September 23, 2020

Surviving the Storm

storm

By Sacha A. McBain, Ph.D.

As of September 15th, there are currently 70,125 confirmed cases and 1,003 deaths from COVID-19 in Arkansas. Projections by the UAMS College of Public Health show Arkansas having nearly 121,062 cumulative cases and 2,088 deaths by October 31st.

For many of us, the experience of COVID-19 may be best described through the analogy of a tsunami. A tsunami begins with an underground eruption that causes a large displacement in water that results in a destructive wave train with unpredictable crests and troughs. While a tsunami is most likely to damage coastal areas, its damage can have widespread and longstanding impacts on the surrounding areas. In this analogy, COVID-19 might be the underground eruption that has caused devastating waves of financial insecurity, societal division, uncertainty, loss of life, and deepened health disparities. This year has been an overlapping series of literal and figurative natural disasters within a seemingly unending news cycle of tragedy and injustice.

Much has already been written about the impact of the year 2020 on mental health including the pandemic, volatile politics, and the racial trauma experienced by Black Americans as a result of the fatal shootings of George Floyd and Breonna Taylor by police. These events sparked national outcry, protests, and increased consciousness regarding the impact of systemic racism on every aspect of Black American lives including a disproportionate burden of COVID-19 cases as well as unequal access to appropriate testing and necessary treatment.

When it feels like your life or worldview have been turned upside down, there is no “right” way to respond. Importantly, how we respond to stressful situations is influenced by our lived experience up until that point, what resources and additional stressors we face, and how we’ve learned to cope with adversity or uncertainty. Those with children, for example, are navigating their own reactions, parenting in a pandemic, as well as the reactions and adjustment of their children and families. The pressures of caregiving and the increased fear of infecting older relatives can feel insurmountable. Those at greatest risk like older adults and people who are immunocompromised due to illness or disability may feel susceptible and unprotected. The point is, not everyone is affected by COVID-19 the same way. It’s important to realize this as we try to understand the mental health impact on our communities and find solutions that are both supportive and inclusive.

For many, this time may be marked by changes in mood – feeling more down, irritable, or fearful. Some may have difficulty concentrating or even feel helpless or powerless. Others may feel little at all as a result of numbing emotions through distraction, over working, or other means like alcohol or drug use. Crisis can also bring out the best in us. We can feel called to action, feel gratitude, or engage in more helping behavior.

Unlike a tsunami, COVID-19 is not a visible danger. As a result, we don’t always know when we are actually in danger and because of that we must always behave as if we are in danger in order to be safe. This means living in a state of constant vigilance that over time can lead to physical stress reactions like headaches, upset stomach, increased heart rate, muscle tension, changes in appetite (hello, nightly bowl of ice cream), and disrupted sleep. It can also lead to burnout, fatigue, frustration, or disillusionment (ever had the thought I don’t care anymore?)

This time has also been marked by grief and a sense of loss. For many, this includes the ultimate loss of a loved one and the inability to mourn through the usual rituals. For others, we cannot underestimate the grief of losing a job, important celebrations of milestones, or even the loss of a daily routine or spontaneous physical and social connection with friends and family. These are the things that hold our lives together, give us purpose, and keep us in the present or hopeful for the future.

So, what do we do to contend with the seemingly endless uncertainty and adversity that characterizes this time? First, remember Aesop’s fable “The Oak and The Reed.” During a storm, the rigid oak is prone to break or blow over while the flexible reed bends with the wind and so survives. In psychology, we call this mental flexibility. Often times in crisis, we have the tendency to tighten up or try to grit through until the crisis ends. While this can work in some instances, given the number of stressors we’re experiencing with no end in sight, this strategy may actually end up doing more harm than good.

To improve your mental flexibility, start by being kind to yourself. This is an unprecedented time with no rulebook or code of conduct. There is no “right” way to emotionally cope and we must remember having an emotional reaction is a normal part of being human. That means allowing yourself to experience your emotions (especially the uncomfortable ones) rather than pushing them away or endlessly distracting from them. While waves of emotion might feel as dangerous as the waves of a tsunami, I promise you can handle them and you’ll get better at sitting with your emotions over time. When we can, it also helps to refrain from comparing ourselves to others. We are all coming to this time with different experiences, resources, strengths, and vulnerabilities. When we are kind to ourselves, we can also be kinder to those around us and adopt a mindset of flexibility and understanding.

Decades of research has shown that positive social support is crucial to mental health and wellness during times of stress. Although we can’t access social support in the ways we are used to, we need to be intentional in finding ways to feel connected to each other and to talk about what’s going on in our worlds. This is especially true if you tend to “get stuck” in your thinking and replay the same thoughts over and over. Talking it through with a trusted other or even writing it out can help ease circular thoughts or worry.

Communication is extremely important during periods of crisis. Ambiguity in communicating with your community, however large or small it may be, makes it difficult for people to be resilient. This was true during the SARS outbreak in 2003 when a lack of information or inconsistent information was one of the primary drivers of later post-traumatic stress disorder symptoms. Given our current situation, some of this ambiguity is to be expected and is unavoidable. However, coordinated, cool-headed, honest messaging from community leaders can go a long way in allaying undue anxiety and confusion.

Imagine this – you’re in a small wooden row boat in a perfect storm. You try to stand up in the boat to scoop out the water, moving around the boat, and paddling against the waves in a frenzy. These actions probably actually increase your likelihood of going overboard. However, if you’re to put on your life jacket, hunker down in the center of the boat, and ride the waves of the storm, you have a greater chance of surviving. Just like in a storm, a cool-headed and thoughtful response, can make all the difference now.

Sacha A. McBain, Ph.D., is a clinical psychologist and associate director of the Psychiatric Research Institute’s Center for Trauma Prevention, Recovery, and Innovation.