easier for you as you worry at home.

Dawson: Considering the mental health field as a profession, coming out of COVID-19, will we be seeing more opportunities for people to work in this area?

Dickey: I hope so. And I hope we work differently. Now we’re seeing our patients virtually and that allows patients to stay in their workplace and still get the mental health care they need or stay at home and get the mental health care that they need. So hopefully we will have much more robust tele-mental health. There’s lots of opportunity for growth if someone’s a technology wizard and wants to contribute to mental health.

I’m also hopeful that we decentralize the provision of mental health care. I don’t think everybody needs to go see a psychiatrist. I’m a psychiatrist, but really. In Africa, there is a place where grandmothers are really revered, they have the highest status in the community. What they’ve done is equipped grandmothers with some basic mental health tools and they’re now sitting on benches and waiting for people to come and describe their difficulties. The power of that is it makes mental health care accessible to anyone who walks by the bench. It empowers the natural community leaders to be supportive of members of their community. It helps build community. And even though it’s incredibly low tech, it’s a way of providing mental health services in a much larger sense.

So my dream is, from COVID-19, that we expand our conceptualization of what mental health provision of care can be like, and empower people throughout our province and country with tools they need to support each other, whether it’s a grandmother on the bench or in a high tech way, but just bringing it out more into other people’s hands.

MacQuarrie: It’s parallel and reflects the idea that I was expressing earlier about empowering ordinary people to be able to support those who are experiencing violence and maybe those perpetrating violence. How do we have those conversations, how do we have it safely, and when somebody needs more help than you’re able to give, how do you make that referral?

Dawson: Regarding motivation and productivity, do you have any insight or advice around making the most of each day?

MacQuarrie: I can just share what I do. Whether or not I felt I was particularly productive the day before, I get up at the same time every morning. I have my office space set up and I spend the same amount of time there every day. I take my breaks for lunch; I take the dog out for a walk on the regular. I maintain my routines. I may not be getting the same amount of work done within that time, but that structure to the day I think is quite important.

Dawson: Thankfully, think we’re beginning to see light at the end of the tunnel, and we are hearing that we can be preparing for the reopening of our economy. For some people, that may trigger another set of stressors around returning to work and staying safe in this world. Do you have any recommendations for people as they manage transition, going from one moment in time to another moment in time?

Dickey:   So, during this time, I’ve been wearing scrubs to work. But because I knew I was going to meet with you and all the attendees, I wore my usual suit today. I was kind of anxious about dressing like I normally do – putting earrings on, I haven’t been wearing earrings because they might attract the bug. And then I realized this morning as I was getting dressed, it’s just my old suit again. It’s OK, I can get dressed. I kind of had to laugh at myself that in my mind, obviously whether I wear scrubs or a suit you know that’s really rather immaterial and sort of petty, but it’s symbolic of the return to work. And I’m going back to that self-compassion, allowing ourselves to be OK. In this instance, it wasn’t a big deal, I laugh at myself and go on. We’re facing so many transitions and so many adaptations that we just have to give ourselves some slack and say ‘It’s OK. It’ll be all right. We’ll get through this. We can wear our suits again.’