Trauma Is the Real Threat of the Coronavirus Crisis. How to Keep Your Mental Health

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People attend a fitness lesson from their balconies at a retirement home in Bordeaux, on March 31, 2020, as the country is under lockdown to stop the spread of the coronavirus.
People attend a fitness lesson from their balconies at a retirement home in Bordeaux, on March 31, 2020, as the country is under lockdown to stop the spread of the coronavirus.Credit: NICOLAS TUCAT / AFP
Ayelett Shani
Ayelett Shani

You live and work in New York, but now you’re here in Israel, in quarantine.

The situation in Manhattan is only getting worse. The city is in true lockdown. My work, with patients, companies and the media, takes place by video only. When Israel announced that Israelis who wanted to get to Israel should do it fast, I realized that they might be closing the borders, and I wanted to be with my family, so I came here.

You are known for your practical approach to dealing with mental crises. Your books and your TED talks are about how we can heal wounds caused by heartbreak, rejection or guilt. In light of our new lives, those suddenly look like “first world” problems.

On the contrary: Now we are all shut inside our homes. We’re very much afraid of getting sick. This situation is causing chronic stress and anxiety, and the mental challenges confronting us are only intensifying. In my view, the really great threat to our health at the moment is a mental one, because emotional pain suppresses the immune system, and the result is powerful physical vulnerability.

We don’t have tools to cope with this situation, because we’ve never been in it. Look, in Israel, we have experienced an existential threat, and more than once. We know what it is to sit in a bomb shelter and wait for instructions. It’s possible that, in contrast to other places, we have already developed a type of mental immunity.

But those circumstances were different. People can even be nostalgic for those times, because we were surrounded by our friends, families, neighbors. We gave support and received support. Now that safety net, which we need so much, has been taken from us.

The most important thing that has been taken from us is physical contact. We need the hug, the pat on the shoulder. But people will live for months now without that contact. The danger is that we will face a prolonged emotional and psychological crisis, even after the vaccine or the treatment for the disease is found.

Psychologist Guy Winch.Credit: Tomer Appelbaum

Universal posttraumatic stress disorder.

It’s already happening. It will take a long time before we feel secure enough to draw close to and touch other people, or to invite people into our home. We are adjusting to new patterns that will be difficult to break the more the situation drags on. We have never experienced a threat of this kind to the social fabric and to patterns of social behavior.

And what most of us feel is fear or anxiety. Could you differentiate between them for us?

Fear is a response to an immediate, concrete danger. I am walking in the street, someone pulls out a pistol and I react by fight or flight. Anxiety is an emotional response that is identical to fear, but in the face of a danger that is not concrete or is not actual. And even if there is something real, like fear of being infected by the virus, it’s vague.

Like a flowchart of uncertainty.

It will take a long time before we feel secure enough to draw close to and touch other people, or to invite people into our home.

Some people who are infected [by coronavirus] don’t develop symptoms, so maybe I’m already sick? And even if I have symptoms, are they related to this virus or to a different disease? The tests are not available, so I can’t know. If it is the virus, will I become seriously ill or not? Again, I can’t know. There are multiple stages until we reach the true point of fear. The event we are afraid of is quite remote in terms of probability, but the anxiety makes it actual.

Let’s say the chance that we will go through that whole process – becoming infected, displaying symptoms, falling ill and developing a serious condition – is 0.001 percent. From the anxiety perspective, it’s 100 percent. Anxiety leads us to think about the worst-case scenario, the one whose likelihood of happening is the lowest. And the thing is that, even if we decide that we are going to disconnect completely from the outside world, locking ourselves into the house, showering all day long and eating canned goods, one day an envelope will arrive in the mail and we’ll be convinced that the sender is ill with the coronavirus.

We are trying to achieve control. We are developing rituals, disinfecting the door handle, stockpiling food – looking for some sort of foothold.

That is exactly the problem. Let’s say we’re in this situation where we haven’t seen another person and we’ve been occupied only with cleaning and disinfecting for three months. We have ratcheted up our anxiety higher and higher. When the situation improves, our anxiety levels won’t allow us to return to our routine, because even if we grasp that it’s all right now to have friends over or to hug an acquaintance on the street – the anxiety will prevent many of us from doing that. The longer we avoid whatever it is that produces the anxiety, the more acute the anxiety will become.

If you are anxious about using an elevator, then every time you use the stairs and not the elevator, you are grounding more solidly your understanding that you have just avoided a terrible disaster in the elevator. After months during which you did not get near an elevator, it becomes the most frightening and threatening thing in the world. By the same token, the longer we refrain from human contact, the more difficult it will be to reverse course.

It’s a unique situation, because it really is difficult to draw a clear line of separation between fear and anxiety; between what we are supposed to do to protect ourselves, and exaggeration. It’s a mixture.

What might help all of us to overcome that, is the information we will receive from our leaders, and the trust we have in them.

Well, in that case maybe we should forget about it.

After trauma comes either posttraumatic stress, or posttraumatic growth. Posttraumatic growth occurs after we work on ourselves in order to convert the trauma into something else – something meaningful.

The more a country can rely on its leadership at times like these, the better, because then, when the moment comes that we’re told we can resume the old routine, we will be able to do so. In any event, it won’t be easy. We will get to that point after a lengthy period in which we have assimilated and adjusted to completely different patterns, but if we have trust, we can move forward. If we don’t have trust, if the information we get is inaccurate, our emotional healing will be delayed, because we will not succeed in overcoming the anxiety sufficiently to take the children back to school and go to work in the morning. Even now, it’s clear how difficult that is going to be.

It’s not just the information we get from the leaders. It’s also their personality. Their humanity. Think of Trump’s crude remarks, or Netanyahu’s scare-mongering performances, in contrast to [New York State Governor] Andrew Cuomo’s briefings, for example.

Cuomo holds his press conferences daily, an hour before Trump, and the residents of New York prefer to watch him, because he’s not ashamed, or afraid to say that things are going to be bad or that he doesn’t have all the answers. He doesn’t fudge things. He speaks straightforwardly. He allows room for people’s fear. He tells them that it’s all right to be afraid.

That is tremendously important. We have another problem, namely the information that is flowing in the social media, real or fake, opinion or fact – everything resonates powerfully and gains momentum.

Governor of New York Andrew Cuomo.Credit: AFP

From what I’ve read, mental health experts seem to agree that we should lower the amount of information we consume, to make do with once a day.

Definitely. It’s enough to watch the news once a day and to make do with just the headlines. All the information we need is there. Commentaries, assessments, opinions – they are not really relevant at this time. Certainly for those who feel fear and anxiety. That false feeling – that we need to be updated about every development, that everything changes by the minute – only harms us. We are in a marathon, not a sprint. We need to take it slow and preserve mental and emotional forces.

I read something you said in a different context, about heartbreak: “Our mind tries to keep our pain fresh.” I wonder whether that is applicable to the present situation.

When a small child touches a hot stove, his brain will always remember how badly it hurt. The purpose is clear: Let’s not do that again, let’s be careful not to get hurt. We know, from FMRI [functional MRI] studies, that the ways that emotional pain and physical pain express themselves in the brain are very similar. Our brain wants to preserve the memory of the pain, so that we will know we need to avoid doing what caused it.

We are now investing all our attention on our physical health, and it’s important that we understand that the emotional and psychological aspect is no less important.

When someone breaks our heart, when we experience failure – we will remember how unpleasant it was, so we won’t be tempted to do it again. Now, because we want to overcome the heartbreak and find a new love, and because we want to overcome the failure and to succeed, we need to cope with it, and that will be hard for us, because our brain is working against us.

But there is a difference between emotional pain and physical pain. If I ask you how much it hurt the last time you were [physically] injured, you may have a hard time remembering. But if I ask you about an emotional trauma that you underwent, you will cringe and start to experience distress. The emotional pain is lasting and even more vivid [than physical pain] when our brain replays it all the time.

People who meditate know that well: The mind tries to flee, and usually it’s into unpleasant memories, troubles, obsessive thoughts. Not into beautiful moments.

We always aim to focus on threats and hazards. It’s a survival thing. Our default is to go to difficult and dark places. Which is why, precisely in this difficult period, when we are in genuine distress, we must not be on auto-pilot, because the mind will lure us in directions that are not good for us. We need to take control of the situation, and not just rely on our instincts or our natural inclinations. Because what we will want to do, what will be easiest for us, is to escape. To avoid.

You are now afraid of being infected, so distance yourself from the company of people. A man broke your heart, so stay away from men. Our mind, which is the most sophisticated machine in the universe, needs a great deal of supervision and direction, because our instinct in most cases is wrong, certainly if we are hurting.

On the first days of the crisis, I enjoyed being outside. But with every passing day, the public space is becoming more and more dystopic, and the experience less and less pleasant. It’s hard when they take your temperature when you enter the supermarket; it’s hard when someone sees you approaching and hurries to cross the street. What you are actually saying is that it’s preferable not to give in to ourselves and that we should not stop going outside.

Unequivocally. I think it’s very important in this period – of course subject to the guidelines and the rules – cautiously, to try to maintain as much of the routine as possible. To go out for fresh air. To be in the sun a little. Those of us who have already become truly afraid to leave the house, can expect to have to deal with a tremendous difficulty when all this ends, because they will have a very hard time going outside. They will have to overcome a lengthy period in which their inner messaging told them, “It’s dangerous outside, the house is the only safe place.”

We all want to crawl under a stone until someone lets us know that it’s all over.

Everything you are feeling now, good or bad, is legitimate. It’s reasonable. There are many others who feel the same way, with different degrees of intensity.

The natural tendency is to think that it’s scary outside, so I will lock myself in the house. Don’t give in to fear. You have to understand that an emotional experience of this kind is not pleasant while you practice it. It becomes rewarding only at the end of the process. It’s like physical therapy: You do something that’s unpleasant for you, but you derive benefit from it. It doesn’t end only with going outside. I’m now writing an article about people who tend to play the role of therapist by nature, helping family and friends, and what they’re going through during this crisis period.

When things are so difficult for all of us, these people need to start setting limits. They are going to feel awful when a friend who needs them calls, and they don’t answer, because they are used to responding, but they are already exhausted and they need to protect themselves and their strength against total erosion.

Part of this mental health thing is to suffer that unpleasant feeling. “I am afraid.” “A friend needs me and I am not responding.” The problem of most of us is that we are not used to having our finger on the pulse and identifying our emotional needs. We aren’t good enough at that.

Certainly not now, when we’re weighed down with survival, and with the needs of other people.

A priest peers from the Church of the Holy Sepulchre, where Christians believe Jesus was buried, before Archbishop Pierbattista Pizzaballa arrives during a coronavirus lockdown in Jerusalem.Credit: Ariel Schalit,AP

But it is precisely this difficult period that allows us to do that. We have stepped out of the insane rat race of daily life, and if we decide to devote time and resources to our mental health, we might even come out of it stronger. It’s not easy. We would all prefer to put ourselves into sleep mode, like with a laptop – that is our natural inclination and our deep wish. But I think it’s preferable for us to think about the day after and how to get there in good condition.

We are all experiencing a sense of threat. We know that after trauma comes either posttraumatic stress, or posttraumatic growth. Posttraumatic growth does not happen by itself: It occurs after we work on ourselves in order to convert the trauma into something else – something meaningful, something that might change our perspective on life. We are now investing all our attention on our physical health, and it’s important that we understand that the emotional and psychological aspect is no less important. It’s not a privilege. It’s not a luxury. It’s a duty. If we invest in depression or anxieties, that will exact a physical price, too.

I’d like us to talk a little about acceptance. That’s what we need to practice now: to adopt to a blatantly unpleasant reality after being accustomed, for our entire lives, to argue with reality and to change it, as much as we can. We’re not satisfied with our weight, with our partner, with where we were seated in the restaurant. Now we have no way to argue with reality, certainly not to influence it.

Totally. And there are many layers of acceptance. We need to accept not only the momentary dramatic change in our reality, but also the deep change in our way of life. We need to accept that life is about to change, period. We can’t believe that we will continue from exactly the same point after this ends.

We will return, let’s hope, to a similar place, but human civilization is about to change in multiple ways, only a few of which we can foresee now. Present reality doesn’t look real to us. We are functioning within it, but we are constantly examining it and realizing and feeling that it’s off-kilter. It takes a long time for the knowledge that the basic reality of our life has changed to trickle down. It’s hard for us to accept that.

The carpet has abruptly been pulled out from under us. Everything that gave us with a sense of security, albeit imaginary, has disappeared.

We live with the feeling that everything is permanent, and now, not only is everything changing – we can’t even see most of the changes yet. I speak with my patients and I realize how hard it is for them.

Yesterday one of them told me, “Yes, because of the situation, I postponed my flight until July.” Now, he isn’t going to be flying, and specifically the place he planned to go to is in a very serious situation. But that is beyond his ability to conceive of at the moment. Acceptance is something we need to work on a lot, and in depth. It’s an extremely slow process, but one that we need to try and accelerate. To talk, to share, to clarify with ourselves how we feel about it.

Street art at Venice Beach, California.Credit: Mario Tama/Getty Images/AFP

I’ll give you a silly example. Until 9/11, you were allowed to take a bottle of water onto a plane. I remember the huge furor that the ban on that caused. People were so angry and outraged: Why because of one incident can’t we take water onto the plane? Why because of one person does everyone have to take their shoes off at the airport? Well, there will be a lot of changes like that. And there will also be deeper and more substantial changes.

Yesterday I watched a reality-TV show. There was a scene where one of the female participants in the house had a guest, someone she didn’t know, and she opened the door and hugged him, and I thought, “Wow, she’s out of her mind!” We’re already starting to move in those directions.

I hear that from my patients – that they’re shocked by the way characters in books or in television series behave: They kiss, she touches his face. In today’s reality, that seems like off-the-wall behavior. And if it looks odd in the perspective of a few weeks, we can only imagine what will happen in another few months.

Ultimately, we are adaptable beings. We adjust quickly. Most people prefer not to think about the future now, but if we are going to be better able to adjust to the day after, it’s best to start dealing with it. To cope with the reality, to bring to the surface what’s difficult for us, to talk about it with our friends. When we are capable of talking about it with others, we are effectively engaging in acceptance. We are starting to internalize.

I had a conversation with a young girl. I told her this was going to be the biggest event of our lives. She was utterly shocked by that thought, that this is what will define her life. She absolutely did not perceive it like that. During World War II, all the men aged 15 to 50 went off to war. Now there are no categories. We are all on this ship, and it’s leaking.

It’s hard for us to understand that while we’re all in the house, washing dishes and frying schnitzel, history is happening outside.

We are living in the shadow of this event, because it is unprecedented and is not on a scale of anything we’re familiar with. The realization that we are now living historic moments is also an important step toward acceptance, even though it’s frightening. It’s a correct perspective, because it enables us to deal with the difficulty.

We need to understand that it’s hard for us not because something is wrong with us, but because we are undergoing something immense, which is forcing on us all, sweepingly, a harsh emotional experience.

The message that it’s most important for me to convey to the readers is that everything you are feeling now, good or bad, is legitimate. It’s reasonable. There are many others who feel the same way, with different degrees of intensity. If we feel fear, despair, panic, depression – that is completely normative. And yet, however normative it may be, we should be mindful of ourselves and think how we can reinforce our ways of coping.

We are not helpless in the presence of this thing. We have a great deal of knowledge – both the medical experts and the mental health experts. Do not submit to helplessness. Do not submit to avoidance. Talk. Share. Work on yourselves, emotionally and psychologically. Now is the time.

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