Therapist Lessons Learned from the 2003 SARS Outbreak

Cheryl Y Leong
3 min readMar 16, 2020


How Shall We Grow Beyond Covid-19?

I have been reflecting on my experience offering therapy during the SARS outbreak in 2003. These reflections may provide some empathy as well as some insight into the current Covid-19 outbreak.

When the SARS outbreak happened in Singapore, I recall that psychologically people went in one of 2 directions: Denial or Panic/Anger. These were initial responses and, while it seemed chaotic at the time, I have now come to see these as entirely human responses. Whichever direction we took, there was transformation and growth that emerged from the initial reaction.

I remember being in some level of denial myself. Even while wearing my N95 mask in the therapy room and using alcohol cleaner on the couch, I had to function on some level of denial to keep seeing clients. The ones who panicked helped me with my denial as a therapist. I found ways to validate their fears but cognitively support them to focus on what they could control versus what they could not. We couldn’t help but be hyper-aware of the 20% mortality rate.

Then there was the anticipatory grief. The heavy feelings that surfaced as we came to terms with what was to come. The deaths, the losses and the economic consequences.

I chose to wear a mask right away, seeing clients. (No video chat options back then.) We were advised to do so. Of course, as a therapist, this was one of the most counter-intuitive things to do. Counseling with an N95 mask? WHAT? It had to be done. And on hindsight, all my hesitations while valid were unproductive. I needed to offer my clients a sense of safety and what better way to do it than to wear a mask. Yes, the mask became a thing to therapeutically process. How could it not be? It was symbolically what the community was experiencing, and the mask meant different things to different clients. Just as “social distancing” or “self-quarantining” means so many things to so many people right now.

It was an odd experience managing trauma symptoms while experiencing the trauma myself. I was washing my hands and wiping down doorknobs each time a client left. I would notice my heart rate going up many times during the day. Clients would say things like, “I think I’m infected,” and that would naturally bring up fears for me. It was hard to keep that blank slate look that we are expected to have as therapists.

By the 4th week of the outbreak, I saw a psychological shift in people. Community mental health seemed to shift from denial and panic/anger to appropriate levels of fear. I witnessed more problem-solving behaviors and thought processes. I observed a sense of altruism, and personal leadership that emerged in the community. The actions of many people moved me. Some of these behaviors were so generous, kind, compassionate, and courageous.

Upon reflection, the outbreak shook my ‘first-world’ privilege. It changed things for me permanently. This lesson was invaluable. It was clear that when it came to infectious diseases (and many other conditions), globalization means that we are all as vulnerable as the most susceptible. The success of our shrinking globe will come only with a dedication to equality. Sanitation, clean water, and medical care are fundamental human rights. Psychologically, that means an evolution of our collective psyche and in-depth exploration of our unconscious “othering.”

I have never stopped thinking about another outbreak, and here we are again.

I hope sharing this helps my therapist friends as they navigate the next couple of months. It will get worse before it gets better. And we will be coping with community mental health symptoms for a long time. We are going to change significantly after this. Call it “post-traumatic growth.” Call it what you will. This growth is coming, and it is unavoidable.

Photo by Ravi Roshan on Unsplash