(The Atlantic) This Is Not a Normal Mental-Health Disaster
If SARS is any lesson, the psychological effects of the novel coronavirus will long outlast the pandemic itself.JACOB STERN JULY 7, 2020
The SARS pandemic tore through Hong Kong like a summer thunderstorm. It arrived abruptly, hit hard, and then was gone. Just three months separated the first infection, in March 2003, from the last, in June.
But the suffering did not end when the case count hit zero. Over the next four years, scientists at the Chinese University of Hong Kong discovered something worrisome. More than 40 percent of SARS survivors had an active psychiatric illness, most commonly PTSD or depression. Some felt frequent psychosomatic pain. Others were obsessive-compulsive. The findings, the researchers said, were “alarming.”
The novel coronavirus’s devastating hopscotch across the United States has long surpassed the three-month mark, and by all indications, it will not end anytime soon. If SARS is any lesson, the secondary health effects will long outlast the pandemic itself.
Already, a third of Americans are feeling severe anxiety, according to Census Bureau data, and nearly a quarter show signs of depression. A recent poll by the Kaiser Family Foundation found that the pandemic had negatively affected the mental health of 56 percent of adults. In April, texts to a federal emergency mental-health line were up 1,000 percent from the year before. The situation is particularly dire for certain vulnerable groups—health-care workers, COVID-19 patients with severe cases, people who have lost loved ones—who face a significant risk of post-traumatic stress disorder. In overburdened intensive-care units, delirious patients are seeing chilling hallucinations. At least two overwhelmed emergency medical workers have taken their own life.
To some extent, this was to be expected. Depression, anxiety, PTSD, substance abuse, child abuse, and domestic violence almost always surge after natural disasters. And the coronavirus is every bit as much a disaster as any wildfire or flood. But it is also something unlike any wildfire or flood. “The sorts of mental-health challenges associated with COVID-19 are not necessarily the same as, say, generic stress management or the interventions from wildfires,” says Steven Taylor, a psychiatrist at the University of British Columbia and the author of The Psychology of Pandemics (published, fortuitously, in October 2019). “It’s very different in important ways.”
Most people are resilient after disasters, and only a small percentage develop chronic conditions. But in a nation of 328 million, small percentages become large numbers when translated into absolute terms. And in a nation where, even under ordinary circumstances, fewer than half of the millions of adults with a mental illness receive treatment, those large numbers are a serious problem. A wave of psychological stress unique in its nature and proportions is bearing down on an already-ramshackle American mental-health-care system, and at the moment, Taylor told me, “I don’t think we’re very well prepared at all.”
Most disasters affect cities or states, occasionally regions. Even after a catastrophic hurricane, for example, normalcy resumes a few hundred miles away. Not so in a pandemic, says Joe Ruzek, a longtime PTSD researcher at Stanford University and Palo Alto University: “In essence, there are no safe zones any more.”
As a result, Ruzek told me, certain key tenets of disaster response no longer hold up. People cannot congregate at a central location to get help. Psychological first-aid workers cannot seek out strangers on street corners. To be sure, telemedicine has its advantages—it eliminates the logistical and financial burdens of transportation, and some people simply find it more comfortable—but it complicates outreach and can pose problems for older people, who have borne the brunt of the coronavirus.
A pandemic, unlike an earthquake or a fire, is invisible, and that makes it all the more anxiety-inducing. “You can’t see it, you can’t taste it, you just don’t know,” says Charles Benight, a psychology professor at the University of Colorado at Colorado Springs who specializes in post-disaster recovery. “You look outside, and it seems fine.”
From spatial uncertainty comes temporal uncertainty. If we can’t know where we are safe, then we can’t know when we are safe. When a wildfire ends, the flames subside and the smoke clears. “You have an event, and then you have the rebuild process that’s really demarcated,” Benight told me. “It’s not like a hurricane goes on for a year.” But pandemics do not respect neat boundaries: They come in waves, ebbing and flowing, blurring crisis into recovery. One month, New York flares up and Arizona is calm. The next, the opposite.