Eight weeks ago, we kept hearing in the US: “Prepare yourselves. Where Italy is now with COVID-19, the US will be in 2 weeks.” Sure enough, in the last 6 weeks, we have seen New York hospitals inundated with cases, resorting to the distressing reality of refrigerator trucks being used as makeshift morgues.
Now that cases in Italy have begun a slow decline, it appears that there is a new storm brewing: the mental health impact of COVID-19. The combination of the protracted shelter-in-place requirements, the significant number of deaths, and grief compounded by many of these deaths occurring without family present or without the ritual of a funeral, has led to a combination of anxiety, listlessness, depression, and demoralization. Compounding matters is the mounting economic toll, with job loss at record numbers and small business owners hurting without the safety net of an unemployment system. Here in the US, this has led to armed protestors convening on the steps of state capitols, demanding the reopening of businesses and an end to shelter in place orders.
In the middle of a crisis, it is difficult to plan ahead, but that is what we must do now, not only for those impacted by this current wave of the COVID-19 pandemic, but also to build inner resilience to care for those who may be impacted by a coming wave in the fall (if the virus should behave as the 1917-18 influenza disease did, with the second half of the pandemic far more consequential than the first half). Not only will this resilience help us with future challenges, it will help to create the space in which meaning and post-traumatic growth can emerge.
Most of us in mental health are used to working in tertiary care roles—that is, we treat people after prevention and self-treatment failed to work. This is important work, but there is a lot we can do before that. Primary prevention attempts to address problems before they begin. This will be important to help prevent people from developing psychiatric problems. The secondary level is focused on preventing impact on more vulnerable populations. Tertiary care begins with primary care providers and is backed up by psychiatric specialists. It is through bolstering the primary and secondary levels of care that we can begin to build the resistance we need to prevent post-traumatic stress from this pandemic.
Primary prevention seeks to prevent illness and wellness practices are an important component for building resilience. It’s easier to practice resilience when we’re starting from a base of our basic needs being met, and right now, some people are struggling with things like the loss of an income or their health. Here’s what I’m doing, and while I’m not necessarily prescribing these steps for anyone else, perhaps they can get you thinking about what works for you to build your own resilience.
• I’m meditating: not very much, and probably not very well, but after I wake and before I get pulled into the busyness of my day, I sit on my cushion for a few minutes and try to allow a slow emergence between the nighttime sea of sleep and the daytime terra firma. Steven Batchelor, author of Buddhism Without Beliefs, recently described in an interview how the intentional practice of solitude that we get from meditation creates the possibility of autonomy from being controlled by the events of the world. It is in this meditative space that we can practice this autonomy.
• I get out and ride my bike. I was an avid bike commuter before all of this started. Riding my bike home along the ocean is one of the best little joys in the week. Sadly, my bike was stolen in the midst of all of this, but I’m looking forward to getting back out on the road soon with the wind in my face.
• I’m taking long walks; the kind where you leave the house and you don’t know exactly where you’re going, but they allow for the ruminative thoughts to drop off and for novel ideas to rise to the surface.
• I’m noticing beautiful things and sharing them. I have been taking photographs on my walks and sharing them with friends on social media. It’s a nice change from the drumbeats of bad news.
• I’m sleeping more. This is more of an unexpected benefit of not having access to the pool where I do my morning laps. I’m allowing myself to wake up without an alarm. As such, I’m more rested and I notice my dreams more.
• I’m cooking more. While I miss a good restaurant meal with friends, I’m enjoying seeing what I can make in the kitchen. My latest effort was a nasturtium hot sauce from some flowers I picked while out walking. It’s pretty good on eggs.