How ignoring mental health can make the coronavirus pandemic worse

When Dr. Joshua Morganstein picked up the phone, he asked how I was doing, and if my family was OK. I gave, at first, an admittedly perfunctory — almost practiced — answer I’ve developed over the last few weeks, before asking him how things were going on his end.

As a society, we’ve all made a polite agreement to never answer the question, “How are you?” with any meaningful measure of honesty or detail. So I was struck when he provided both. Morganstein’s wife had to shut down her business. They’re working out the logistics of their daughter’s virtual school lessons, which are teetering closer and closer to feeling like home-schooling. He’s working all hours of the day. An early morning walk through the woods with his daughter and wife, where they discovered a new creek, gave him some solace.

Dr. Morganstein is the Chair of the American Psychiatric Association's Committee on the Psychiatric Dimensions of Disaster. Like an increasing number of medical professionals, he is pushing back against the interpretation of social distancing as social isolation. “What really we want people to be thinking about is physical distance with increased social connectedness,” he says.

So maybe he shared a part of himself on purpose. Maybe he was just doing his part. Regardless, connecting with this stranger felt uplifting, despite the content of the conversation being depressing.

The concept of social distancing, designed to curb the spread of the coronavirus, recommends six feet of physical space between people in public. It also includes staying at home, working from home, taking classes online, and avoiding large gatherings.

The feeling of social isolation it can create also carries a host of psychological ramifications. Loneliness increases stress, alters brain function and heightens the threat of cardiovascular disease and stroke. Its health risks might rival smoking and obesity.

A Pittsburgh public works employee removes a basketball rim from a court Monday because people were not following social distancing rules while using the courts during the weekend. (AP Photo/Gene J. Puskar)
A Pittsburgh public works employee removes a basketball rim from a court Monday because people were not following social distancing rules while using the courts during the weekend. (AP Photo/Gene J. Puskar)

As the world works to slow the coronavirus pandemic, mental health concerns have taken a backseat to immediate issues. But left unchecked, they can be dangerous.

According to Steven Taylor, in his book “The Psychology of Pandemics”: “Psychological factors are relevant to behavioral methods of disease containment, and for managing emotional distress and maladaptive or disruptive behaviors that can occur during times of pandemic.” In other words, unchecked psychological stress can distort our ability to make reasoned decisions, like grabbing just one box of toilet paper, or staying indoors to stop the spread of the coronavirus.

Throughout the world, social distancing recommendations were ignored until they turned into orders. In Los Angeles, any public area that wasn’t banned attracted congregants — basketball courts, soccer fields, beaches — eventually pushing the county to close beaches, trails and parks on Monday. Some still look for ways to flout the rules, getting together in private residences. Morganstein has said that for some, “A lack of social connectedness feels as impactful as not eating.” Rule-breaking is seen as selfish, indulgent. But in this case, it’s more productive to view it as the natural response to deprivation.

Human beings are inherently social. Most people have organically leaned into means of social connection that obey social-distancing guidelines: phone calls, group video chats, collective cheers and block parties where all the guests remain at least six feet apart.

Most of America is sheltered in place now, likely for the long term. Our routines and social infrastructure will need to reliably make up for the social connections we’re losing. That starts with acknowledging what has been lost.

“One of the conversations that’s beginning,” Morganstein says, “is around the issue of collective community grief. People have lost and are losing things, whether it's an income, stability, their sense of certainty about the future, perceptions of safety, routines. More than just about any disaster that this country has ever faced, more people are facing and dealing with these kinds of losses. Sometimes, there is no replacement for the loss. Sometimes, we can find something that helps us as a substitute.”

In the face of death and human suffering, grieving anything else can feel shallow. But we often mistake reflection for self-pity, glossing over the parts of our lives that are short of tragic but still present difficulties worth examining. Reflection doesn't just help people cope. It can turn them into problem-solvers.

For example, working from home — an option not available to everyone — cuts off employees from interactions that, on the surface, don’t seem meaningful: a smile, a pat on the back, an acknowledgment of good work and the idle, presumably “wasted” moments at the proverbial water coolers and break rooms where co-workers gather to socially nourish.

Dr. William D. Parham, the National Basketball Players Association’s director of mental health and wellness, uses professional athletes as an example. When you go to work, when you succeed when ballers are contributing to a team, they're feeling valued, feeling honored, they're feeling special, they're feeling appreciated. If they can get down to that level of understanding of what makes them tick, then there are any number of ways to feel appreciated, valued, wanted, to feel like you make a difference, to feel like you're satisfying your purpose. Hidden in pandemics and crises, we are needing to manage exactly those opportunities to feel valued, to feel engaged, wanted, special and helpful.”

The better we understand ourselves and the lives we built before the pandemic, the better equipped we are to build physically distant routines that serve us spiritually.

For those who are able, Morganstein suggests altruism to close the connection gap. “If you have even a small amount of money that you can donate to relief efforts, if there is one person who you could help regardless of how busy you are, doing things for other people takes our mind off our own problems,” he says. “It gives us a sense of meaning and reduces our own sense of stress. Even though it might take energy, it will calm most of us mentally and leave us feeling more hope about the future and a sense of, ‘I can do something to help.’ Which is true.”

To help players navigate the coronavirus crisis, the players association is setting up weekly virtual office hours for players to drop in and chat with each other.

“I think there are benefits that come from engaging in a shared journey,” Parham says. “This clearly has triggered a lot of feelings: questions, uncertainty, panic, fear, boredom. Talking with others frees up that energy to engage to conclude, ‘I’m not in this by myself.’ It also positions you to learn — what you think is working might be helpful for somebody else. You are helping others by simply talking and sharing your story. You are also on the receiving end of people sharing their story.”

In the fight against the coronavirus, we can be lonely or we can be alone together. We can ignore our nervous energy or channel it in a positive direction. We can call or text one extra lonely person every day, making it just a little more likely that he or she stays home. We can learn to see social connection as a basic need, and fulfill it within each other. The next time someone asks how you are, you can tell them the truth.

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