Editor’s Note: Dr. Andrew Solomon once said “It is the worst moments in our lives that make us who we are.” That advice continues to resonate strongly in our current crisis. Dr. Solomon was kind enough to allow us to re-share his continued advice, from his community newsletter, below:
Our institutions are addressing the current crisis in physical health better than the current crisis in mental health — which, given the standard of physical care for people with COVID-19, despite the self-sacrificing nobility of the healthcare workers in our midst, is setting a low bar. We suffer now from the dual trauma of a terrible disease and the isolation required to avoid infection.
Many of us have lost or will lose people we love. We fear for ourselves, too. Meanwhile, shelter-at-home directives have had two apparently opposite effects: cutting you off from your social circle, which is hard, and forcing you into inescapable contact with your companions in shelter, which is equally hard. Hell is both other people and the absence of other people. Somehow, the coronavirus has catapulted us into both harms.
Countless people are also experiencing financial disaster: millions have lost their jobs, and tens of millions have seen their life savings dwindle. We are disoriented by disruptions in our work and identity. All these factors place us in the territory of chronic fear and grief, which can readily spiral into anxiety and depression.
All of us are being changed as we shelter from a terrifying virus we don’t understand very well, for which we were completely unprepared. The toxic effects of prolonged fear are well documented. Fear heightens levels of cortisol, the stress hormone, which, over time, alters immune and digestive function, and causes heart disease and memory impairment. Grief likewise has its own, less well mapped biological component. Prolonged social disruptions such as the occupation of one’s country — by a military force or by a virus—can have lasting consequences. Safety measures give us the feeling that we are doing something and restore to us a sense of control, which can improve our brain function; but that control hardly overwhelms our underlying sense of being entirely out of control.
Isolation causes changes in brain chemistry. Isolated flies develop uncharacteristic aggression. In 2018, researchers at Caltech isolated mice for two weeks and observed increases in fear and aggression. The problem was located at the tachykinin gene Tac2, which encodes neurokinin B (NkB), a neuropeptide active in the amygdala and hypothalamus. Scientists believe that NkB acts throughout the brain, orchestrating the behavioral effects of isolation. Humans have a comparable Tac2 signaling system, suggesting the potential for extending this work to our species. When the researchers manipulated NkB in mice, they were able to induce or resolve many of these problems. Could we discover similar means of biologically manipulating the neural substrates of social isolation?
Research on the brain demonstrates that to differentiate physical from mental health is to indulge in a fiction. Evidence that mental health is just as “physical” as physical health is well-established. To address the respiratory symptoms of COVID-19 while giving short shrift to the impact of depression and anxiety is to do us all a grave disservice, regardless of whether our distress can best be mitigated by physiological or other means.
Social distancing is easiest for those with means, and nearly impossible for most who live in poverty. Isolation creates terrible psychological and economic stress in poor and minority communities, making these citizens more vulnerable to the virus and escalating its spread. This problem is oft-lamented but seldom studied. Even prior to the pandemic, depression was diagnosed much less frequently in those who are poor than those who are not. This disparity does not occur because poor people experience less depression; rather, clinical depression is characterized by distress out of proportion to circumstances, and poor people have such a tough reality that their depression seems an appropriate response to their difficulties. The pathology gets overlooked. Now, while everyone in isolation is suffering, so are those who cannot isolate, those who sleep six in a bed, those who must leave home to work every day, those lacking immigration status who are hiding from authorities.
We have all rightly grown to fear one another. Our cortisol is out of control.
My advice to everyone is to sustain human contact whether you feel like it or not:
- Zoom or video chat with friends.
- Take advantage of social media, if that provides you with a positive sense of ambient intimacy.
- Make phone calls and write letters to the people you love. If you’re with other people, try to mute your reactions for the sake of peace.
- Keep communicating.
- Go for walks together if you can do so without violating social distancing guidelines.
- Avoid loneliness if you can do so, even while practicing aloneness.
Human beings are social animals; your emotional stability depends upon interaction.
Every day, I wish you the epitome of good physical and mental health, deep tolerance for all the distress and disruptive restrictions this moment has brought to us, and sustaining interactions with friends, family, and others.
Photo Credit: DieselDemon/Flickr Creative Commons Attribution License
This article was originally printed in Dr. Andrew Solomon’s April 20, 2020 Newsletter, and is reprinted with his permission.