The coronavirus pandemic is becoming a brutal psychological test. This is a dreadful moment with a potentially deadly pathogen on the loose. This public health crisis can take a mental toll on people, especially those struggling with anxiety, depression and other conditions.
One common emotion that might not be immediately obvious: grief.
“Right now people are feeling grief over the loss of routines, certainty, and a perception of themselves as being generally healthy and protected,” says psychiatrist Joshua Morganstein, the chair of the American Psychiatric Association’s Committee on Psychiatric Dimensions of Disasters.
He and other mental health experts say there are steps people can take – practical ones – to ease some of that anxiety and give a person a better sense of being in control of this chaotic situation. Some of the advice comes from research on natural disasters, mass shootings, terrorist attacks and other traumas.
Much of the professional advice is obvious, but bears repeating, Morganstein said: “Things like getting good sleep, eating regularly, staying hydrated, exercising. When we take care of our body, with good sleep in particular, but certainly food and water, our ability to think clearly, our ability to solve problems, our ability to manage our emotions, are all optimized.”
Kathy HoganBruen, a Washington-based clinical psychologist specializing in anxiety disorders, echoes that advice: “Now is the time to start establishing some healthy habits.” For example, start the day by getting exercise and fresh air in nature if possible. And a person feeling overwhelmed by the grim news might do better by limiting time following coronavirus bulletins. “Really try to limit the news consumption or just staring at your phone and your computer, because for most of us that makes mental health worse rather than better,” she said.
The news coverage has focused foremost on the confirmed cases of covid-19 – the case fatality rates, the contagiousness of the virus, the missteps in rolling out testing in the U.S., and so on. What is harder to measure is the psychological contagion – the sheer stress and worry and outright fear, and how these can pass from person to person as quickly as a virus.
Joshua Gordon, a neuroscientist and psychiatrist who is the director of the National Institute of Mental Health (NIMH), suggests that everyone develop a plan for how to deal with this moment. Having a strategy for day-to-day living isn’t just a matter of protecting oneself from the coronavirus and limiting its spread in the community. It’s a form of mental therapy, as Gordon sees it.
“Having conversations with your family about what they can do to protect themselves and also what they can do to stay active, physically and socially, can be therapeutic in and of itself,” Gordon told The Washington Post.
A pandemic plan could involve ensuring that social distancing doesn’t result in extreme loneliness and a feeling of isolation. People who are staying home can set up group chats via Zoom or FaceTime or some other platform.
Make a plan for helping people who are most vulnerable, or at least making sure that someone is checking with an isolated elderly family member each day – something Gordon’s family has been doing.
“Remember that what is most disturbing about what we’re going through is the uncertainty. When we know what’s happening, when we know what to expect, we feel safe – even if what we expect might be threatening,” Gordon said. “Develop a plan – find your place in the world. It can take time, it can take preparation, but it can help a lot.”
People with mental illnesses can be especially vulnerable in a time like this. About one in five adults in the U.S. experiences a mental illness or disorder in any given year, Gordon said.
“For those with anxiety disorders, that concern [about the coronavirus] can become all consuming,” Gordon said. “We’re all a little suspicious of others on the subway, on the street, if they’re coughing or they look sick. Imagine if you had schizophrenia – that concern or suspicion could turn into frank paranoia.”
This is also challenging for anyone suffering from depression. The lack of social engagement and the disruption of routines can worsen symptoms. People with mental illness need to make a plan for how they can continue with treatment and therapy, including contact with support groups and ensuring that they have a supply of medication.
HoganBruen said this pandemic creates a kind of “forced depression” because it disrupts plans for the future that normally give people hope.
“It’s like this kind of forced depression. No one knows, ‘Can I go on a summer vacation, can I go to my daughter’s graduation?” We don’t get to do that planning and daydreaming in our heads right now. Depression is feeling hopeless about the future, and right now I think that’s how a lot of people feel, rightfully so. If you have underlying depression, that might be exaggerated at this point.”
Everyone should be aware that a crisis like this can result in what are known as distress reactions.
“Distress reactions include trouble sleeping, difficulty in concentration, a feeling of being unsafe. Anger. Blaming others. A desire to socially isolate. It can lead to risky behaviors such as excessive use of alcohol or tobacco. Interpersonal violence can flare. One common response to disasters is work-life imbalance – working long hours and letting other important duties and needs in one’s life slide,” Morganstein said.
A crisis can also bring out the best in people. People in the U.S. have a history of collective action and resilience in hard times. The covid-19 pandemic, however, is unfamiliar to most people, and social distancing runs counter to human nature. Today’s pandemic has to be taken as seriously as the Spanish Flu of 1918 – which is deep in the history books.
It’s too early to know how long this crisis will last or what its ultimate toll will be. Experts have suggested it might be comparable to the 1957 influenza pandemic, though it’s not out of the question that it could be as severe as the Spanish Flu. The virus remains enigmatic, its favored modes of transmission still under investigation.
Covid-19 can be a mild illness, or a severe one, or even a fatal one. The virus usually spreads from direct person-to-person contact, but it can also remain viable for many hours on surfaces. Thus people must struggle with basic decisions about how to go about their lives. Is it safe to go every so often to the grocery store? Hit the gym? Visit neighbors (staying a few feet apart, of course)? Attend a 12-step meeting? A wedding?
“I think a lot of people are pretty freaked out already, anxious and fearful,” said Francis Collins, the director of the National Institutes of Health, in an interview with The Post. “As in all things, it comes down to the balance between having a reasonable concern, especially if it’s motivating to take actions that can reduce risk, verus having this take over your entire world to the point where you become paralyzed.”
Figuring out what is a reasonable concern is not easy for anyone in a public health crisis like this, which is so full of unknowns. Morganstein said he avoids using the word “anxiety” or “panic” when discussing how people react to a crisis like this, because it implies the reaction is excessive or inappropriate. And he cautions that a person in distress does not need to be told to be rational and logical: “Logic is often an ineffective antidote to emotion.”
But one thought is comforting: Everyone is affected by this. This is a time for communities to find common purpose, even if people are forced to stay apart.
“Understanding and reminding ourselves that we’re all going through something together, sometimes that can help us feel less alone,” he said.