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Everyday Health Tweetchat on Isolation and Depression

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On Thursday, May 28, 2020, Everyday Health sponsored a Tweetchat on the impact of the coronavirus pandemic on mental health. Participants included Andrew Solomon, author and Professor of Clinical Psychiatry at Columbia University; Dr. Lloyd Sederer of Columbia Psychiatry; Heidi Hanna of the American Institute of Stress; psychiatrist Dr. Allison Young; suicide survivor Kevin Hines; Dr. Regine Galanti of Long Island Behavioral Health; and Dr. Debra Kissen of Light on Anxiety CBT Treatment Center. What follows is a transcript of organizer Carolyn Fagan’s questions, and Andrew’s answers.

Hi, everyone. I’m Andrew Solomon, author of The Noonday Demon: An Atlas of Depression and Far from the Tree: Parents, Children, and the Search for Identity. I’m a professor of clinical medical psychology at Columbia University. I write and lecture on politics, psychology, LGBTQ rights and the arts. I’m now writing a book on expanding ideas of family: divorce amp stepfamilies, interracial families, assisted reproduction, single parents, adoption, foster care, gay families, multiparent families, paid childcare, and child-free families. Anyone with stories to tell — please get in touch!

1. How is the coronavirus pandemic affecting people’s mental health and what factors (ex: WFH, fear of sickness, grief) are contributing to that?

Those whose mental health is immediately affected by the coronavirus are dealing with four stresses at once: the fear of dying; the grief associated with losing loved ones; the anxiety created by economic uncertainty (or, in some case, ruin), and the loneliness attached to isolation. Any one of these would be sufficient to tip someone’s mental health from coping-pretty-well to not-coping-well-at-all. All four at the same time are tipping some people who would in ordinary times be merely the worried well into a state of clinical illness. But even for those who don’t officially qualify as mentally ill, this level of stress is very difficult to tolerate. People should take advantage of any resources they have (inner or outer) to remain as calm as possible.

2. What effects does isolation have on mental health in the short-term and long-term? Are there major differences for people isolating with others — their family, roommates — vs. people isolating alone?

Human beings are social animals and we weren’t designed to be isolated. I have many single friends who are sheltering alone, and the sadness of being completely out of contact with other people (except perhaps a clerk at the grocery store) is enormous. Even flies isolated for two weeks begin to show uncharacteristic behavior. Our sense of reality comes from our interactions with other people; without them, we are floating in a pool of uncertainty. Having said that being alone is a great stress, I would say that being with a small group of others is also a great stress. You don’t need a medical degree to recognize that people get on one another’s nerves, and they do so most of all when they have no escape from one another, and they do so most of all when they have no escape from one another. Sartre said that hell is other people, and he was right; as it turns out, hell is also the absence of other people. In this crisis, we are dealing with both at once.

3. Will there be a long-term impact on the mental health of children? How might remote learning impact their cognitive abilities and interpersonal skills?

Children past infancy are more observant than we think, and they pick up on their parents’ moods to an alarming degree. When researchers at Columbia investigated treatments for childhood depression, they found that the most effective of all interventions was to treat the mothers. So when parents are struggling, children struggle, too. They may not show stress and depression as we are accustomed to seeing them; they may, for example, be sullen rather than sad and angry rather than doleful. But do not doubt they are experiencing this, too. Online learning is a wonderful tool and we are lucky to have it given the circumstances; but academic instruction is only 25 percent of why children go to school. They go to learn from one another and to develop useful social skills. Isolation deprives them of that fundamental learning. Depending on how long this lasts, the deficits will be hard to make up.

4. The coronavirus pandemic is affecting the typical grieving process, as many people aren’t able to visit their loved ones when they are ill, and funerals aren’t happening the way they typically do. Is there an effective way to grieve without these protocols?

It’s monstrous not to be able to grieve together. Even more, it’s monstrous not to be able to visit people you love who are dying. I’ve had several friends lose parents they couldn’t go to see; one of them sang her father a song over Facetime every night until he died. She never got to give him a hug; she didn’t get to comfort him as he slipped from the world. After he died, none of the people who loved her could go and offer her an embrace. We could tell her over Zoom how much we had loved her dad, but human comfort comes out of direct interactions, and these technologies mediate our emotions and make them less palpable. I have no magical advice here, except to recognize that people love you even when they aren’t beside you, and to take the condolences any way they come. Use the technologies — even the good old phone — to talk to people and to remain in contact. And give yourself leeway to plan a memorial to take place as soon as the vaccine arrives, whenever that may be.

5. What can people do to maintain their mental health right now? To what resources can people turn?

There are basic mental health hygiene measures that can be taken now to sustain your sanity.

• Regularize your sleeping and make sure you are neither sleeping too little nor too much.

• Regularize your diet and eat at the same times each day.

• Avoid alcohol, excessive caffeine, too much sugar, and any substances of abuse.

• Exercise however you can; it’s astonishing what basic exercise can do.

• Spend time in the sunlight, even if it’s only through your window.

• Take a shower every day.

• Avoid watching the news all day long; it is not cheerful, and if there is a big breakthrough, you’ll know soon enough.

• Stay in touch with friends and others you love; you want to be in dialogue as much as possible, and to talk to people who can tell you if you’re slipping. Be no more isolated than your situation demands. Hug the people with whom you are sheltering even when they annoy you; touch deprivation is a serious concern.

• And then be aware that the rates of depression and anxiety are sky high right now, and that there is no shame in being one of the vast number of people grappling with these symptoms. Remember that depression is very common and very treatable. Find a therapist if your insurance or your means allow it. Take medication if the situation seems to require it. I’d suggest people who are in bad straits contact the closest major teaching hospital, but there are also resources at the Depression & Bipolar Support Alliance (DBSA), including online support groups. Also, the National Network of Depression Centers (NNDC) can be helpful. And for younger people, the JED Foundation has amazing programming; their hotline is 1-800-273-TALK(8255). There are so many good resources; there’s an excellent list of them at the JED Foundation.

6. How can people mentally prepare for when the country reopens? Will there be long-term effects from going through a pandemic?

Well, of course there will be long-term effects for years and years. Will we ever again feel safe shaking hands with many strangers in a row at some kind of public event? Will we ever presume that our way of life is unshakeable? Will we have a different relationship with the idea of resilience? This has been a war, and wars change people — not only those who have fought in the trenches, but also those who have not been directly affected but have seen all their values disrupted. What is and will be possible is going to change. Already, we see people who are taking foolish risks as though to refuse the knock from mortality they have faced. We see other people still terrified to engage in basic activities even with masks and social distancing. And no one knows what is appropriate and what is excessive now, and no one will know those things for a long, long time, though the information is gradually getting better. We will be changed by this. The question is whether we will also be changed to understand the world differently, to recognize global vulnerabilities and try to fix problems such as climate change and economic injustice. One way to strengthen your own recovery is to engage in a larger fight to live in a wiser and more judicious world.