When New York City went into lockdown in March, Catherine was in the middle of an intensive outpatient program for her eating disorder. Consequently, her familiar, after-work routine of going to in-person therapy quickly shifted to sessions behind a screen.
“I found virtual programming to be more challenging in terms of remaining accountable.” Catherine, 24, explained, noting that the experience of living alone and being isolated made managing her eating disorder even more of a struggle.
As a result, her mental health took a hit and Catherine, who did not want to disclose her last name due to privacy concerns, went through a relapse. “The quarantine felt like a slap in the face towards the hard work I endured in the months prior.”
In many ways, Catherine’s story isn't unusual.
Dr. Gillian Galen, a clinical psychologist at McLean Hospital in Belmont, Mass., explained, “Often people with mental health issues work hard to create structure and routine in their lives, and the disruption of routine that COVID-19 has created can lead to increased loneliness, isolation, avoidance, substance use and what we are beginning to see in the research: depression, anxiety, suicidal ideation.”
Derek Odom, a 26-year-old from Louisiana who regularly takes antidepressants, also saw his existing anxiety and depression take a turn for the worse once lockdown orders were implemented. A self-proclaimed introvert, he noted, “Looking back, I didn’t realize just how influential seeing and conversing with friends at work and church, or chatting with the sales associate at the mall or server at a restaurant, was to the quality of my mental health - even as a ‘loner,’ being alone all the time proved to be too burdensome.”
“I didn’t think being isolated would have such detrimental side effects since I thought I was so strong and loved being alone,” Derek added, noting at one point he contemplated taking his own life and went as far to prepare a video suicide note.
Cate Heiner, a 25-year-old graduate student who struggles with Seasonal Affective Disorder (SAD), went from being surrounded by friends and seeing classmates five days a week to being completely alone in her apartment 24/7. She noted that not being physically touched, whether it be a hug or handshake, and the lack of in person interaction has taken a psychological toll on her.
“It’s made me feel untethered, like if I were to disappear it might not even make a difference because no one would notice,” she said. Contemplating this sense of physical disconnection with others, she noted, “there were nights I was laying on the floor hugging myself and crying.”
Schools and businesses may be opening back up in many parts of the country, but the stress and anxiety over whether life will truly go back to normal — and if COVID-19 infection rates will increase — has taken its toll on many.
“I think that the feeling of claustrophobia is very real. People are anxious about COVID-19, they are anxious about getting sick, and living in a state of not knowing when this will end,” said Dr. Galen. “… I do think the idea that we don't know when this will end is extremely hard for many people to live with, or for some that feels intolerable.”
The CDC recently published a study showing that 25 percent of young American adults in the past month have contemplated suicide as a result of the pandemic, while others show that over 150,000 Americans could die by suicide and other ‘deaths of despair’ as a result of the pandemic’s effects on mental health.
Dr Anthony L. Rostain, chair of the department of psychiatry and behavioral health at Cooper University Health Care noted, “We’re seeing rises of people coming into the emergency room saying they’re feeling suicidal and people calling the suicide line.”
COVID-19 hasn’t just affected young people with preexisting mental health issues. Many young people I spoke to said new mental health struggles have developed during the pandemic.
Leah, 29, a former buying manager, shared she’s having a hard time managing mood swings and new anxieties as a result of being laid off due to COVID-19 and the isolation that has come with it.
“My fiancé and I have been moving back and forth between our parents’ homes. We’re constantly living within other people’s rules and on their time – which feels very claustrophobic,” she said.
She also struggles with feelings of guilt and shame due to her job loss. “I noticed I say a lot of ‘not so nice’ things to myself – like this wouldn’t have happened to me if I were better, if I were smarter, had better connections, were more personable… you name it, I blamed myself for it.” She added, “I like to think I’ve nailed managing my mental health by now, but I haven’t.”
There’s also the fear of the virus itself.
Alan Moore, a 30-year-old lawyer from Virginia, struggles with the stress over the health of his family members. “It’s really hard having relatives who don’t buy the public health advice we’re getting because many of them are high risk or work in essential jobs that can’t be done from home,” he told me.
The loss of hope has, thankfully, resulted in some reaching out for professional help. “Therapy was one of the best decisions I made,” one person told me.
Still, many of those I spoke to for this piece have yet to seek out therapy or a mental health professional, citing hesitancy to ‘open up’ and the inability to afford the cost associated with seeking mental health services.
So where do you begin if you’re looking for help during this uncertain time? Remember this:
You don’t always have to be optimistic. Focus on being hopeful instead.
“Hope is the belief if you hang in there, eventually you’ll be able to get through it. Optimism is thinking ‘it will all be fine,’” said Dr. Rostain. He added that feeling pressured to feel more optimistic isn’t helpful when you’re feeling pessimistic. It’s easier to alienate yourself or feel like there is something wrong with you for not sharing the same level of optimism.
Instead, in those moments where you feel your thoughts going to a dark place focus on having hope. “Hope is simply the way of getting through, the belief that somehow you can find a way and you can learn how to be resilient in the face of unforeseen adversity. It’s new for many people because they really haven’t had to face this level of adversity, disconnection, uncertainty, or financial crisis,” said Dr. Rostain.
Seek out others
If you’re feeling like you are on the verge of a breakdown or find yourself having suicidal thoughts there are a couple of important things you can do, according to Dr. Rostain.
First, look out for these warning signs: Feelings of hopelessness, helplessness or a sense of futility, a feeling that no matter what you do there is no path of things getting better.
Then, identify people who you can talk to about how you’re feeling. “It’s important to turn to help, start with people who you know or consider turning to a helpline or enrolling in some sort of treatment program.”
“We’re all telling our patients ‘make sure you’re not feeling cut off from the people around you,” Dr. Rostain explains.
Dr. Galen suggested using apps for mindfulness and letting it guide you (Try one of these), “Begin to train your mind so that when it goes down the rabbit holes of "what ifs" and "should's and shouldn't be's" that you can learn to ask yourself if it is helpful to continue that line of thinking that will inevitably lead to suffering. In those cases, our thinking leads to much more suffering than the reality we are suffering about.”
Mindfulness doesn’t have to necessarily be meditation, according to Dr. Rostain (although that can certainly work). “Some people get more out of yoga, dance, hiking or biking.” The key he says is to develop a way of channeling energy to allow you to live in the moment rather than worrying about the future, especially if that future is uncertain. He uses this example: “When you’re walking through a fog, the tendency is to say ‘I’m lost’ as opposed to ‘well, it’s foggy but I’m going to learn to appreciate that this is a time for walking through a foggy road and not asking why the sun isn’t out.”
Having routines or implementing new ones can bring assurance we might otherwise not have.
“For many young people with preexisting mental health issues daily structure is a critical part of staying steady,” said Dr. Galen. “Specific times to get up in the morning can help maintain sleep cycles, going to work or school gives a sense of mastery and purpose, showering and getting dressed help differentiate parts of our day, leaving the house gives people the opportunity to find connection, attending activities and groups in the community also enhances connections and can add meaningful activities and opportunities for joy. This kind of balanced structure supports mental health. Without it, it leaves us emotionally vulnerable and for people already struggling with mental health issues the disruption of this can have serious consequences.”
Focus on what you can control
The pandemic is hitting people from every direction possible. We can’t control the virus, or when a vaccine is coming, and don’t have full control of accessing our usual support system or activities.
Dr. Rostain suggested offsetting the anxiety that comes with uncertainty by identifying things you can focus on that give you a sense of control. Start by asking yourself, “How do you begin to build a life again that gives you a sense of purpose and allows you to exert some level of control over what’s going on?”
Additionally, he recommended not spending too much time doomscrolling, trying to get outside when you can, and to meet up with people through socially safe contacts.
Dealing with feelings of guilt
Even if you haven’t dealt with COVID-19 up close or gone through a traumatic loss during this time, give yourself space to mourn the collective grief we’re all going through. Instead of suppressing those feelings, Dr. Rostain said, it’s important to acknowledge “the heightened sense of vulnerability of experiencing suffering of people around you while also honoring your own inner suffering. Bearing witness to that is the first step in how to cope with it. Acknowledge it rather than make it go away.”
Engaging in acts of self-care can be helpful during this time, and it doesn’t have to be extravagant, Dr. Galen said., “Something like getting up and dressed every day, having a cup of your favorite coffee or tea in the morning, going outside to get fresh air, exercising, doing something every day that brings you joy and practicing gratitude daily are all ways we can practice self-care along with many other things. Do these things with compassion for yourself, if you miss your self-care one day, don't beat yourself up and give up, approach it with compassion, today was a tough day, I will recommit to my self-care tomorrow.”
Dr. Rostain cautioned against using negative language that might end up being a self-fulfilling prophecy. For example, instead of saying “I can’t take this anymore,” you could consider rewording it to say, “I’m in a lot of pain right now but I need to learn how to live with it and how to transcend it.” It helps shift the mind from a place of avoidance, escapism, or suppressing emotions to helping the brain engage in problem solving instead.
And remember, if you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).
Daniela Pierre-Bravo is a producer for MSNBC's "Morning Joe," a Know Your Value contributor, Cosmopolitan magazine columnist and co-author of "Earn It" with Mika Brzezinski. Follow her @dpierrebravo