The pandemic has tested all of us. Those with some mental illnesses, especially forms of anxiety, have contended with perhaps our largest fear: uncertainty. Early on, we heard about new symptoms, new theories about how the coronavirus was transmitted, and the startling way it affected some children and even some of those with no underlying health conditions.
To the anxious mind, the unfolding knowledge was not a comfort but a reminder that there was so much more to understand about this virus and covid-19, the illness it causes. It’s a relief to no longer think we need to wash our groceries, for example. But the new, more contagious variants of the virus means our old cloth masks might not be enough.
Every month has expanded this tension — discovering more, knowing less, wondering what’s next. Sometimes I wonder if I have the coping mechanisms for this ongoing crisis, one that has grown bigger and affected more parts of our lives than any in recent memory.
Still, many of us with anxiety went into this stressful pandemic with a slight advantage. We were already prepared with coping strategies, relationships with therapists and some understanding of the warning signs of an impending mental illness crisis. No need to tell us about the role the amygdala or stress hormones play in anxiety, we knew how we were wired.
For a while, decisions about how to go about day-to-day life were clear. Governors outlined protocols. Work and school went remote. Masks emerged as a tangible way to mitigate risk of exposure, and we could look at a map of the United States and covid and see bright spots of green, indicators of contained spread and a sign that even hard-hit areas like New York could get to the other side of a surge.
We are now in the heart of winter. The pandemic is worse and we have less clarity. You will not find much green anywhere on that map. I’m hesitant to list the litany of sad facts, aware that by the time this is published, they will already be out of date. But as I type this, the national death toll is over 435,000, new and more contagious mutations of the virus are in the United States, and vaccine distribution is slow and confusing.
A few days ago, I stood in the shower and noticed a small bump on my right breast. This was new, I thought, but the flood of panic and catastrophic thoughts were familiar. They raced down well-worn pathways of my brain, the ones that lead to dread and fear. When was my last mammogram? My next appointment with my gynecologist? Was this a cyst? Could it be cancer? How could something occur so suddenly? My mom was 55 when she was diagnosed with breast cancer, I’m still too young. Check that area again, I said to myself. Maybe I was mistaken.
This is how obsessive-compulsive disorder starts for me. After years of doing well, my nemesis had returned, hovering near me, looking for a way in. I gave in for a few hours, trying to solve the problem in my brain, checking the bump, quickly making an appointment with my doctor, and, as I’d done with my fear of skin cancer, I asked my husband for reassurance.
There are millions of Americans like me who find themselves fending off mental illness, be it anxiety, OCD, substance abuse or depression at the same time they are fending off exposure to a virus, political and economic instability, and a loss of believing we have a common understanding of truth and goodness in a rational world. We are depleted, perhaps from making so many decisions about so many things with so much to lose if we misstep. My decisions focus primarily on my children and keeping them safe. But each of us has a weighty responsibility — our parents, our spouse, our jobs, our friends, our pets.
I fought off my OCD intruder. I saw it for what it was — a response to anxiety. I did what I know can help. I suspended judgment about the physical concern, spoke to my therapist, and investigated what lay beneath the fear, which was making a decision about sending my children back to in-person school in the context of accelerating risk.
That bump? It went away, not because of magical thinking but because it was probably superficial — a hive, a blemish, who knows? This might sound like a trivial episode. But for those who work to keep their mental illness or substance abuse disorder in check, reverting to old patterns or behaviors is dangerous and troubling. It’s a wake-up call.
My situation is nothing like that of many Americans who grow up with trauma, or who face threats simply because of the color of their skin, or those who live with memories of combat or working in intensive care units during this pandemic. And it’s not equal to the anxiety faced by those dealing with a diagnosed physical disease or who have recently lost a parent. But mental illness comes with its own cost — to society and to each family.
By some estimates, depression costs the economy more than $210 billion a year and more lost workdays and impairment than arthritis, asthma, back pain or diabetes. The pain to individuals and families is more difficult to measure, but that does not make it any less real.
I worry about the mental crisis ahead, the one that will come when the immediate crisis is over. Many experts have warned us about the effects of our current isolation and stress. The past year has shown increases in drug and alcohol use, with women also showing higher rates of binge drinking. Suicidal ideation has increased. And 60 percent of young people with severe depression, whose ability to find help can set them on solid trajectories for years to come, are not receiving treatment.
For those with anxiety disorders like mine, whose coping method is worry, the calm after the storm brings a different type of fallout. I imagine it might happen the first time I let my kids go to a sleepover, or I visit my parents, or travel on a train or plane with strangers. Something will stir a memory of an old threat, and the panic and dread will rush in. It won’t be obvious where the fear is coming from.
When we have this second crisis of anxiety, depression or confusion about the loss of friendships and family that this first crisis has produced — what is in place to help?
Some of us can turn to the network of support and tools we have. A person looking for help for the first time may find it confusing, as I did, in part because there are not enough providers for the population that needs them. I hope, as we make our way into spring and summer and some semblance of a new era, we have a concerted effort to make mental health a priority. If we can’t put it on the top of our list, it should be a component of everything else, a value we protect and nurture.
I have an acquaintance, the father of my daughter’s former classmate, who told me about his OCD after reading my article about it. It’s an ongoing struggle for him as it is for most of us. Whenever he sees me, he asks, “How are you doing?” Usually, I say that I’m fine. Then he looks at me, adding a pause that conveys his deeper meaning, and he asks again. “No, how are you?”
It’s a powerful question when it’s asked so simply — and the person asking it really wants to know.