A Therapist on What You Need to Know About Your Own Mental Health in the Time of COVID19

On March 22nd at 8pm, New York City went into lockdown in order to – finally – most effectively confront the spread of COVID19 (more commonly known as coronavirus). The goal was to “flatten the curve” of the proliferation of the virus, sparing hospitals and other medical centers from being completely overwhelmed with patients in need of critical care. As a native New Yorker, I’ve lived through hurricane protocols, 9/11, and snowstorms that have shut down the city to the point of people electing to cross-country ski down 2nd Avenue to get to where they need to go. But I’ve never seen anything like this.

New York City is the epicenter of the coronavirus pandemic in the United States right now, though other cities have enacted a mandatory lockdown before us. As a practicing therapist in NYC, the impact of coronavirus on mental, emotional, and relational health, unsurprisingly, seems to have taken over all of my clients’ concerns. From wondering how long we’ll be out of work or operating under severely reduced hours (especially those of us who work per diem, in the service industry, in retail, or in other “non-essential” sectors), to fretting over family members out-of-state who don’t seem to grasp the severity of the situation, to folks who are quarantining alone and now must navigate the emotional impacts of self-isolation and loneliness, COVID19 is weighing heavily on everyone’s minds.

But what, exactly, is this unprecedented event doing to us on a psychological and embodied level, both individually, and collectively? And what is the best way to take care of ourselves, and each other, in this moment in time, however long it may last? Here are a few things to keep in mind.

Social Distancing and Attachment

“Humans are social creatures,” is an adage so well worn among sociologists and therapists, it almost sounds trite. In this moment, however, it’s the context we need when considering the impact of COVID19 on mental and emotional health. Humans are mammals. This means that we’ve evolved to live in community with each other. The reason we’ve survived as a species for as long as we have is because we know how to work together as units, for protection, for sustenance, for defense. To interact socially and to care for each other is part of our biological blueprint.

The United States, built on white supremacist cishteropatriarchy inextricable from disaster capitalism, is arguably the most pathologically individualistic of Western countries. The U.S. “bootstrap” mindset loves to forget the very simple fact that we need each other. In this moment in time, it is also clear that this mindset intentionally forgets and obstructs the wisdom of so-called “unproductive” members of society: our elders, folks with disabilities and chronic illnesses who have had to make an art of adaptation by necessity and in order to survive. Perhaps living the last vestiges of a frontier myth, we move thousands of miles away from our families and friends, rent rooms in apartments with strangers or acquaintances, and consider intergenerational households infantilizing “failures to launch” rather than natural and time-honored alternatives to isolated – and therefore vulnerable – nuclear families. Though we often have very good reasons for making these decisions for ourselves, the consequences of these decisions is laid bare in moments like this one, when we need to be reaching out, caring for, and supporting each other, and are met with the fact that this task may be more complicated than expected.

Attachment is defined as the “deep and enduring emotional bond that connects one person to another across time and space” and was studied in depth by psychologists Mary Ainsworth and John Bowlby in the 1960s and 70s. Attachment, in essence, is how we learn to relate to others and meet our needs for safety, security, love, and care. We learn this in childhood, through our relationships with our early caregivers: our parents, our grandparents, the adults in our lives who raised us. As children, we’re helpless, and completely reliant on them in order to survive. Safe, secure, loving, and above all, consistent relationships, therefore, are as basic and fundamental a human need as a food and shelter.

There are a lot of different ways to experience attachment. Secure attachment is categorized by confidence in a caregiver’s ability to be there for us, to provide consistent care and soothing, and to keep us safe. Insecure attachment styles (avoidant, anxious/ambivalent, or disorganized attachment styles) develop in response to things like inconsistent availability of caregivers to meet a child’s needs, real or perceived rejection on behalf of caregivers, and, of course, experiences of neglect and abuse.

It might seem strange to be asked to focus on our childhoods in a moment of crisis. In fact, some of my clients have described this particular historical moment as requiring an extraordinary level of presence, which for some of us is a welcome break from future-oriented anxiety or past-oriented regret and rumination. Still, a working knowledge of how we were raised to understand relationships is relevant when you consider the impact of social distancing on mental and emotional health.

Our attachment style directly informs how we relate to fear and uncertainty. Those of us who are lucky enough to have experienced more-or-less secure attachment, for example, might have a higher tolerance for fear and uncertainty, or have an easier time trusting and relying on others for care. Fear, especially fear around survival needs and scarcity, is experienced differently if, on the other hand, your earliest experiences with caregivers were inconsistent, erratic, or frightening. Our ideas of what it means to trust others and to be held when we are afraid, sad, or lonely, can present more of a challenge if we do not have a blueprint, cultivated by consistent, present, and empathetic caregivers. Being raised securely attached, in other words, increases the likelihood that we are able to perceive the world as a mostly safe and predictable place, and other people as mostly trustworthy. While a global pandemic perhaps isn’t the best moment to try to heal all our childhood wounds, the one thing we have on our side right now – especially in places where you’re encouraged to stay home – is time to reflect. What roles have intimacy, care, and reciprocity played in our relationships?

The good news is our attachment styles are not set in stone. It’s important to remember that, while our experiences with early caregivers provide our initial understanding of relationships, and illustrate the interconnectedness of relationships and survival, we have continued learning throughout our lives, in our friendships and romantic relationships. We are constantly learning and changing. Particularly for queer folks, this is why the idea of a chosen family is so important. We learn all manner of lessons in early childhood, and unfortunately for many of us, the relationships we learn from are often inconsistent, stigmatizing, and sometimes even violent. But we contain within us the seeds of resiliency and courage – queer folks perhaps more so than most, out of necessity. Now, more than ever, is the time to draw on that.

Reflection Questions

What were the earliest lessons you learned about relationships? What comes to mind when you think of the words trust, vulnerability, intimacy, connection, care? If you had to write a story about your relationships, past to present, what would the arc of that story be? What are some of the themes? How do these words land for you, in a visceral sense? Does “trust” cause sensations of openness and expansion? Where in your body do you feel that? Does “vulnerability” or “intimacy” make you feel as though you are brittle, or need to contract protectively around yourself? Is it somewhere in between, or do you perhaps feel numbed out? All of this in information we can use to build awareness around what is being activated for us relationally right now, which we can then consider with the added factors of social distancing and isolation in mind.

Chronic Stress and Resolving the Stress Cycle

In Burnout by Emily Nagoski and Amelia Nagoski, the two sister educators essentially describe modern life as one longstanding and uninterrupted stressor. The scenario Burnout uses to illustrate the way our stress response cycle is supposed to operate is, quite literally, being chased by a lion. That’s what stress feels like in our bodies: a literal, high stakes, life-or-death fight to stay alive. Burnout breaks down what happens in our bodies biologically when our stress response is activated. Cortisol (the stress hormone that, if present in our bodies beyond the moment of stress & response, as in cases of chronic stress, PTSD and C-PTSD, can wreck havoc by causing things like autoimmune disorders and chronic pain), is increased. Increased, too, are our heart rate (which is why exercising can sometimes be triggering for folks who have experienced trauma). “Non-essential” bodily functions (such as digestion) by contrast, are “paused” or slowed down in order to ensure that our bodies are focusing every resource they can on getting us through the moment of stress to survival. (If some of this language sounds familiar, here, it should: This is what we are meant to be doing on a collective level, too. “Pausing” all non-essential functions in the moment of crisis in order to allow for our greatest chance of survival, for all of us. The problem, of course, is that structurally, a capitalist society does not allow for all of us to “P.A.U.S.E.” in the same way, with poor and working class folks – who make up the foundation of our economic hierarchy – bearing the brunt of both financial and health risk with no safety net.)

Our fight/flight/freeze responses are descendants of this process, but the stressors we face today are a lot less easily identifiable or contained. Today, according to the Nagoskis, stress comes in the form of things like racism, sexism, homophobia, and, as Emily says in a video summarizing the stress response cycle, “money…and the fate of the world.”

“Money” and “the fate of the world” are two of the topics weighing most heavily for many of my clients, and for me as well. In a moment like this, with businesses and entire industries shut down, no safety net in place for millions of Americans, and an unemployment rate projected to hit 20% due to the pandemic, the stressors are clear. Combine this with the ambiguous nature of this pandemic – it is impossible to assess exactly how bad it is going to be, though politicians are fond of reminding us that “it’s going to get worse before it gets better” – and we are being asked to hold a lot of uncertainty, while simultaneously navigating restrictions on how we might normally manage our stress response. To make matters worse, many of the ways that the Nagoski sisters encourage readers to complete the stress response cycle are no longer freely available to us. They encourage running, moving our bodies, as a go-to method of completely the stress response cycle, but we’re now tasked with finding new ways to do that in the context of social distancing and quarantine. Ditto for the 20-second hug from someone you love, a form of attachment-in-action and an illustration of the co-regulation that humans have evolved to be able to do.

On the bright side, however, is the knowledge that while stress response in the time of coronavirus looks different than it has previously, humans are eminently adaptable creatures. The Nagoski sisters, too, took things like able-bodiedness in mind when they were writing Burnout, recognizing that not everyone is able to just get up and go for a run or work out to resolve the stress cycle, and that intersections of oppression operate so that folks with disabilities need to be centered in the conversation about the impact of chronic stress even more than able-bodied folks do, considering the drastic way they experience it.

Exercises

If you can’t run, because we’re social distancing, your city is on lockdown, or it’s just not something you can or like to do, consider dancing it out in your apartment. Before you pick your music, ask yourself what your body needs to express. Are you afraid? Are you angry? Are you sad? What type of music would help set the scene for the expression of those feelings? How would you put those emotions in motion? Can you think of another time when you were feeling heightened and intense feelings? What music were you drawn to then? What would it be like to call those moments back into you body, if the idea of a pandemic is too big, too heavy, too scary to feel right now? What other experiences could stand in for that, and help you move through?

If moving or dancing are too hard, painful, taxing, or uncomfortable, consider singing. What happens in your body when you sing? Singing is a full body experience, involving our breath, our lungs, our throat (where pain and constriction often get stuck when we’re not expressing ourselves fully), and, most importantly, our voices. Whether singing is something you like or are good at or not, just remember: It doesn’t have to be good, it just has to get out of your body. Stress, pain, and trauma live in our bodies; they’re stored there, and not knowing how to move them out is what keeps us stuck, and exacerbates our pain.

If these don’t work, the Nagoskis point out that even the smallest movements, when undertaken with intention, can help release stress. Laying or sitting in a position that is comfortable, close or lower your eyes, and tense the muscles of your body, holding tightly for ten seconds, breathing deep, and then letting go. Tell yourself that in this moment of stillness, you are safe. Release.

Finally, remember that fight/flight/freeze aren’t our only options for interrupting the stress cycle. Tend and befriend is a much lesser known stress response, and – unsurprisingly – one that tends to be coded feminine. It involves reaching out to your circle of friends and loved ones and checking in with each other. Holding space. Asking, “How are you?” and really listening for the answer. While we can’t do this in person the way we used to right now, we are all leaning on this response more than ever before, with FaceTime check ins, Zoom speed dating, even banging pots and pans and singing across courtyards and between balconies.

Trauma and Survival

One of the most difficult questions to field as a therapist is, How can I trust that I’m safe, when I have never felt safe in my body? It’s the question that my clients who have long histories of childhood trauma ask, in a myriad of different ways, their actions and coping mechanism their bodies’ desperate attempts as seeking safety in a world where, from their earliest memories, their earliest attachments, safety was nowhere to be found.

If you’ve experienced childhood trauma, attachment trauma or trauma around resources and scarcity (i.e. poverty) chances are, the pandemic, social distancing, the financial crisis, and the pressure to stockpile food and household items, are all activating that trauma right now.

This is, of course, experienced differently for different people – you might feel relieved, for example, at the opportunity to live in survival mode once more, because survival mode is more comfortable than the ambiguity and uncertainty things being “mostly okay.” (This is one of the places the impulse to self-sabotage comes from, by the way – a life lived in survival mode is familiar, and familiarity signals safety, regardless of the high stakes or the damage that survival mode might take on ourselves or those around us.)

Others may be experiencing regression, “acting out” in ways that have worked in the past in terms of keeping us safe or allowing us to feel like we have some control over what is going on around us. This is normal. This is your body doing what it evolved to do to keep you safe, and doing what has worked for you in the past. You don’t have to judge yourself harshly for it.

If you’ve experienced trauma, be extra gentle with yourself right now. Pay closer attention to what you’re feeling, and what your body is doing. At what moments do you feel the need to shut down? As non-judgmentally as possible, just notice, observe. When I practice with folks who have a trauma history, this is where I like to start: Just noticing what’s going on. No judging, no crafting of stories and narratives. Not yet, at least, because sometimes when we try to tell stories about why we are they way we are, and why we are responding the way we are responding, we inadvertently invite shame: I’m broken; I’m messed up; I’ll always be messed up; there’s no hope for me.

No.

We are in a crisis now, and perhaps it feels a lot like crises you’ve weathered before. That is frightening. It’s okay to be afraid. It’s okay to grieve: For your past self, who was so afraid and unprotected. For your current self, if you’re numb, or checked out. It is natural to grieve even your resilience, for all the things you were forced to overcome. There is no wrong way to feel right now, and, as the Nagoski sisters write, “Wellness is a state of action, and freedom to oscillate between states of being” – even those states of being that include fear and despair.

We are living through an unprecedented moment in time, no matter where in the country you are – though where you are certainly informs your experience of it. Part of what is so difficult is precisely that: events seem to be unfolding at different rates all over the world, and certainly all over the United States. Our experience of time, individually and collectively, is shifting. Simultaneously, we’re navigating interruptions in our usual way of coping during crises: In many ways, what we are being asked to do for our collective good (practice social distancing) goes against our best instincts when it comes to managing anxiety, and now more than ever, we are in a chronic state of stress. We’re also being asked to hold large amounts of uncertainty and ambiguity; while we can access more information than ever before, we also seem to be, as a country, waiting with bated breath at the top of a roller coaster none of us ever asked to be on.

COVID19 is illuminating a lot of things about the way our society is structured – how we have devalued the labor of folks who are the foundation of a functioning society, grocery store workers, sanitation workers, cafeteria workers, home health aids, social workers and shelter workers, nurses and caregivers and hospital staff. We are being given the opportunity, en masse, to reconsider the way we relate to these systems. To hit “pause,” as the NYC initiative is named, and reassess: Do we want to live our lives this way? Can we choose differently, for ourselves, and for each other? Can we practice collective, communal care, mutual aid, reciprocity, and a strengthening of relationships with humility, vulnerability, tenderness, courage, and joy? Can we turn toward each other, protect and provide and take our cues from the most vulnerable among us to lead the way? Can we release our hold on productivity and perfection, and allow it to release its strangle grip on us?

I believe we can. I believe it starts with each one of us tuning into what we need in the long weeks ahead, weeks of solitude, weeks of reflection, weeks of saying “I love you” more, of asking “How are you?” and really meaning it. But the work starts at home, quite literally, and internally, for each of us. Your full time job now is to pour into your own cup, put your own oxygen mask on first, to check in with and prioritize your body and the messages it is trying to tell you in a way that we’ve all been too busy to do until now. We all must do the internal work of unpacking how the harms of our social structure have become internalized, have lived in our bodies, have shown in our relationships. We must allow ourselves to feel the weight of it. Maybe not all at once; maybe only in pieces that feel manageable. And we must complete our stress cycles. Imagine different ways of being. Express what comes up. Move it out of your body. Then do it again, together.

Christina Tesoro is a New York City-based writer, sex educator, and therapist. In her spare time she loves to read tarot cards, lift heavy objects, and go on long walks with her dog. She is determined to learn how to do a split.

Christina has written 21 articles for us.

5 Comments

  1. thank you for this!

    this part made me say “yikes” out loud in recognition:
    “you might feel relieved, for example, at the opportunity to live in survival mode once more, because survival mode is more comfortable than the ambiguity and uncertainty things being “mostly okay.” “

  2. There’s a lot to think about here… I don’t really have a trauma history per se, but having lived for a long time with an untreated anxiety disorder, there’s definitely something weirdly comforting about retreating into survival mode. It’s like I don’t have the mental space to think about the other uncertainties in my life.

    I’m starting to worry about both touch starvation and increased social anxiety in the longer term. Not sure yet if my roommate will be coming back, but for the past couple of weeks it’s been just me and my cat here. And the longer I go without interacting with strangers, the harder it tends to get! I think in many ways it’ll be a slow adjustment process for me when this isolation finally ends—a sort of reverse culture shock, like coming back from a year abroad and finding that nothing feels the same.

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