It’s Been a Year – Things are Looking Up, So Why Haven’t We Adjusted to COVID?

Americans are reconnecting – there is tremendous joy in hugging a loved one for the first time and experiencing those first moments of normalcy in over a year. Yet, according to the CDC, the number of people reporting symptoms of anxiety and depression has increased compared to this time last year, at the height of the pandemic.

The pandemic was not a one-off disaster, but "a slow, recurring onslaught of worsening conditions" says Tamar Rodney

The pandemic was not a one-off disaster, but "a slow, recurring onslaught of worsening conditions" says Tamar Rodney, a trauma specialist at Johns Hopkins University. The massive crisis changed people's behavior in two stages. First, the population became numb, even apathetic. Second, the shock led to a phase of heightened sensitivity to further trauma - a pattern seen in people who have experienced multiple disasters, such as 9/11, Hurricane Sandy and the Boston Marathon bombings. With each new blow, stress is added. Following the same logic, and without warning, the pandemic struck. Repeatedly, we were placed in quarantine, stripped of all our social ties and sense of belonging, leaving us feeling extremely lonely. Perhaps we lost sources of income and experienced financial instability, or worse, we lost a close relative or friend. 

In survival mode, we often set aside our needs and emotions

Given this context, we all went into "fight or flight"mode, with little time to process what happened.  Most of us focused on protecting and caring for our families, dealing with social and financial stressors, including the loss of a year of personal freedom – and essentially surviving. In survival mode, we often set aside our needs and emotions – ignore or bury them to avoid being overwhelmed. However, as we gradually return to normalcy and adrenaline levels begin to drop, these feelings of anxiety and discomfort resurface.

Mental health professionals emphasize that recovery takes time.“There’s a lot of healing we haven’t done, we haven’t really processed it. We haven’t really grieved. I don’t think we’ve really felt all the feelings that need to be felt for the loss of everything” says Jessi Gold, a psychiatrist at Washington University. But now, that some of our worries about life and death are easing, it's time to start dealing with the trauma.

Three things to keep in mind when grieving loss

1)     The effects of trauma can flare up when things calm down

For most individuals, trauma symptoms have a delayed trajectory – they do not manifest immediately after a stressful event, but later, when least expected. Take the example of a person undergoing long periods of stress, working hard to meet a deadline at work or studying for an important exam. When they finally get a chance to relax a little, they fall apart.

According to a 2008 study of Hurricane Katrina survivors, post-traumatic stress symptoms, mental illness, and suicidal ideation were highest not immediately after the storm, but nearly two years later – perhaps in part because by then, the initial post-disaster supports and safety nets were gone.

In many cases grief outlasts human compassion

Similarly, one of the reasons some of us continue to suffer from delayed pandemic stress is that the benefits gained during the crisis, such as financial aid, more flexible work schedules, etc., are dwindling – not to mention the small benefits that may soon disappear. Most of us enjoyed working from home, away from rush hour traffic, and dread having to deal with these usual stressors again.

2)     Grief isn’t a linear process

Grief is a natural response to loss, small or large, from the cancellation of a prom, wedding, or graduation to the death of a person. Both types of losses have a significant impact on our mental health. In the case of these smaller losses, most people don't realize that the discomfort they are feeling is due to grief.

For something so fundamental to the human condition as grief, there is still much to be learned about the grieving process. What is known is that grief is unpredictable and does not occur in a linear order. Moreover, in recent decades, new theories, based on rigorous empirical research, have challenged commonly held beliefs about loss and grief.

For a long time, the clearly defined five-stage model of grief proposed by psychiatrist Elisabeth Kübler-Ross in 1969 was considered a useful framework for understanding the grieving process. Although people do not necessarily proceed through all stages or in linear order, the five stages begin with denial: It’s just a flu. The second stage is anger, perhaps at the need to upend one’s life for a quarantine. Bargaining, I’ll give social distancing and self-isolating a chance, is followed by depression – from the impact, the numbers, the deaths. The final stage is acceptance that the world we knew is gone.

George Bonanno, a professor of clinical psychology at Columbia University, found more variation in how people experience grief than psychologists initially thought. He identified three pathways. Some individuals, whom he calls "resilient" bounce back within weeks of a loss. Others recover more gradually, following a "recovery" path, including periods of progress and setbacks. They slowly regain their mental and emotional balance. People who suffer from complicated grief struggle to recover. Their grief becomes what Bonanno calls "chronic" remaining at a high level of intensity for years.

One school of thought suggests a "dual process" model: since grief is stressful, we alternate between confronting the emotional pain of our loss and setting it aside. Hope gradually returns. The dual process model is a dynamic model of grief where we oscillate between two states of mind.

It is now widely accepted that everyone experiences grief differently and that there is no single theory of the grieving process 

3)     Healing together is essential, but the pandemic broke down community ties

Surprisingly, communities subjected to extreme trauma, such as years of daily rocket fire, show low levels of post-traumatic stress. According to Cohen Silver, a psychologist at UC Irvine, three factors seem to protect them: trust in authorities, a sense of belonging and community solidarity. In this sense, the pandemic was an unprecedented disaster that eroded all three of these factors: it undermined trust in institutions, separated individuals from their loved ones and deepened political divisions. The disaster was self-perpetuating, exacerbating the conditions for a collective healing.

We are all in this together

While recovery from a disaster is typically measured in terms of dollars spent on recovery, jobs restored and infrastructure rebuilt, the impact on mental health is harder to measure and therefore easier to ignore. Sociologist Lori Peek of the University of Colorado warns that society's natural desire to move on from the pandemic may further alienate those still suffering from symptoms and grief. Imagine someone asking for help in, say, six months and being told, "What are you talking about, the pandemic is long over?"

At this point, if you feel overwhelmed and anxious about the future, it's perfectly normal. You are not alone ; we all share the same feelings. Although some of us may differ in how we process and respond to those feelings – we're all in this together. There is some level of interconnectedness in that we all experienced a deeply traumatic event. So, remember that mental health issues are not a sign of weakness or lack of resilience. We all need time to recover and heal from this collective trauma – we are humans after all.

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