WEDNESDAy, MARCH 18 , 2020. THE WASHINGTON POST EZ RE A
The coronavirus outbreak
BY JOEL ACHENBACHThe coronavirus pandemic is
becoming a brutal psychological
test. This is a dreadful moment
with a potentially deadly patho-
gen on the loose. This public
health crisis can take a mental toll
on people, especially those strug-
gling with anxiety, depression
and other conditions.
One common emotion that
might not be immediately obvi-
ous: grief.
“Right now, people are feeling
grief over the loss of routines,
certainty, and a perception of
themselves as being generally
healthy and protected,” said psy-
chiatrist Joshua Morganstein,
chair of the American Psychiatric
Association’s Committee on Psy-
chiatric Dimensions of Disasters.
He and other mental health
experts say there are steps people
can take — practical ones — to
ease some of that anxiety a nd give
a person a better sense of being in
control of this chaotic situation.
Some of the advice comes from
research on natural disasters,
mass shootings, terrorist attacks
and other traumas.
Much of the professional ad-
vice is obvious but bears repeat-
ing, Morganstein said: “Things
like getting good sleep, eating
regularly, staying hydrated, exer-
cising. When we take care of our
body, with good sleep in particu-
lar, but certainly food and water,
our ability to think clearly, our
ability to solve problems, our
ability to manage our emotions,
are all optimized.”
Kathy HoganBruen, a Wash-
ington-based clinical psycholo-
gist specializing in anxiety disor-
ders, echoes that advice: “Now is
the time to start establishing
some healthy habits.” For exam-
ple, start the day by getting exer-
cise and fresh air in nature if
possible. And a person feeling
overwhelmed by the grim news
might do better by limiting time
spent following coronavirus bul-
letins. “Really try to limit the
news consumption or just staring
at y our phone and your computer,
because for most of us that makes
mental health worse rather than
better,” she said.
The news coverage has focused
foremost on the confirmed cases
of the disease the virus causes,
covid-19 — the case fatality rates,
the contagiousness of the virus,
the missteps in rolling out testing
in the United States, and so on.
What is harder to measure is the
psychological contagion — the
sheer stress and worry and out-
right fear and how these can pass
from person to person as quickly
as a virus.
Joshua Gordon, a neuroscien-
tist and psychiatrist who is the
director of the National Institute
of Mental Health (NIMH), sug-
gests that everyone develop aplan for how to deal with this
moment. Having a strategy for
day-to-day living isn’t just a mat-
ter of protecting oneself from the
coronavirus and limiting its
spread in the community. It’s a
form of mental therapy, as Gor-
don sees it.
“Having conversations with
your family about what they can
do to protect themselves and also
what they can do to stay active,
physically and socially, can be
therapeutic in and of itself,” Gor-
don told The Washington Post.
A pandemic plan could involve
ensuring that social distancing
doesn’t result in extreme loneli-
ness and a feeling of isolation.
People who are staying home can
set up group chats via Zoom or
FaceTime or some other platform.
Make a plan for helping people
who are most vulnerable, or at
least making sure that someone is
checking with an isolated elderlyfamily member each day — some-
thing Gordon’s family has been
doing.
“Remember that what is most
disturbing about what we’re go-
ing through is the uncertainty.
When we know what’s happen-
ing, when we know what to ex-
pect, we feel safe — even if what
we expect might be threatening,”
Gordon said. “Develop a plan —
find your place in the world. It
can take time, it can take prepara-
tion, but it can help a lot.”
People with mental illnesses
can be especially vulnerable in a
time like this. About 1 in 5 adults
in the United States experience a
mental illness or disorder in any
given year, Gordon said.
“For those with anxiety disor-
ders, that concern [about the
coronavirus] can become all-con-
suming,” G ordon said. “We’re all a
little suspicious of others on the
subway, on the street, if they’recoughing or they look sick. Imag-
ine if you had schizophrenia —
that concern or suspicion could
turn into frank paranoia.”
This is also challenging for
anyone suffering from depres-
sion. The lack of social engage-
ment and the disruption of rou-
tines can worsen symptoms. Peo-
ple with mental illness need to
make a plan for how they can
continue with treatment and
therapy, including contact with
support groups and ensuring that
they have a supply of medication.
HoganBruen said this pan-
demic creates a kind of “forced
depression” because it disrupts
plans for the future that normally
give people hope.
“It’s like this kind of forced
depression. No one knows, ‘Can I
go o n a summer vacation, can I go
to my daughter’s graduation?’ We
don’t get to do that planning and
daydreaming in our heads right
now. Depression is feeling hope-
less about the future, and right
now, I think that’s how a lot of
people feel, rightfully so. If you
have underlying depression, that
might be exacerbated at this
point.”
Everyone should be aware that
a crisis like this can result in what
are known as distress reactions.
“Distress reactions include
trouble sleeping, difficulty in con-
centration, a feeling of being un-
safe. Anger. Blaming others. A
desire to socially isolate. It can
lead to risky behaviors such as
excessive use of alcohol or tobac-
co. Interpersonal violence can
flare. One common response to
disasters is work-life imbalance
— working long hours and letting
other important duties and needs
in one’s life slide,” Morganstein
said.
A crisis can also bring out the
best in people. People in the
United States have a history of
collective action and resilience in
hard times. The covid-19 pandem-
ic, however, is unfamiliar to most
people, and social distancing
ru ns counter to human nature.
To day’s pandemic has to be taken
as seriously as the Spanish Flu of
1918 — which is deep in the
history books.
It’s too early to know how longthis crisis will last or what its
ultimate toll will be. Experts have
suggested it might be comparable
to the 1957 influenza pandemic,
though it’s n ot out of the question
that it could be as severe as the
Spanish Flu. The virus remains
enigmatic, its favored modes of
transmission still under investi-
gation.
Covid-19 c an be a mild illness,
or a severe one, or even a fatal
one. The virus usually spreads
from direct person-to-person
contact, but it can also remain
viable for many hours on surfac-
es. Thus people must struggle
with basic decisions about how to
go a bout their lives. Is i t safe to go
every so often to the grocery
store? Hit the gym? Visit neigh-
bors (staying a few feet apart, of
course)? Attend a 12-step meet-
ing? A wedding?
“I think a lot of people are
pretty freaked out already, anx-
ious and fearful,” Francis Collins,
director of the National Institutes
of Health, said in an interview
with The Post. “A s in all things, it
comes down to the balance be-
tween having a reasonable con-
cern, especially if it’s motivating
to take actions that can reduce
risk, versus having this take over
your entire world to the point
where you become paralyzed.”
Figuring out what is a reason-
able concern is not easy for any-
one in a public health crisis like
this, which is so full of unknowns.
Morganstein said he avoids using
the word “anxiety” or “panic”
when discussing how people re-
act to a crisis like this because it
implies the reaction is excessive
or inappropriate. And he cau-
tions that a person in distress
does not need to be told to be
rational and logical: “Logic is
often an ineffective antidote to
emotion.”
But one thought is comforting:
Everyone is affected by this. This
is a time for communities to find
common purpose, even if people
are forced to stay apart.
“Understanding and remind-
ing ourselves that we’re all going
through something together,
sometimes that can help us feel
less alone,” he said.
[email protected]Mental health experts’ advice for navigating pandemic
JEENAH MOON/AGENCE FRANCE-PRESSE/GETTY IMAGES
A woman shields her mouth while riding the subway in New York City. Joshua Gordon, d irector of the
National Institute of Mental Health,urges people to develop a plan for how to deal with this moment.Practical steps can help
people keep from being
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