The data paint a very bleak picture of mental health in the United States during the coronavirus pandemic. A recent Centers for Disease Control Household Pulse Survey showed 30% of people had symptoms of anxiety and 24% had symptoms of depression. This is a significant jump from the comparison survey from January to June 2019 when 9.2% of adults had symptoms of anxiety and 6.6% had symptoms of depression. Some experts are also concerned that without intervention the so-called deaths of despair (deaths due to suicide, drugs, and alcohol) will increase significantly from COVID-19 related unemployment, isolation, and uncertainty.
Yet, while people are certainly anxious, depressed, and struggling mentally to cope during the pandemic, not everyone is. In fact, some people are actually doing surprisingly well. Donn Kleinschmidt, MD, a psychiatrist at the Habif Health and Wellness Center at Washington University in St. Louis explained, “It’s been fascinating to observe how patients are responding to COVID-19, sometimes in ways that are truly unexpected. Not everyone is struggling more.” Laila Halaby MA, Depression Care Counselor at the University of Arizona Cancer Center added, “the one generalization I can make from early March until now is that most of my patients have not shown an increase in depressive symptoms, and many have shown a decrease.”
For those with anxiety, feeling better or at least not doing worse, seems to be related, in part, to the fact that with coronavirus, their worries are actually grounded in fact. Kim Davis, who has had a diagnosis of Generalized Anxiety Disorder for years, notes that usually in anxiety, “a person perseverates on fears that aren’t real, and then worries about the anxiety they have about those fears, so you get a never-ending spiral.” Fears about coronavirus are not just real, but everyone else is experiencing them. So, as she says, “the actions associated with those fears are legitimate and socially acceptable [and] the spiral never happens.” Similarly in depression, according to Dr. Kleinschmidt, some patients have been able to remove the shame and sadness they previously felt by being alone and isolated, because being isolated is now required and necessary for safety during the pandemic.
Isolation has also decreased anxiety by simply removing people from their triggers. Those with social anxiety, no longer have to constantly socialize. Those who felt set off by friends out and about without them, especially when they have to work or study, no longer have to deal with that; There is no fear of missing out when everyone is at home. And, those who feel a pressure to perform or fit into a certain peer group can actually stop doing all of that, as they are physically removed from that stress. This in itself can be therapeutic as Drew Perkoski says, “I’ve had the space to decompress and just exist as myself.”
Being at home can also feel safe, comfortable, known, and appealing to some people. The more virus, illness, and unrest outside, the more therapeutic inside can feel. Leah Jackson states that she would get overwhelmed when she was physically at work and by working from home, she has been able to take more time for herself and stay in a better place mentally. Jeanine Hoff, MSW and Peer Specialist and Founder of Where is the Sunshine?, who has struggled with Generalized Anxiety Disorder, Obsessive Compulsive Disorder, and Depression, adds “being home has afforded me full control over my experiences, what I am exposed to, and what my family is exposed to.” Often the reduction in structure and constraints can allow for more time for self-care. While it is true that being home has its’ downsides including an increase in behavioral addictions like online gambling, many have truly leaned into this experience by journaling, exercising, and maintaining good sleep hygiene. Despite what social media might suggest, not everyone is falling apart, in sweat pants 24-7, and unsure what day of the week it is.
Trauma is adaptive in a pandemic for its own reasons. Lou Godbold, Executive Director of Echotraining.org explains, “Many trauma survivors live in a constant state of readiness for the next bad thing to happen. When you have lived through danger, the brain and nervous system adapt to make you better at detecting and responding to threat.” Godbold says that the upside to this response is that it can help us survive dangerous situations. On the other hand, it can also cause people to be over vigilant. Godbold calls people with trauma “disaster planning experts,” because they are always preparing for the next catastrophe, and were very likely prepared (with toilet paper and bottled water) for this pandemic way ahead of time.
Survivors of trauma, like those with depression and anxiety, have also long before coronavirus mastered effective coping mechanisms. Godbold explains, “We’ve found the routines that are helpful, the tricks to calm down our nervous system, the tripwires for our thoughts, and the things we should avoid.” Many of those skills are already built into daily activities, and others are only strengthened for those who have already been to therapy and learned more. Kim Davis says, “All of the skills that I have learned in therapy are old hat-I meditate, I make lists to put down my worries, I do reality checks, I make sure I get enough sleep, I put away technology and the news when it becomes too much, [and] I make sure I get outside. We, as a family, check in with each other after we get snarky or overwhelmed.” These are not things most Americans already know how to do, and, many have not even heard of them.
It is like those with mental health challenges were practicing for a pandemic to occur. They have long known the world is heavy, unpredictable, and unfair. Rebecca McEachern who has Post-Traumatic Stress Disorder (PTSD) explains, “I think we recognize that we are not in control and that bad things will happen. Feeling like you control your own fate completely is a nice idea, but those of us with PTSD know that we don’t control everything. So, we learn to determine what is within our power to change and that’s a big thing.” Acceptance is not an easy thing to have, especially when so many things feel out of control and unknown, like in a pandemic. Yet, it is still possible for even the most anxious brain to do. Perkoski adds, “when you’re dealing with a brain that constantly acts as if the sky is falling, you know exactly what to do when the sky IS falling.”
But, it is falling for everyone right now. For many of those who were interviewed, it has been particularly unique to see others begin to identify with anxiety or loneliness or depression for the first time. Hoff says, “Some of the most interesting things I’ve been asked include ‘Is this what you feel like all the time?’ or ‘How do you deal with this every day?’ While I never want people to experience what I have felt, it’s comforting to know that so many more now understand what it’s like for me and my fellow advocates with lived experience.” This has normalized discussions of fear, stress, hopelessness, and anxiety in our day-to-day conversation. Even for those with mental health histories, this new freedom allows them to openly discuss symptoms they are having without it being overly pathologized. Perhaps that alone has taken some of the added self-stigma off of their experience and may be a reason they feel better. They have also been able to become the teachers and have helped, as Dr. Kleinschmidt’s patients called them, “anxiety amateurs,” cope. Helping others can itself also improve mood.
With more discussion between friends and about mental health in the media, hopefully it won’t be long before we all begin to value and see the strengths of these lived experiences. Halaby states,“I think we as a society tend to look at most mental illness as problems to be solved. If we shifted that to understanding that mental illness does not happen in a bubble, and that often what is anxiety/depression today was a coping skill that years ago kept us safe — and maybe a coping skill that is helping us through this difficult time — we might be more generous.” More empathy, and less denial and invalidation, could help us understand how some people may be struggling, and others may be doing just fine, and there is no “right or wrong” response to a global pandemic. Either way, we can (and will) get through this together.