You think it’s been bad so far, right?
You’ve been self-isolating, working in your pajamas and ordering everything online. Every trip to the grocery store is a white-knuckle adventure through a claustrophobic hellscape, recently under “Blade Runner” skies, and it’s hard to carry on normal, everyday conversations with … anybody.
You think it can’t get any worse as we approach and pass 200,000 COVID-19 deaths in the U.S. Well, we’re here with some bad news: just wait. We’re about to hit rock bottom.
Sept. 23 will mark exactly six months since Gov. Jay Inslee first issued the stay-home order to curb the spread of the coronavirus pandemic. Since then, economic woes, the stress of social justice protests against police brutality, divisive national politics, and now devastating wildfires that have killed dozens and fouled our air have piled up, deepening the strain on every one of us.
The stress is tremendous.
“Nobody is immune from this,” said Kira Mauseth, one of Washington state’s top behavioral health officials. “Nobody.”
Throw in the start of the new school year, the coming election, the usual onset of seasonal affective disorder and what surely will be an unusually stressful holiday season, and we have a unique set of circumstances swirling together just as we are about to hit a communal low emotionally, says Mauseth, a practicing clinical psychologist and Seattle University instructor who is co-lead of the state Department of Health’s (DOH) Behavioral Health Strike Team.
That’s because, as the six-month mark of the stay-home order approaches, we’ve already begun the transition from the “honeymoon” phase of our emotional response to the pandemic and are rapidly moving toward “disillusionment.” This is the fight-or-flight stage and, emotionally speaking, we’re constantly scanning the horizon for danger. Next up, a potential second wave of the virus when cold weather returns.
For Washingtonians, the timing couldn’t be worse. The state says as many as 3 million state residents will experience “clinically significant” behavioral health symptoms.
“It’s really a perfect storm when it comes to all of this,” Mauseth said. “We can do it. People are stronger than this. Collectively we have more resilience and more compassion. But it’s going to be tough.”
The state’s Behavioral Health Strike Team tracks where we are on the behavioral health scale to help officials, health professionals and many others, such as human resource managers, understand what they’re dealing with. They combine national and international data with what’s already known about how humans react to stress from large-scale disasters.
Our first reaction in a disaster is heroic, quickly followed by the honeymoon phase, where we see some community cohesion and we rally around potential solutions (or not). Those relatively short phases have ended and we’re now on a long decline to disillusionment. If you think of it as a roller coaster ride, it’s the long drop where people raise their arms and scream till they hit bottom.
It’s at this point we’ll start to see real problems for vulnerable communities with social isolation, fears of the unknown around further restrictions and economic losses, plus mounting stress related to child care, school and work.
“Everybody’s brain right now is under a sort of stressed or traumatized way of acting — and that’s trauma with a small ‘t’ — as a result of being part of a disaster,” Mauseth said. “We’re all in the midst of this natural disaster. So one of the neurological consequences that happens when that’s the case is that our brains go into a mode where we process more emotionally, generally, and less thoughtfully, less slowly. We just tend to have more emotional responses. And that’s clear from people lashing out on social media, and just some of the awkwardness in parking lots or at the grocery store.”
Let’s call it COVID brain.
If it continues to shut down normal interactions as expected, we’ll start to see increased instances of depression, anxiety, mood disorders, psychological distress, post-traumatic stress disorder, insomnia, fear, stigmatization, low self-esteem and a lack of control.
Medical risks will also increase for those with vulnerable conditions or who are fighting addiction.
This effect will be even steeper among vulnerable populations like communities of color, LGBTQ+ people and people in lower income brackets, who are forced back to work sooner and generally have more difficult access to mental health care in regular times, let alone during a pandemic. (LGBTQ+ stands for lesbian, gay, bisexual, transgender and queer/questioning, with the + denoting everything along the gender and sexuality spectrum.)
“I see an increase in daily email, daily phone calls, people reaching out,” said Ashley McGirt, a Seattle therapist who works with the Black community. “Unfortunately, I’m actually at max capacity, so I can’t even take any more clients on. I’m also seeing a huge portion of individuals who cannot afford therapy, but they’re still seeking the help.”
There’s probably someone in your life struggling right now. It might be you or a loved one. Perhaps you have an elderly neighbor you haven’t seen in a while. Or you know a first responder who’s been fried by the fray. It’s time they got help.
“You have to shift expectations, you have to change your time frame and your picture about life right now,” Mauseth said. “It just has to change. And that’s what disillusionment is all about: making those adjustments.”
We’ve talked to experts about how to recognize if the particularly vulnerable people in your life need to seek the professional help of a psychologist or therapist — here’s what they had to say.
Young children and older adults
You’re working at home. Maybe your toddler is in your lap while you Zoom (or your teen is right next to you doing schoolwork, or your college-age child just moved back in). Or perhaps mom or dad live with you. Family dysfunction is probably the coronavirus norm.
“It’s just a big swirling mess right now,” said Tona McGuire, a colleague of Mauseth’s on the state’s strike team and the behavioral health representative on the state’s Disaster Medical Advisory Committee.
The key to straightening out that mess starts with recognition that if you’re struggling, everyone else probably is, too. The signs may not manifest in the same way they do for you, however, especially with the young.
“For example, a 2-year-old who’s been weaned suddenly wants to nurse again,” McGuire said. “Or a 4-year-old who’s been potty-trained just starts having accidents. So that’s a really normal response of children. But as parents, I think sometimes we just think, ‘What’s going on, why are you just being so ornery?’ But that’s not really what’s happening for them. They’re picking up on the anxiety and the emotional responses of all the adults around them and mirroring that to some level.”
For tweens and teens, the signs are easier to recognize since kids that age are more communicative and have a better understanding of the surreal circumstances we live under. Your older child may act out, getting more angry and aggressive. Or they may head in the opposite direction, withdrawing further into an already lonely adolescent existence.
Beyond clinical help, carving out a way for children to socialize through family partnerships is key. Friends and allies are important for children, even more so for those evolving into young adulthood.
“This loneliness and social isolation is really taxing and not good for kids,” McGuire said. “So finding ways to increase that social connection, which we know is a piece of resilience, is really important. But you have to be clever about it and you have to have a kid who’s willing to go along with that.”
The same goes for the elderly who are also vulnerable to emotional struggles at this time, particularly if they live alone or are socially isolated.
As we know, older adults are far more physically vulnerable to coronavirus and the virus has hit them hard — especially those with already complicated medical conditions.
But older adults may also be struggling mentally and socially at higher levels than younger folks. Some are living at home with multigenerational families in stressful situations that may become unhappy ones. And others are sequestered alone in their living space or in a quarantinelike state in assisted-living facilities.
While it’s easier to evaluate those who live in your household or still have a spouse or partner, make sure to check in on the senior in your life who lives alone. Be on the lookout for signs of fretfulness or too much worry, a shift in eating and sleeping patterns, and worsening medical and mental conditions.
Beyond direct contact and providing resource information, it’s a good idea to increase interactions. If in-person interactions aren’t possible, AARP suggests things like handwritten letters or cards sent the old-fashioned way, a socially distanced meal via Zoom or sending small gifts or meals meant to bring cheer.
AARP has created a new community connections website to help seniors find help during the pandemic. The state DOH and federal Centers for Disease Control and Prevention also have links to resources. Don’t be afraid to use them.
Each level of the challenges we’ve encountered this year comes at a steeper price for Seattle’s marginalized communities.
For instance, school children in communities of color are now more likely to be studying in crowded multigenerational households where access to technology is often more limited. Even the wildfire smoke impacts these families at a steeper level because of a lack of ventilation or air-handling systems.
“We’re all experiencing COVID, but at two different levels,” said McGirt, one of a handful of Black therapists in Seattle. “Our marginalized communities, our families of color are experiencing it a lot harder. We know that Black and brown people are most impacted by COVID and are the No. 1 essential workers. So you have to take all of that into consideration. It exacerbates mental health concerns.”
McGirt says she’s seeing Black people reach out for help at a higher level than ever before. But once they decide to seek care, the cost becomes another limiting factor.
To help, McGirt founded the Washington Therapy Fund Foundation, which helped 100 people seek mental health help over the summer. She’s starting a new round of grants later this fall and points those who need help to a handful of others, like The Loveland Foundation and the Boris L. Henson Foundation, started by the actress Taraji P. Henson.
“A lot of the research around psychology has really been detrimental and harmful to people of color,” McGirt said. “So there’s this stigma and resistance for people of color to get into a field that has been historically oppressive and harmful. But then you have clinicians of color like myself, who got into the system so that we could dismantle it and create evidence-based practices and treatments that are for us and by us, and [are] really working creatively to develop healing techniques that are specific to people of color.”
Health care workers and first responders are always in the trenches of a disaster, but things have been coming fast and furious with the twin turmoil of coronavirus and the wildfires.
For those in the medical field, there’s another danger beyond the stress of dealing directly with the sick, Mauseth said: moral injury. This is when health care workers are asked to provide care without the proper resources, like ventilators or empty beds.
“They aren’t able to provide the kind of quality care that they feel compelled to do as a result of who they are as people, and that is so unsettling and so upsetting on a very deep level,” she said.
And while we look to them for our safety and protection, you have to remember that the nurse working the ICU floor or the cop walking a beat are people, too.
“Tolerance is a spectrum,” said psychologist Owen Bargreen, who evaluates police officers for fitness of duty. “Some people have a good ability to cope with stress or anxiety or depression and some people don’t.”
Unlike many of us, health care workers and first responders have been dealing with day after day of stress for months. This might go on for a few weeks or a month due to hurricanes or fires. COVID has been taking lives since last November (at least), and the recent outbreak of wildfires in Washington, Oregon and California hasn’t helped either.
“And this pattern just continues, and over time it becomes mentally exhausting having this response for a lot of people,” Bargreen said. “Over time there’s a psychological principle called learned helplessness. Once you’ve experienced this cycle, essentially during an extended period of time, you develop learned helplessness, which is despair and kind of giving up.”
This manifests in a lot of ways: anger, depression, sadness. They might also lose interest in the things they used to enjoy.
“There are little things that you can do in a relationship, obviously, to help,” Bargreen said. “You can try to try to encourage them to stay busy with activities that they enjoy. But for some, when they experience this learned helplessness, it becomes problematic. So the best way to cope with this is to speak to a mental health professional about the problems you’re experiencing.”