Mental health in the pandemic – It’s a marathon, not a sprint
By: Kenneth M. Certa, MD
As the weeks drag on into months, with only a glimmer of hope mid-winter, the pandemic is becoming more and more difficult to endure. We are winning the numbers war, at least in Pennsylvania, but the need to keep socially distant is taking a toll that is beginning to show. As a psychiatrist working in inner city Philadelphia, I am seeing a rising tide of addiction-related emergency room visits and hospitalizations. The same is true all over the country.
A big part of what keeps all of us sane is our interactions with other people. Human beings have evolved to exist in cooperative societies, as all primates do. Our brains are not suited for solitary confinement; we can literally go crazy without being able to make a connection with another person.
Addiction is a disease with complex roots, but a big part of healing depends on the ability to somehow get outside of our own thoughts and rely on something else. The higher power of the 12 Steps can be conceived in a lot of ways, but there is a common thread of recognizing that by myself I will get into trouble.
The pandemic requirement of social distancing, of not meeting up with friends, of not going to the movies or out to dinner or just hanging out, takes away the natural way that our society helps us get back to center. There is a lot that can be done by phone, text, Zoom and Teams, but our brain is not so easily fooled. We have a visceral need to be in the presence of others, even those we don’t really know. It is comforting. Our ancestors who roamed Africa in troops were reassured when they saw others of their kind, getting a greater sense that this must be safe if these fellow primates are here.
I am too much of a scientist – and have seen too much of how ill COVID-19 can make someone – to argue strongly that we should go back to business as usual. For the sake of all of us, we need to maintain our work to limit viral transmission, wearing masks and staying apart.
But I am also too much of a student of human behavior to ignore the cost to the psyche. Many of the pleasures which keep us going are not available right now. Older folks who struggle with chronic illness get the motivation to stick around by thinking of the next time they can have their grandchildren over. It is hard to keep this thought in mind when you know we may not be able to meet until New Year’s. (And no Mummers Parade!)
There is a hierarchy of defense mechanisms which our minds use to fend off anxiety; things like repression, reaction-formation, stuff you might remember from psych 101. People quibble over what sorts of thoughts and actions are related to which particular defense mechanism, but what is very clear is that the defense mechanisms which involve other people are the most effective.
So what to do? It can be helpful just to recognize what is happening – to cut yourself some slack and not get worried about that glum feeling. It is a natural response to enforced isolation; no need to feel bad about feeling bad.
It is important to take affirmative steps to interact with others when possible. Keep the six feet between you, but see your friends and family. Call, text, Zoom and try to be in the physical presence. If you can’t be together, engage in the same activity while in contact electronically. Watch the same show on Netflix in real time and comment on the action, put the iPad by the stove and make the same recipe together, or do an online yoga class together. Our brains appreciate the simulation. It helps.
For those who traditionally rely on support groups such as 12-Step meetings, the move to an all-virtual platform has been a two-edged sword. It is a lot easier to make a meeting if you can do it in your living room in your pajamas. They are good and helpful but lacking in the many other sensory elements that make meetings powerful (like forcing you to get dressed).
For those struggling during this difficult time, the Physicians’ Health Program has compiled resources, which can be found at www. foundationpamedsoc.org/physicians-health-program/physician-burnout-resources.
Kenneth M. Certa, MD is an associate professor of psychiatry and human behavior at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia. He is also a member of the Foundation of the Pennsylvania Medical Society Board of Trustees.