What do you think is more harmful? The coronavirus, or the fear of contracting it? Psychological stress is capable of modifying various features of the immune response. Acute stress enhances, and chronic stress suppresses, the immune response. During this pandemic we have experienced both: our stress gets acute when we read the news or hear from new deaths, and is becoming chronic because more than six weeks in isolation and uncertainty make everything chronic. So, the fear we have been experiencing is also debilitating our immune system which makes us more vulnerable to the virus. How ironic!
Even without contracting the virus, millions of people may be going through traumatization. In a previous post, I explained how that traumatization could happen. In this post, I’ll talk about how to prioritize your mental health even if it feels trivial compared to other priorities, and why a better understanding of trauma beyond PTSD (post-traumatic stress disorder) can help on an individual level and a societal level.
For centuries, society has been less than empathetic to people who struggle emotionally. Psychological trauma has been denied one time after another. When we encounter someone emotionally challenged, instead of empathy, we might feel fear, contempt or shame.
The mainstream reaction during this pandemic is no different.
Understandably, most of the international attention is focused on physical health. In the U.S., little is said and almost nothing is done about mental health problems that are also developing, problems that can have worse long-term consequences than the physical ones. This could lead to a collective failure to alleviate stress, depression and trauma. Those who are upfront about reporting emotional suffering from isolation face embarrassment. I have seen this with my clients. Most of them are reporting is that they have been criticized by a member of the family or a friend for their behavior calling it “need for attention.” Some even feel embarrassed for having “escaped” to the country — something that is being shamed on social media and on the news. Though less urgent than physical health issues, the mental health challenges that most people are experiencing during this pandemic are no less dangerous. It’s necessary to know what the stigmas that keep people with trauma from reaching out for help are, so that we can eliminate them for individuals and the collective.
Some Experiences of Shame and Trauma
Mental health disorders have long been misunderstood. Talking about mental health used to mean nothing more than unacceptable behaviors, distorted thoughts and a variety of pathologies that carried the stigma of being “crazy.” (There is no better way to invalidate a person than to call her/him “insane.”)
Trauma is even harder to understand and accept. Trauma not only carries the general stigma of mental issues, but historically there have also been conflicts in attempting to recognize what causes traumatization. Every time a collective trauma has appeared — hysteria, shell-shock, sexual abuse, domestic violence and oppression to name a few — there was a tendency to minimize or deny the problem, from society in general, and from the medical community or authorities in particular. Recognizing trauma implies accepting a problem, and then actions need to be made, and money needs to be spent. The studies show that we tend to blame the victim and shame people for the symptoms, rather than hold the people or situation that inflicted the trauma accountable.
I hope this time we act differently.
The recognition of psychological trauma is a recent development. It was not until after the Vietnam War, when the evidence for the mental consequences of the war was overwhelming, that PTSD was accepted as a disorder and its treatment started to be funded. Even though trauma is much bigger than that, and takes many forms than what we commonly refer to as PTSD, not much more than the typical “tragic” event is covered by insurance companies. Trauma, which is a disorder of the autonomic nervous system, can develop after experiencing many situations that are not objectively “terrible.” Many people may experience long-term trauma after experiencing events that are challenging to them, even if they are not challenging for most.
In addition to PTSD, it has been observed that similar or more extreme versions of the disorder develop after experiencing different types of circumstances such for a prolonged period of time such as neglect, emotional abuse, racism, etc., in which the person ends up feeling hopeless and defeated. Traumatization during the virus is different from, for example, September 11, since we have no idea when and how the danger will end, and the fear grows together with the uncertainty. PTSD symptoms are appearing like after 9/11 — nightmares, hyper-vigilance, avoidance — due to the fear, but shame, mistrust, paranoia, impulsivity and other similar symptoms of more Complex Trauma are appearing as well.
If we embarrass someone for their struggles, we exacerbate the traumatization. We could even do it to ourselves. One of my clients has gone back to an old strategy of shutting down and disconnecting from feeling because she feels guilty of her privilege. She is closer now to develop a more complex traumatization than when the pandemic started.
Traumatization. How Does It Happen?
Although trauma is normally linked to an event — war, rape or violent deaths — its most fundamental aspect is its physiological connection to fear — the fear of dying, or losing something as valuable as life.
Trauma is about the struggle to stay afloat, and the loss of hope to thrive.
Trauma does not happen overnight. Trauma — especially the complex type — is something that develops internally over days, weeks, months or years. After experiencing a devastating event, some PTSD symptoms appear in almost everyone who has experienced or witnessed it, but less people have symptoms after the first month, and even less will experience them after the first year. The nervous system will do its best effort to go back to functioning as usual, especially if we contribute to the process and have support.
For example, the phrase “I couldn’t live without you,” so often used and ridiculed in literature, is a traumatic reality for many. If a person believes he/she can’t live without a person or condition they depend upon, such as a mother, a partner or even something like status in society, the possibility of losing what they so highly value can be terrifying. This is a scenario in which trauma would develop out of that fear, and the person’s loss of faith in the capacity to maintain the object of desire will make the emotional damage permanent.
Pandemic Traumatization: What Can We Do?
The emotional consequences of this pandemic will not depend on whether or not the virus is contracted, or whether we lose a loved one, but rather on the prolonged terror, and on whether people have or generate the ability to control their fears.
During this pandemic, our day to day life has a whole new set of fears. We fear suffering from a horrible disease such as pneumonia, dying, losing loved ones, losing a livelihood,and not being able to return to living as it used to be; some people fear starvation or running out of basic goods even if they don’t lack supplies. Fear calls fear and we can end up fearing our own shadow. All of that fear — which many people are calling “anxiety” — is activating our nervous system to such levels that many of us may be struggling with traumatization without knowing it, and therefore doing nothing to stop it. Being ashamed of struggling with fear is highly conflictive and increases the possibility of turning emotional dysregulation into a permanent disorder.
The more traumatized a person has been, the more prone they will be to develop additional traumatization, and to experience an amplification of previous symptoms, such as depression, anxiety, insomnia, paranoia, dependence, phobias, obsessions, rigidity, hyper-vigilance, irritability, lack of concentration, impulsiveness, self-destructive behavior, mistrust, shame, etc.
Stopping traumatization is almost as much a responsibility as the “social distancing” we’re doing to avoid contracting and spreading the virus. Emotional support should be an important part of pandemic relief, and several countries have it among their priorities and actions. But not all. And when mental health is not considered in danger and a priority on a national level, there is a possibility that we may ignore our own suffering — either for fear of being judged as sick or weak, or because we don’t have the tools to understand it, and therefore be left without help.
Regulating our emotional responses, accepting them, processing them and not succumbing to panic is necessary and beneficial for us, for our loved ones and for society at large; even for future generations. Among recent trauma findings, it has been discovered that trauma can be inherited, and that it can be transmitted. Dr. Gilad Hirschberger, a professor of experimental social psychology who studies how existential concerns influence our relationships with the world, defines Collective Trauma as “a cataclysmic event that destroys the basic fabric of society” and adds that in addition to the loss of lives, the trauma becomes a crisis of identity and meaning of life. “The tragedy is represented in the collective memory of the group” and will pass between generations even though none of them ever lived that experience.
The pandemic can leave serious marks if we do not overcome the fear of it.
Some of my clients have mentioned that they experience “fear of fear.” The bombardment of news during this painful isolation about the horrors of contagion coupled with news of a lack of supply in hospitals is truly disheartening and aggravates the fear of fear. It is understandable to want to be informed, but it is counterproductive to read more than necessary if you notice that it causes more fear and insecurity than you can handle. Even in isolation, it’s the lack of understanding of the emotional situation of each one of us — not to mention the lack of priority and support from the authorities — that puts us in danger.
To avoid experiencing permanent consequences, you can be proactive by making small modifications in your daily routine. It is important that you notice how long and in what way you entertain the thoughts that cause anxiety.
Here are a few things to try:
- Noticing your thoughts is the best way to understand and manage them.
- Taking “mindful” breaks during the day allows you to assess your emotional state and calm your system.
- Naming each of the emotions you call anxiety will help you not to feel overwhelmed. Feeling emotionally overwhelmed is a trigger for the survival mechanism that can traumatize you.
- Making the decision to stop reading or watching the news when you notice it altering you is a good way to calm yourself down and protect your mind. The same goes for sharing the news with others; that makes the emotional response to worsening.
- Noticing your attitudes and the type of behavior you are having in this new life situation will be an indication of how you are handling the pandemic. It will give you confidence in yourself even if you recognize that your behavior is not optimal.
- Accepting that the situation makes you vulnerable and that you may be experiencing emotional fluctuations more than normal will help you feel strong and in control.
- Brining into your awareness in some way — be it verbal or in writing — your fears and moods will help you to metabolize them and therefore dissipate them. Face your emotions; they are telling you something you should hear.
- Seeking professional help if possible will make a huge difference in your future. Right now there are many therapists adjusting their rates to be able to serve those who need mental health support.
- Observing when your thoughts are pessimistic and the effect that pessimism has on you will give space to other — more positive –possibilities.
- Reading some of the articles that offer solutions to manage the pandemic and offer tools is a good way to replace reading alarming news.
- Implementing nourishing routines to fill in the empty spaces of the day removes the risk of using the time in unhealthy activities.
- Find humor in the situation. Be playful and creative. Laughter is one of the best medicines for our spirit.
Essentially, be present! Connected to your body and mind; be aware of your thoughts, sensations,and emotions; be curious. That will give you space to control the reactions of your emotional system and will keep you away from getting traumatized.
The situation we are living in is unique, but we can make the best of it with an approach as unique as the circumstances. We may never again have an opportunity to make changes as imperative as this situation demands. We have the opportunity to recognize the causes and symptoms of psychological traumatization before they harm us long term. We have the information, and we have the time to deal with it. We can become healthier emotionally if we modify our previous habits. We can react differently because the scope of this event requires better solutions. We will be serving the collective by taking care of our own mental stability. We can also give support to those in need right now, before a collective trauma takes hold. We can replace our past failed attempts to stay present with fresh and informed actions — actions that give us both the resources to get through the pandemic, and also prepare us for a brighter future when the pandemic is over. This isolation time could be the best mental health bootcamp we ever had.