Monday, March 23, 2020
“I can’t quite explain what it is,” I told my wife a few days ago. Seems like weeks ago, actually.
“I agree,” she replied. “I can’t put my finger on it either, but something is not quite right.”
We were having what now seems like the first of dozens of conversations about the latest threat to our stability and wellbeing. Of course I am talking about the coronavirus scare that we have all been grappling with over the last few months. The threats posed by COVID-19 have inserted themselves into our vernacular, our school systems, our places of worship, our nursing facilities and our workplaces. We have read newspapers, listened to television reports, made toilet paper and canned goods runs on Costco, and washed our hands more in the last few weeks than ever before. What is it about this latest threat that makes us so uneasy?
Things that we do not fully understand make us anxious. I hear about anxiety virtually every working day from my patients but this is different. None of us know what to expect. Someone told me last week that this is like knowing that the tsunami is coming but not knowing how big it will be and how much damage it will do. All of us, patients and families and caregivers and healthcare providers alike, get anxious about this kind of threat. This is a novel virus. Most of us do not like novelty, change, things that are different and are likely to disrupt our routines. We fight against things that we can see, touch, or manipulate. This is different. This is an invisible threat that will not kill most of us, or even make many of us really sick, but may potentially sicken or kill the most vulnerable among us if we do not act now, and decisively so. This kind of anxiety is normal. Let me repeat that. This kind of anxiety is normal. It helps to make us more attentive, more attuned to the things around us that will help us not only survive, but prosper and move forward. Anxiety can be a catalyst for positive change. It is both a warning and an energizer. It slows us down but propels us to action at the same time.
Now, what happens if we do not stay abreast of the science and the rational warnings being offered by those who know how best to do this, but fall prey to rumors, speculation and frenzy? If that happens, our normal, adaptive, productive anxiety turns to fear. If we touch anything we will get sick. If we do not wear a mask we will breathe in something horrible. If we do not buy up everything in sight, we will run out of something vital. Anxiety turns to fear, which can lead to further speculation which leads to more false information being internalized which leads to more fear and on and on. As you might surmise, this is not adaptive, positive or productive. It makes us circle the wagons, cuts us off from sources of legitimate information, and erodes trust. Anxiety can be motivating. Fear can be paralyzing.
Some of my patients describe going up one more rung of this anxiety ladder, all the way up to panic. If fear is paralyzing, panic is even more isolating and disruptive. Rational attempts to socially distance oneself from large crowds or potentially infected people becomes absolute isolation. Panic makes you feel the most anxious and out of control you have every felt. You feel, literally, as if you might die. Your heart races, your pulse quickens, your palms are sweaty and you feel that you must run out of the room immediately. Panic keeps you from taking in new information, even if it is rational and useful, makes it hard to concentrate and keeps you from making good decisions for yourself or those in your care.
Panicked is not where we need to be at this time of crisis. Afraid is not where we want to be. Anxiety? Now, that is another thing. If I told you I had not been anxious about how COVID-19 was going to affect me, my practice seeing patients in a busy mental health center, my eighty four year old mother or my six grandchildren and their families, I would be lying to you. Of course it makes me anxious. That drives me to seek out good, useful information, make good, safe decisions and take care of myself and those under my care the best way I know how.
How can you keep yourself in a state of productive anxiety, not fear or panic?
Connect with others, but in a healthy way. Write letters, text and make actual phone calls to those you want to check on. FaceTime with family. Skype with business associates. You do not have to weather these kinds of stresses alone. We are truly all in this together and we are stronger when we support each other through the stressful times.
Educate yourself. Know the facts about COVID-19 and issues related to it. It is very true that knowledge is power, and from my perspective, it is a pretty darn good treatment for anxiety as well. Check out cdc.gov and scdhec.gov for timely and ongoing updates on the state of the virus outbreak and related topics.
Know yourself. Do you have underlying health issues that put you at risk? Are you over age sixty? Do you need to be careful with routine exposure to crowds, avoid sick people, or avoid going out at all unless absolutely necessary? Do you have support from family, friends or neighbors who can run errands or accomplish tasks for you that might be too risky for you right now?
Reframe any mandatory time away from school, church, work or social contacts as time for you. Read. Paint. Put together a puzzle. Take a nap. Watch comedies. We are all guilty of being too busy and never taking enough time for ourselves to just be still, meditate or relax. This is the time to retrain ourselves and understand just how important that time is.
Wash your hands often, use hand sanitizer if you need to in between scrubbings, avoid shaking hands and practice good respiratory hygiene.
Remember, anxiety can be a productive, adaptive, healthy response to stress.