As a psychiatrist, part of my routine, not surprisingly, is asking people how they are. Recently, I have been struck by the fact that most people now reply with the same phrase: “I am hanging in there.”
One patient broke it down for me when I asked what this meant: “Doc, it means I am OK for the moment, but I have no idea what’s going to happen next.”
Other patients have agreed with this sentiment. A few recalled a poster from the ’70’s of a kitten hanging from a rope. The kitten is OK — for the moment.
One year ago, thinking about how the pandemic might affect the mental health of the nation, I wrote an essay for PublicSource on what has been learned about mental health during prior disasters. At the time, some were predicting that a second epidemic – a tsunami of psychiatric distress – would follow in the wake of COVID-19. I noted the importance of anticipating how the disruptions of the pandemic might radiate out over places and time, affecting different populations in different ways.
Since then, many people have expressed increased anxiety and fear. Grief and emotional exhaustion are common. School aged children and adolescents, at-home parents, essential workers, unemployed workers and communities of color have carried particular burdens. Calls to crisis lines have surged. Deaths due to overdose are up. Violence is surging. The suicide rate hasn’t increased, but this news should be received cautiously. It usually climbs with the passage of time after a disaster.
Meanwhile, COVID cases are dropping and the mortality rate is, too. Large numbers of people are vaccinated. Spring is here, and vaccinated people can mingle outside without masks. Businesses are opening or expanding. Traffic is picking up. People are visiting in small groups in each other's homes. Some are flying again.
Is it all over, or is there a coming tsunami? Or something else?
When talking about mental health and disasters, it's the dramatic disruption that attracts attention. But this way of thinking obscures the way events ripple over time through the complexity of human lives. Each response to a disaster can be as stressful as the initial event itself. This is particularly true of the pandemic. Its fingers and the reactions to them have reached into the fibers of our bodies and our society.
We are entering the pandemic’s aftermath. (It would be poetic justice if the etymology of aftermath derived from the “math” after an event, as in the summing of the losses and the gains. Sadly, it's an old English word for the mowing after the first harvest.) The aftermath of an event is about societal reckoning. The initial event is receding and both it, and the responses to it, begin to come into full view.
At the same time, an uncertain future looms.
I have been working from home for over a year, seeing all of my patients on my computer or listening to them over the phone. I think they are moving into the aftermath. They are noting their survival and their unclear futures while starting to reckon with both the pain of the losses and the appreciation of the support and love they have experienced.
I am doing the same. One of my patients died of an overdose. Others have lost relatives. Many have been in the ICU. A significant number are waiting for work to return, getting by on unemployment and pandemic-related government aid. The younger ones wait to return to school — most happy to be vaccinated, but some fearful of it. Some patients say they are impatient to return to their old lives, while others have found some peace in the slowdown. Many await seeing relatives and friends. Some wish they had friends and relatives to see.
Like them, we can all celebrate the passing of the pandemic while doubling down on self-care, mutual aid and basic generosity. Let's continue to do our best to:
- eat well and exercise
- reach out to one another
- listen to each other
- ask for help when we need it and when the need feels dire, seek emergency and crisis services (contact resolve Crisis Services at 1-888-796-8226)
- help others when we can
- avoid assuming that everything will be great when the pandemic is over
- encourage each other and keep our morale up as we navigate what is to come
- remember that we will always carry the shadow and the hurt of this year, some more than others. None of us is alone.
In my practice, I have seen a tsunami of traumatic distress and psychiatric disorders. I have also seen a sea wall of resilience, of recovery, grit and pluck — and maybe even some denial. We are hanging in there, using all we have learned, digging deep. I tell my patients that I see them doing this, and I praise their efforts and their sacrifice. They thank me for these small words. Often they cry.
The emotional challenges of the unfolding aftermath will test us, in their own ways, as much as the pandemic itself. Let’s all hang in there together. We have seen the suffering and the sacrifices. We have faced despair and we have found the tools we need to carry on. Let’s praise the efforts we have all made. Let’s thank each other and carry on. Don’t give up. Better days are coming. We are earning them.
Kenneth S. Thompson, M.D., is a psychiatrist at the Squirrel Hill Health Center, and director and co-founder of the Pennsylvania Psychiatric Leadership Council. He can be reached at Visiblehands@mac.com or on Twitter @visiblehands.