HealthCareTips blog: The Pandemic’s Toll on Mental Health and Relationships: What Can We Learn?

pandemic's toll on mental health relationships When Mark asked me to write a post about the toll the pandemic is taking on mental health and relationships, I didn’t want simply to detail the ways it’s hard to live through a pandemic. Nor did I want to throw a bunch of statistics at you about how many people are having a difficult time. You know that it’s like living in the world’s least entertaining Groundhog-Day-meets-dystopian-thriller film.

If you’re like me, you’re sick of kvetching about 2020. The fact is, though, that I don’t know anyone, myself included, who isn’t struggling in one way or another right now.

After a lot of reflection, I’ve concluded that a big reason why 2020 is so draining is that our usual coping strategies don’t work like we want or expect. Most are aimed at reducing the source of our distress or dealing with the emotional aftermath. This pandemic is ongoing. We’re stuck in the middle of it, with no end in sight, and no way to speed the process along.

That doesn’t mean we’re helpless, though. Personally, I’m a huge believer in practicing self-compassion as a means of coping, almost no matter the situation. I’m talking a formal practice of self-compassion, as outlined by Dr. Kristin Neff and others.¹ This requires self-awareness—mindfully tuning in to what is happening in your brain and body—and then offering yourself understanding and grace for what you’re feeling and how you’re responding. It’s perfect for situations like the one we’re in now, where we have little control over our suffering (the term used in the self-compassion literature), but we desire peace.

Because of my background, in the quest for self-awareness, I always look at situations through the dual lens of ancestral health and social psychology. Ever the optimist, I also look for opportunities to learn and do better when possible. Here’s what I’ve come up with so far.

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Facing the Unique Challenges of Living Through a Pandemic

I said I didn’t want to gripe, but let’s acknowledge that the pandemic is taking a serious toll. Survey after survey shows that more people are struggling with depression and anxiety. Distance learning is a challenge. Healthcare workers are under a tremendous amount of stress, as our other essential workers. People are sleeping poorly. Substance abuse is on the rise. ² ³

Which is to say, 2020 is exhausting, for lots of reasons.

Stressors Are Meant to Be Acute

Mark talks about this all the time. Humans are best equipped to deal with brief, intense stressors. We fight, flee, or freeze, and then, assuming a saber-toothed tiger hasn’t eaten us, we recover.

Everything about the present situation is misaligned with our genetic expectations. We’re simply not built to withstand long-term, unyielding stress—not from our jobs, chronic cardio, chronic sleep deprivation, and certainly not from six months of pandemic with no end in sight.

Remember back at the beginning of the pandemic where people were all, “Use this time to work on a new skill, build your side business, Marie Kondo your whole house!”

Lololol.

Now we’re beating ourselves up for feeling unproductive, lacking the motivation to exercise, and craving comfort foods. Instead, we should be lowering our expectations and telling coronavirus, “It’s not me; it’s you.”

Staying Afloat

When it comes to stress, even chronic stress, the goal is usually to eliminate it as much as possible. Here, though, our only real option is to try to keep our heads above water while we wait for things to get better. It doesn’t surprise me that substance abuse seems to be on the rise. When we can’t control stressors, sometimes it seems easier to numb out. The problem is, numbing isn’t coping. It’s avoidance. Drinking a bottle of wine while binge-watching a show may be great escapism, but at best, it’s a temporary fix.

In many cases, our best option is, in fact, self-compassion, radical acceptance, whatever you want to call it, plus a heaping dose of self-care. The trick, I think, is to acknowledge that the goal isn’t to alleviate stress or feel “normal.” It’s to stay afloat long enough to see the other side.

Questions I’m asking myself:

Am I expecting too much of myself, or failing to give myself necessary grace, given the amount of stress I can’t control
Am I using numbing strategies instead of coping strategies?

Mismatch Between Basic Needs and Coping Strategies

I’ve come to believe that many mental and emotional hardships are due to a mismatch between why we’re struggling and what we’re told to do about it.

Let me back up. Psychologists have proposed various models of basic human needs. You’re probably familiar with Maslow’s hierarchy, for example. At the base of Maslow’s pyramid are basic physiological and safety needs (food, warmth), then you work your way up to belongingness (relationships), esteem (pride, accomplishment), and finally self-actualization.

Academics don’t put a lot of stock in it, but it’s stuck around for more than seven decades because it has high face validity. That is, it feels right. We need to attend to physiological and safety needs before we can worry about connecting to other people, and certainly before becoming the best version of ourselves.

Those foundational needs are always more pressing, and all of us are facing novel threats to our safety. Not surprisingly, data from two polls conducted by the Kaiser Family Foundation and one from the U.S. Census Bureau confirm that the mental health toll has been greater for people who have experienced job loss or income insecurity.⁴ ⁵

Yet, much of the coping advice is aimed at those higher-tier needs—connecting to others, learning a new skill, becoming a zen master. I’ve been guilty of this, too. I love talking about self-care. At the same time, I understand why people are sick of being told to take a bubble bath or go for a walk when they’re worried about paying rent. (I do think social connection is always important.)

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A Problem of Self-Determination

My favorite psychological needs theory—doesn’t everyone have one?—is self-determination theory. SDT posits that humans have three basic psychological needs: autonomy, competence, and relatedness. Unlike Maslow’s hierarchy, there is a boatload of research demonstrating how meeting those fundamental needs, or not, affects motivation and well-being.⁶

It seems to me that most common coping strategies address competence (developing mastery) or relatedness (connecting to others). However, loss of autonomy—the freedom to control our own actions—is undoubtedly a primary reason we’re struggling.

The problem is, there’s not much we can do about that. The best option is to focus on controlling the things we can control and accepting those we can’t (major serenity prayer vibes, here). I’m not suggesting that we should be reasserting our autonomy by flouting the rules and doing whatever we want, virus be damned. No, the point is to understand why things still feel hard even when we’re trying our best to practice self-care so that we might give ourselves grace.

Questions I’m asking myself:

Am I meeting myself where I’m at, or am I using generic coping strategies that, while well-meaning, aren’t really what I need?
Am I blaming myself or feeling guilty for struggling, instead of accepting that the pandemic is hard in ways that are hard to cope with directly?

What Can We Learn from People Who are Doing Well?

I’m fascinated by people who are actually doing better now than before. Some kids are thriving at home, free from the social and academic pressures of traditional schooling. Lots of adults are realizing that they are happier and more productive working from home.

Getting back to the topic of this post, when I started to dig into the data on how the pandemic is affecting relationships, I expected to find dire news. I didn’t. While it’s logistically harder to see friends or travel to visit distant relatives, many people have seen their close relationships improve.

FThe Behavioural Science and Health Research Department at University College London is conducting weekly surveys looking at the psychological response to the pandemic, along with other socioemotional and behavioral variables. More than 90,000 people have responded. As of writing, data are available for the first 23 weeks here.

In July, week 16, the researchers asked about relationships. The majority of respondents said the pandemic had not changed their relationships with spouses, friends, family members, or coworkers. More people felt that their friendships had suffered since the beginning of the pandemic, compared to the number whose friendships improved—22 versus 15 percent of respondents, respectively. The data were similar for coworkers. However, relationships with some family members and neighbors were more likely to have improved:

27 percent said their romantic relationship got better, while 18 percent felt it was worse
35 percent reported their relationship with children living at home had improved, versus 17 percent who said it had suffered
26 percent had better relationships with neighbors, versus 8 percent worse

I really wish there was more attention to being paid to those people. Why are they doing better? What’s their secret? It must have something to do with the time we have to invest differently in relationships now, but is there more to it than that? Academics are going to be writing about this for decades, I’m sure.

Shaping a “New Normal”

Since we have no choice about living through a pandemic, I hope we can at least learn from it.

When we go back to “normal,” it won’t be—and shouldn’t be—the normal we knew before. The ways people are suffering and thriving both offer important lessons about human nature, our ability to cope, and the ways we do and do not support one another effectively. That some people are doing better during an arguably terrible time is telling. It says a lot about the challenges and shortcomings of our pre-pandemic way of life.

The question is, will we heed the lessons?

What about you—how are you doing, really? Will you go back to “business as usual,” or have you gained any insights from the past six months that will change how you approach things in the future?