From "The guardian": 'For those of us with depression, coronavirus is a double crisis' by Andrew SolomonRead Now
For Those of Us With Depression, Coronavirus Is a Double Crisis
by Andrew Solomon
From now on, when someone who hasn’t experienced clinical depression and anxiety asks me what they feel like, I won’t have to resort to florid comparisons. I’ll say: “Remember when the Covid-19 pandemic hit town?” and they will understand. Except that for people with depression and related conditions, the present moment is one of escalated distress. For this is a double crisis, of physical and mental health, and those living the psychiatric challenges need not only acknowledgment but also treatment. I have had dozens of letters and Facebook messages from people who are anxiously upping their doses of antidepressant and anxiolytic medication.
My depression and anxiety share a lot of territory with how most other people feel now: fear of getting sick and dying, fear of losing people I love, fear of unpredictable shortages and economic disaster. Others worry whether their cough is a symptom of Covid-19 or just an allergy. I am in the sizeable part of the population who must seek to distinguish between ordinary fear and the beginnings of a breakdown. I’ve had to alert the doctors who oversee my mental health that I am Code Fragile and will count on them to help me discern whether I cross over from ordinary unhappiness into neurotic paralysis. I have had to cancel my planned withdrawal from a medication that makes me sleepy and fat; lowering my dose would leave me unsettled for a spell, and that’s more than I’m up for now.
In March, I experienced the whole panoply of Covid-19 symptoms: a racking cough that kept me up all night but was not accompanied by any congestion, a fever that soared over 103F (39.4C), aching joints and trouble breathing into lungs that felt like they couldn’t expand all the way. Despite pulling every string I could muster, I was unable to get a test. My doctor diagnosed flu at first; when I couldn’t breathe, I had a chest X-ray and he diagnosed pneumonia. I took Tamiflu, then azithromycin. I quarantined myself at home and rigidly kept distance even from my husband and our son. Now I am fine, and nobody who was in contact with me has been infected. But the unavailability of tests was terrifying and the circumstances seemed to invite in psychic decay.
Quarantine is the oldest medical technology out there: isolation of the sick dates to the ancient world. While it protects those who are not ill, it is toxic for the patients, who show elevated rates of depression, anxiety and post-traumatic stress disorder. Physical recovery is slower for those cut off from friends and family. Quarantine is often necessary for people with incurable or highly contagious infections such as MRSA, Sars or H1N1, but it comes at a terrible cost. No one wants to die alone.
Sheltering inside when you have no symptoms, however, is essentially a new phenomenon: it happened in Toronto during the Sars outbreak of 2003, and many authorities felt its costs far exceeded its benefits. Richard Schabas, formerly Ontario’s chief medical officer of health, wrote: “In the unlikely event of another Sars outbreak in Canada, public health officials should quarantine no one.” His intent was not to dismiss the physical dangers, which were real then as they are now, but to illuminate the psychiatric ones.
This is a bizarre time, and people are dying – but people are always dying, I remind myself. One acquaintance of mine died yesterday of the virus, and another has died tonight of cancer. The first death terrifies me; the second merely saddens me. Social distancing is staunching the proliferation of new cases, but some of us are overreacting and some of us are underreacting and no one knows which are which; it is unlikely that many have hit the sweet spot of appropriate caution. The need for caution must also take into account the effect of isolation on mental health, as anyone knows who has seen The Shining or Cast Away. When I lived with the Greenlandic Inuit, I found that their high rates of depression and suicide were tied not to the sunless winter, but to the intimacy it forced. Whole families gathered in small houses and were stuck with one another and no one else for months because it was too cold and dark for anyone to leave or visit. Emotional repression was the natural consequence, and it was calamitous.
I was on holiday with my extended family when the idea of social distancing was introduced into the popular vocabulary, and had to come home early when the place we were visiting sealed its borders. I have since been sheltering with my husband, my son and my father-in-law in upstate New York. Two weeks ago, I set out for New York City to pick up our family dog, get my 10-year-old son’s school books and pay some bills. I didn’t recognise the empty city where I had grown up. I perched in my office thinking grimly that I would never be able to live at home again. I lie awake with my mind running and have to remind myself that this is how my mind runs when it is in bad shape. I saw my elderly father today and we met outdoors and kept a 6ft distance. I suffered anew the collapse of that feeling of safety he had created in earlier crises, a role he cannot fill at nearly 93. Intellectually I know that my father could never have solved this crisis; that I will eventually live at home again; that I am probably safe in the house upstate. It is my project to keep up a good face for my son, and it is utterly exhausting, sometimes impossible and profoundly redemptive.
Yet, as always, at the bottom of depression’s box there is hope. The very feeling of frailty gives me a window into the suffering of friends who are waiting out this terror by themselves. The feeling of isolation awakens me to the ongoing plight of older people who are alone all the time. I feel singularly well-placed to comfort those who are taking their first deep plunge into depression. I can help them assess what is pathological and treatable.
I am in pretty good shape. I had a bad depression two years ago, and I feel much better now, which seems bizarre given how much worse things are than they were then. I am not all by myself, and I have not lost my job. I don’t feel sorry for myself and I don’t think I am suffering more than others are, but I am suffering a bit differently. The second-guessing all the time is burdensome. Am I proportionately or disproportionately having these particular feelings in this particular moment? Depressives find that our intense sadness and fear easily become intense depression and anxiety. People with pre-existing pulmonary illnesses drop dead of this thing. People with previously existing mood disorders will die of it, too, if mostly in a slower and less obvious ways.
Feeling Anxious? Here’s What You Can Do About It Now
By Lucie Zhang
April 14, 2020
As those of us in New York are coming up on one month of life “on pause,” feelings of anxiety and unease have only become more layered. We’re facing entirely new fears. We cry at unpredictable times. We crave intimacy and connection.
Keeping mounting anxiety under control is an increasingly challenging task during unprecedented times, and it is top of mind for many. Since Laurie Santos, a Professor of Psychology at Yale University and host of The Happiness Lab podcast, uploaded her popular Yale course, The Science of Well-Being, to Coursera two years ago, she’s had over 500,000 people enroll. In the last three weeks of March alone, 800,000 new learners signed up for the lecture series.
“People are worried about their physical health, but we know what we need to do [there], like wash your hands, socially distance six feet from other people. We have stuff we can do to protect our physical health, but I think people are searching for evidence-based things they can do to protect their mental health during this time,” says Santos about the recent surge in sign-ups. “This situation is unprecedentedly scary and anxiety-provoking and uncertain. It’s causing us to face our mortality in a way that I think most Western, first-world-problem people haven't had to face in a long time. And I think we’re forced to do it without the one coping skill that most of us use during a crisis, which is to be more social.”
Below, Santos gives advice on how to recognize and cope with anxiety amid the coronavirus pandemic.
Notice How Your Body Responds to Stress
Because many have had their sense of normalcy and safety upended during this pandemic, Santos says the resulting stress has activated our sympathetic nervous system, which is our “fight or flight” mode that’s basically preparing us for a tiger that’s going to jump out from a bush. Our “tiger” is doorknobs, other people, not washing our hands after getting the mail, and so on.
“It’s flooding our body with stress hormones. It’s actually causing us to tighten our muscles so they’re prepared to run away. Being in a constant state of that can lead to things like muscle problems, digestive problems, even sexual health functioning problems. The ‘fight or flight’ system is meant to be activated in tiny, short bursts when there is a real emergency, and many of us are activating it chronically right now.”
To assuage our sympathetic nervous system, Santos says we must consciously activate our parasympathetic nervous system, which is “our ‘rest and digest’ system.” She notes, “Naturally, it’s not turning itself on because we’re flooding our autonomic nervous system with cues that everything is threatening.”
But one simple (and free) thing to do is to take deep, calming, “belly” breaths whenever you begin to feel signs of anxiety, such as chest-tightening.
Give Yourself a Mental Break
“I think the thing to notice is: If you get a moment free, is it like all the anxiety pours in at that point?” Santos says. She recommends making a habit of taking breaks in order to allow feelings to emerge. "That can feel really scary, especially if you’re not the kind of person who’s mindful normally, to sit there and feel what it feels like,” she acknowledges. “But those things are going to come out naturally and if you’re not letting them out in some form, that’s when you get the neck troubles and the sleep troubles and the digestive stuff that a lot of us are facing. If you’re feeling that, it might be a sign that you need to do some paying attention and really give yourself explicitly some time to notice that you’re feeling anxious, or notice that you’re feeling sad or scared, and just kind of be with that for a little bit.”
Create a New Social Routine
Santos says everyone, including introverts, should make a point to reach out to people for virtual time together. “In fact, it’s a great time to reconnect with people you might not normally interact with. I’m realizing that if I have to Zoom with my lab, who I would normally see every day, I can also Zoom with my friend in Seattle who I haven’t seen in forever, or my college roommates who are all in different states,” she says. “In theory we could’ve done that all the time before, but it would have been weird. But now it’s not weird, because it’s our only way of connecting.”
Our bodies and minds are creatures of habit, so creating a routine can add structure to your life, Santos says; but you may have to reevaluate old habits and schedules in the process. So-called workaholics, for instance, should recognize if they are burying themselves in busyness in order to avoid feeling their emotions.
In particular, Santos notes, it’s important to schedule in informal social time–i.e. social interactions that are casual and without an agenda–into your routine, to fill in for those types of spontaneous exchanges that we are now missing.
“One thing that we don’t notice as part of our routine but core to our normal day is we also run into lots of people,” she explains. “Those can be our coworkers, our friends, but even just a barista at a coffee shop, who you don’t notice you’re having a conversation with, [but] your mind notices. There is research showing that we’re happier when we have those quick interactions with a person on our commute or someone in the coffee shop or something like that. And we’re really missing those right now.”
Be Self-Compassionate, Not Just Self-Aware
Santos cautions against defaulting to filling a social void with social media, warning: “This might be a time to wean off the social media more than you think, for a couple of reasons. That tends to be a really easy, low-cost, go-to, fix-our-boredom strategy, but the content on that is going to be different right now. Especially if you’re a person who experiences anxiety—you’re not going to see as many baby videos or cat videos or good recipes. It’s going to be doom and gloom. I think limiting that is important. I also think that those kinds of moods–when you’re bored and feel the need for social [interaction] and the easy thing to do is to click on Facebook or something–can come at an opportunity cost for putting in that little bit of extra effort to call a friend or call your mom.”
Another thing to keep in mind is that everyone is going to react very differently to this unprecedented situation. “Some are going to be like, ‘This is my time to get the perfect abs in the next three weeks and I’m just going to show off my ab videos.’ That’s a way of coping, not my way of coping, but it’s someone’s way of coping. Whereas other people are going to be like, ‘I’m going to watch Netflix and eat my entire cartons of ice cream that I bought for three weeks in one night,’ and that’s also a way of coping. That’s fine. I think we just need to chill out with ourselves,” says Santos. “...Realize that we’re all doing it in our own way–and what counts as our own way is going to change because this is going to be a long process. There is going to be ups and downs.”
This is not the first time that people have faced uncertainty, but we have never been as technologically advanced as we are now, says Santos. “As a species, we’ve faced pandemics. We made it through the 1918 flu, which was as bad as this and required as much socially distancing, and we did that without Netflix or Zoom meetings or even really good telephone technology. In some ways, we’re so grateful,” she says. “Even relative to 9/11, which wasn’t that long ago, technology-wise we couldn’t be doing this back then. So I think we’re really lucky to live in the time that we do live in, where there are these modes of communication and modes of staying connected that can allow us to get through this stuff.”
Likewise, Santos predicts what she calls a “surge” in happiness will occur once things do return to normal. “We’re going to realize all the things we took for granted,” she says, such as getting your favorite latte at your go-to cafe or giving your mom a hug.
We did that every day without an enormous burst of happiness from that, and now we’re kind of like, ‘How was I not incredibly grateful every time I did that?’ I think we’re all going to have so much more to savor when we get out of this. And recognizing that–that we are going to get out of this. Most of us are going to be fine. We’re going to get to enjoy things that make us happy in a way we’ve never experienced before."
My ongoing exploration into therapy related topics.