Mental Health Struggles and Strategies
By Mark Ragins, MD CSULB campus psychiatrist
On March 16, my birthday, I learned to use Zoom and took a laptop computer home, where I have been seeing students from ever since. My life has changed in dramatic obvious ways: The only person I’ve been within 6 feet of is my wife. I haven’t been to a movie theater, eaten in a restaurant, gotten a haircut, or walked on the beach since then. I cancelled a trip to Yosemite, and what happened to the Lakers – Clippers playoff series I was looking forwards to?
But, in some ways, it’s the more subtle, quietly pervasive changes that have been the most disorienting and difficult. There are many things I took for granted in my life that have changed. As I’ve worked to regain my mental balance, talking with friends, family, colleagues, and lots of students, I’ve seen that some people are actually calm and thriving while others are miserable in a variety of ways, but everyone’s life has changed profoundly. I’ve also tried to learn and take inspiration from people in even more difficult situations in the past (I’m rereading “The Diary of Anne Frank”.). I’ve come up with this list of common struggles and strategies I want to share with you:
- Time may seem to be flowing strangely. Some days seem very long, while weeks pass rapidly. Sometimes it’s hard to know what day it is. I think this is partially a result of losing a regular schedule. Working or going to school entirely from home tends to blur everything. Not only is it disorienting, but it’s also easier to procrastinate and harder to feel productive. Empty time turns boring and just filling it with distractions like You-tube or puzzles doesn’t re-normalize time. When I’ve talked with people who have worked from home for a long time, they talk about keeping clear schedules, and of sharply dividing work from play – for the sake of both sides. Work doesn’t get done if it can be done later and play isn’t fun if you’re feeling guilty about work not done. Interruptions can go both ways too. Many people have specific rooms or furniture, or at least move things around to be “at work” or “at school”. It’s best to keep a schedule – including dressing, work times, studying times, even mealtimes – it’s best not to snack throughout the day. This is a good time for more intentional meal planning and cooking. Weekends should still be different from weekdays. Children can be very disruptive and exhausting to be around all day. They’re easier to handle with a schedule too. Get time to flow more normally again. Then schedules can include time to laugh, breathe, do something fun or silly, and to be kind to yourself without feeling guilty for things you haven’t finished yet.
- Sleep may be shifting later and later, especially for young people, until you’re almost backwards, going to bed very late and waking up after noon. Our circadian rhythms are naturally a little more than 24 hours, so most of us will tend to drift later and later without a schedule, especially if we’re not getting much sunlight. It’s usually much harder to force ourselves to go to sleep than to force ourselves to wake up. Set an alarm for the same time every day and force yourself to actually get out of bed. Don’t’ take naps, and then you’ll be more likely to be tired at a reasonable hour. The alarm anchors your sleep schedule.
- We’re not getting much physical activity isolating at home. People who are more used to regular exercise are likely to feel the change more than those of us who are less active, but we’ll all become more lethargic over time. We need to have a substantial amount of exercise – at least half an hour to an hour every day to keep our energy moving. In many neighborhoods it’s safe to go for long walks around the neighborhood. Or do an exercise or yoga video or group on-line session. Put it in your daily schedule.
- Many people are struggling with practicalities. Without a job there may not be money for food or rent or bills. Some students have had to give up on their apartments and go back home. Good mental health is almost impossible to sustain without food, shelter, and safety. There are a lot of programs, including at CSULB, available for practical needs. They do, however, take planning and coordination to access and utilize. Phone lines can be overcrowded. Answers and services can be delayed. It takes perseverance. Don’t give up.
- Some people seem unafraid of the medical risks from catching corona virus, while others are panicked, frightened of dying. Psychologically, it’s very difficult to be threatened by something we can’t see, that can be hiding in any of us, even ones who are feeling fine. We’re usually not very good at emotionally evaluating statistical risks – in general we’re more frightened of less common things (like terrorists or sharks) than more common things (like car accidents or cigarettes). This pandemic is very dangerous to us as a group – lots of people are dying – but not much risk to each of us individually. The odds are in all of our favor of living through this, even if we’re older or impaired, and massively in our favor if we’re younger and healthy. (By comparison, the bubonic plague repeatedly wiped out 20-30 % of medieval Europeans, while we’re unlikely to ever get to 1% deaths.) We should be self-protective, though not panicked, but more importantly we should be community-protective. We don’t want to overwhelm our medical system or have lots of unnecessary deaths. This is also the time to asses if you have access to medical care in case you need it. Do you have insurance? Are you eligible for MediCal but haven’t applied? Find out where you can get testing if you need it. If you’re socially distancing and prepared for if you get sick, you’ve probably doing enough. If you don’t need more medical information and it’s making you more anxious, limit it. You’re not going to miss a breakthrough if you’re not following the pandemic news all the time. Think of news like food: Is it nutritious, beneficial, or toxic? Are you using “portion control” or getting overstuffed? Sitting all day binging or even “snacking” on pandemic news isn’t likely to be good for you. Turn it off.
- Almost all of us are having much less personal face-to-face contact with other people (except some socially anxious avoidant people, some of whom are actually doing fairly well and tell me, “Welcome to my daily reality. I’m always anxious and alone.” Some of them have been dealing with isolation for most of their lives.) Most of us have far more social interaction in our daily lives than we realize and we take most of it for granted. Extroverted, highly social people are likely struggling the most with this, while people living alone are the most at risk. I’ve come to believe that the experts who have been warning us that virtual contact and social media doesn’t really replace personal contact are right, but it’s better than nothing. Make it a point to connect with someone who is meaningful to you, every day with whatever media you have, but not just more social media contacts with people who are really strangers. When you do connect, actually check-in with each other by identifying and sharing real feelings. Our TV is filled with “We’re in this together” messaging. Which of it makes you feel more connected and which of it makes you feel lonelier? Some people may like “good news” reports, or honking for health care workers, or country music stars and SNL performers entertaining us from their homes, or touching advertisements, and some may not. Do more of whatever of this makes you feel connected.
- Many students are staying at homes with their families. If you’ve been working on building your own life and self-identity separate from your family, this can feel like a step backwards or very restrictive. All the old dynamics get replayed endlessly as you’re trapped together, cut off from your friends and other activities. (Anne Frank went through a much more dangerous shutdown hiding in that attic for over 2 years with her family and I’ve noticed that most of her biggest depressions came from not being able to grow out of her family circle.) Some people have old traumas triggered being with their families and some, who had hoped to escape and move on, are in highly conflictual or traumatizing situations that are ongoing right now. It can easily feel like you’re stuck, repressed and dulled, and need to escape. Keep connections going to people who aren’t in your family dynamics that bring out other parts of you and do things that express yourself in roles beyond family member.
- As this shutdown goes on, it’s easy to feel helpless. We don’t know when the end will come or even what that really means. Will things ever return to “normal?” Mostly we’re taking orders from our political leaders and waiting on the medical experts and researchers to develop effective tests, drugs, and vaccines so we’ll be safe. Hiding from the virus waiting for someone else to fix things for us is inherently a helpless position. What kind of information and from what leaders (including not just political and medical leaders, but also celebrities, other people you admire, friends, social media, spiritual and religious leaders, etc.) makes you feel safer and what makes you feel more helpless and vulnerable? Choose carefully. Just because we’re helpless about ending the pandemic, doesn’t mean we’re helpless about everything. Set goals each day that are under your control and achieve them. You can still control and master a lot about your life. Strangely enough, one of the best ways to combat feeling helpless is to help someone else. You don’t have to have your act together to help others. You just need to care enough to connect to them. Find some way you can help others, or just to be kind to them, even while you’re struggling – it will make you more compassionate and empathetic.
- When we’re shut off from so much of life and what usually energizes us, it’s easy to feel depleted. We’re just not getting enough stimulation to feel alive like this, so we’re dragging or over-anxious. Most of us already have ways of artificially stimulating ourselves to keep going when things are dragging or over-anxious. (The list is long – alcohol, marijuana, other drugs, caffeine, nicotine, dark chocolate, sugar, carbs, sex, love, exercise, risk taking, meditation, prayer, gratitude, creativity, nature.) Now is the time to re-evaluate your “pleasure center stimulators” of choice. If you indulge in them more during this shutdown, you can energize yourself, but what are their negative effects? (I’m letting myself eat extra chocolate as long as I don’t gain too much weight.) Are your usual choices available to you during this time? Maybe some of your dullness is being deprived of your normal boosts when you actually need them more than usual. Can you adapt? (Charles Darwin is known for sailing across the world to the Galapagos Islands, but when he was older and persistently physically ill, he still spent hours engaged with nature, getting orchids shipped to him, analyzing all the life in a wheelbarrow of soil, and walking endless circles in the woods around his house.)
- Many of our students are missing important opportunities in their lives and their lives can feel stuck and ruined as a result. “The world has stopped at just the wrong time for me.” Internships, jobs, conferences, athletics, study abroad, graduations, research labs, art studios, performances, professional networking, and even dating are all cut off. This is “time you’ll never get back again” and can be a serious loss. The vast majority of these restrictions will be short lived. What can you postpone and not miss out on? Many people lose years of their lives for a variety of reasons and do well afterwards anyway. (For another extreme example, lots of Japanese Americans were tragically put in internment camps like Manzanar for several years during WW2, where they did the best they could in an extremely difficult situation, keeping active schedules, teaching their children, creating arts, and socializing, which likely helped them to rebuild, gradually returning to school, university, careers, and full lives after they were released.) You may be stuck working in a grocery store, living with your family for a year or two, but do not give up on your plans and dreams. (I saw a tee-shirt recently that said, “Class of 2020: Our graduations have been cancelled, but our dreams haven’t.”) You can still achieve many things after this is done. Try to avoid falling into an existential funk in the meantime.
- Our lives normally consist of a number of roles that satisfy and nurture us in various, complementary ways. We may be a son and brother and boyfriend and worker and hiker and churchgoer and social justice fighter and karaoke singer and…. With the shutdown, many of these roles feel lost, and as a result we can feel like we’ve lost some of our self-identity and personal strength. It can start to feel like our only roles are pandemic victim and bored, anxious person. Even at home, think of things to do that express your real roles and personal gifts. Look for virtual groups or activities. Connect to others who will relate to you in those roles. Find ways to express yourself. (For example, Frieda Kahlo could’ve focused only on her roles as an often-housebound, physically injured person in chronic pain and the wife of a womanizing husband, but instead she also creatively focused on her role as an artist, while expressing her loneliness and losses. )
- This shutdown can act like a personal retreat. (I’ve been on a weeklong retreat and they intentionally cut us off from others and normal time and our routines and leave us alone with our thoughts a lot.) For some people, this can be a good time-out, to take a breath, for reflection, recharging, consolidating a life that has been going by too fast. For others they sink into their own negative thoughts and existential despair or unending anxieties and ruminations. Have you been avoiding being quietly with yourself for your whole life? You don’t have to, but if you decide to take advantage of this opportunity for an impromptu, unplanned retreat, spend a little time planning and guiding it. What part of you would you like to focus on? Creativity, emotional trauma, sobriety, getting closer to God, opening up your Chakras, getting physically healthy, practicing gratitudes? There are lots of choices. Then build some structure, regular practice, and supports. Maybe keep a journal, read a book or watch some videos, work a “program”, join a group, get a mentor, meditate, set a schedule. Productive retreats are intentional, focused on opening up possibilities for growth, not just wallowing. (Another extreme example, Nelson Mandela made great personal use of decades of imprisonment.)
- What’s the meaning of all this? It’s easier to deal with suffering when we can make meaning from it. But usually meaning making requires humanizing or even anthropomorphizing a situation, and a virus is so small and seemingly so mindless, it’s hard to humanize. In our search for meaning, we’re likely to deflect from the infection itself to other humanized issues – ranging from criticizing an unpopular president, to blaming China, to flaws in the medical marketplace, economic and racial inequities, globalization, governmental restrictions of individual freedom, etc. (The last enormous pandemic, the Spanish flu of 1918 seems to have left no lasting meaning, perhaps because it was overshadowed by the last stages of WW 1. Even at the time, parades celebrating the armistice apparently led to a huge flare-up and numerous deaths because it was more essential to celebrate than to protect against an invisible killer.) Meaning is often easier to apply in retrospect, and we’ll have to wait to see what this pandemic means. (Most of my examples have garnered serious meaning making over the years, which may make them seem either appropriate or not, applied to our current situation.) Maybe this pandemic will be the defining event of your generation, or maybe it will be buried under other events, ranging from our next election, to a global recession, to the still building climate change dangers. What lessons do we want our young children to be learning? Ultimately, your generation will be the ones to make meaning of this.
If you’ve been struggling, I hope some of these thoughts make sense to you as explanations of what’s going on, and also give you some ideas for strategies for sustaining your mental health in these challenging times. Positive mental health is built on the beliefs that we can learn and grow from our struggles, we can find strengths within us and around us that we may not have known were there, and we can build resilience so that we can better handle the inevitable challenges the future will bring.
Take care.
Mark