The Underlying Effects of COVID-19 from a Mental Health Perspective, in Comparison to the 1918 Flu Pandemic

I am a marriage and family therapist living in Metro Detroit during the COVID-19 pandemic, and I am frustrated. There is a dichotomy on social media, in which one group is concerned about the economy and their freedoms, and another group is concerned about their safety and saving lives. Both groups offer valid concerns, and I believe it is possible to be concerned about both of these things simultaneously. My goal in writing this article is not to start a debate. Social distancing is saving lives, and it is extremely frustrating to see people not abiding by social distancing guidelines in a protest at our state capital. However, fears about social distancing are not unwarranted. There have been articles written about the effect of lockdowns on the economy, and the concerning impact of lockdowns on women stuck in abusive homes. There are also plenty of articles out there about the importance of social distancing, what this is doing to flatten the curve, and what will happen if we lift these restrictions too soon. I am not an expert in that field, so my recommendation is to follow your state and CDC guidelines when it comes to COVID-19. But these topics are not what I came here to write about today.

I have recently observed more and more memes, comments, and articles written about how much privilege we have in staying home. These often come from a place of shaming people into remaining in their homes (often with the added expectation to learn a new language or become a gourmet chef). These comments are what I want to focus on in this article, as I have not (yet) seen any articles addressing them. There are numerous articles about how to take care of yourself during lockdown and COVID-19, acknowledging that this is having an effect on our mental health. Some articles have begun to touch on the problematic response of expecting people to be productive in their homes. But very few articles have addressed many of the causes of our declining mental health or the shaming nature of comments toward people who admit that they are, in fact, struggling. I have seen people comparing our current social distancing efforts to the Spanish Influenza epidemic in 1918, and to Anne Frank being locked in a small room with family. The mentality seems to be, “If they can do it, we can do it.”  “We have food, video games, Netflix, and video conferencing.” “Stop complaining.”

On some level, these statements aren’t wrong. Many of us are more privileged than people were in 1918 – the internet alone allows us to do much more to entertain ourselves indoors. However, entertainment alone does not counteract the devastating effects that social isolation can have on our mental health. There are many other factors to consider here.

First, most people who were social distancing in 1918 were in homes with their family members. In 1920, the median age for first marriage was 21 for women, and 25 for men. In 2018, the median age for first marriage was 28 for women, and 30 for men [1]. In a related trend, the proportion of Americans living alone has increased from 5% in the 1920s to 27% in 2013 [2]. With a quarter of the population living alone, asking them to social distance for an extended period of time, with no idea of when this will end, is going to be extremely difficult. Studies show that loneliness in America was already a concerning public health crisis prior to COVID-19, affecting one-third of adults and putting people at risk for depression, substance use, and suicide. One study even showed that loneliness in older adults predicted functional decline and death.

Loneliness and isolation go hand-in-hand with a lack of physical touch. Physical touch is incredibly important for humans; it allows us to connect and bond with the people around us. It also has biological implications for the human body. Touch releases oxytocin in our bodies, a chemical otherwise known as the “feel good” or “cuddle” hormone. Oxytocin helps us remain optimistic in stressful situations and helps create compassion during interactions with those we are close to. If you are noticing yourself, your friends, or your family being “on edge” or lacking a sense of understanding or compassion about our current predicament, it may be (in part) due to social isolation – especially if they are one of a quarter of Americans currently living alone. On the flip side, oxytocin can also cause people to seek social interactions with those who are like-minded, particularly during times of social distress or isolation. Therefore, if we are socially isolated with individuals in our households, we may be more compassionate toward those we are living with due to the “favoritism” that oxytocin facilitates.

In addition, touch releases dopamine and serotonin in our bodies, which helps regulate mood and decreases stress and anxiety [3]. If you or someone you love is currently living alone, it is important to remember that they are currently struggling with the lack of physical touch in their lives, especially with their (highly likely) increase in stress and anxiety. Many people have never experienced this level of distress, and now cannot even obtain a hug when they most need it.

Physical touch also offers an increase in our immune systems, as well as a decrease in heart rate and blood pressure – something we are all needing right now. One study even showed that something as simple as holding your partner’s hand can reduce a person’s experience of pain. Without access to physical touch, many Americans are struggling in very different ways than families living in 1918, or even Anne Frank’s situation. It is important to acknowledge the unique struggles of all of these situations, rather than to compare them.

Even if people are socially distanced with partner(s), roommate(s), or family, they are likely still feeling the pang of isolation in a different way than people in 1918. This is due to the fact that we are now a much more global society. It is easier than it has ever been to move far from our homes, away from our friends and loved ones. The increase in technology has also helped to facilitate this change, as people are now able to video chat with their loved ones miles away. However, 100 years ago, these things were not an option, and people were much more likely to live near their loved ones. We may be able to video chat with loved ones rather than waiting for a letter, but that still means missing the touch that actually soothes anxiety in the body.

My guess is that people who lived across the street from their parents, around the block from their childhood best friends, and down the street from their favorite teacher had a much different experience with their mental health during social distancing measures in the early 1900s. They could at least take a socially-distanced walk with a loved one. In today’s world, our friends and family live all over the country and all over the world. Personally, I have friends and family currently living in California, New York, Connecticut, Ohio, Illinois, Indiana, Colorado, and West Virginia, to name a few. This level of natural social distancing prior to COVID-19 may have been more manageable for many people due to the ability to travel and see loved ones. Now, however, many people are stuck in cities where they barely know anyone, and their close friends and families live hundreds of miles away. They may even have heightened anxieties if, for example, they currently have a loved one living in New York City, and they are feeling helpless living in rural Iowa.

One problem I am seeing is not only about social distancing guidelines, the economy, or the healthcare system. As I’ve stated, these are huge issues. We should be focusing on them. But that is not my area of expertise, and there are many other articles you can refer to in order to learn more.

The problem I am seeing is a lack of empathy for others’ social situations and personal struggles. It is about shaming others for complaining about their isolation, or boredom, or fear of not being able to do the things we normally do. It is people minimizing these struggles by comparing them to the isolation of Anne Frank or other human struggles in history – or to the struggles of others that they know. It is people being dismissive about the necessity of physical touch, or the loneliness people are experiencing. It is people ignoring – or barely acknowledging – the impact of social distancing on those who are less fortunate. It is people ignoring – or barely acknowledging – the impact of social distancing on themselves.

We are living through a global pandemic. This is a societal trauma. Every cancelled plan, furloughed job, or deferred opportunity during this time can, for many, be a shadowloss – a term coined by thanatologist Cole Imperi to refer to a loss in life, not of life [4]. Shadowlosses that many people may be experiencing during COVID-19 include: loss of jobs and economic security, loss of feelings of safety in leaving their home, loss of travel plans, loss of wedding plans, and a loss of eating out at restaurants. When these losses aren’t recognized or validated by others around us, they can lead to a complicated grief response. We don’t need to compare our current losses or previous societal traumas as a way of saying, “get over it, other people have had it worse.” We are all going through our own losses and trauma responses, and it is more important than ever to hear one another.

We would never say, to a woman who was abused, “Get over it, other people have had it worse.” However, that woman often tells herself this story. People who have been traumatized often tell themselves that others have had it “worse,” which makes their own trauma “unimportant.” I have heard this belief restated again and again as a therapist; but it is always important to remember that other peoples’ suffering does not negate your own. Everyone is affected differently by trauma and grief, and it is not helpful to invalidate your own feelings or those of others.

Your own trauma and grief responses are not unimportant. The trauma and grief responses of your friends, families, coworkers – are not unimportant. We are not in a competition. Frontline workers and people in hospitals with this disease are the most impacted, YES. And we need to do what we can to help them by social distancing. But that doesn’t mean that you cannot grieve or go through the trauma cycle yourself. It does not mean we have to shame people for grieving their losses or the loneliness they are experiencing.

It is okay to be fearful, and to express those fears. It is okay to grieve. Reach out to your friends and family members who live alone, or who live in cities separated from most of their friends and families. Understand that they are going through their own unique experiences, and those experiences are not necessarily better or worse than your own. Technology is not a replacement for physical closeness and comfort. But it’s better than nothing.

-Steph.

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