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Dr. Steven Siegel wakes every morning at 5, feeds his dogs, makes a fresh cup of coffee and begins exercising. By 7:30 a.m., he's had breakfast and a shower, has dressed and is at work in his office.
Never mind that office is just a spare bedroom in his Glendale home. Routine, Siegel says, is the best way to combat the monotony and stress of the COVID-19 lockdown, now stretching into its sixth week.
“We do have more control over this than may otherwise be apparent,” argued Siegel, a psychiatrist with Keck Medicine of USC and chair of the Department of Psychiatry and Behavioral Sciences. “Whatever your routine is, do it. Then go to work, even if that means that the kitchen counter becomes your desk between the hours of 8 and 5.
“You can’t control the rest of the world, but you can control what you do. I have no power over when COVID ends as an individual, but I have a lot of power about how I respond to this.”
Concerns about the coronavirus infecting us or our loved ones have fueled anxiety and fear, but the isolation and boredom of staying at home can be harmful in their own way. And the psychological harm of the lockdown is harder to measure and likely to last longer, driving up the rate of domestic violence, depression and other mental conditions.
“That is a reality,” said Ellen Bradley-Windell, a licensed clinical social worker and co-founder and director of the Valencia Relationship Institute. “We’re already seeing the fallout with families being home, kids being quarantined and home-schooling.
“So I’m concerned about suicide, people with social isolation, that people are living by themselves. I’m also concerned about the delayed response with family conflict, marital conflict and behavioral issues with kids.”
Mental health experts also fear a rise in alcohol and drug abuse as people self-medicate to deal with the stress. Alcohol sales nationwide are up 55% from this time last year while sales of recreational marijuana jumped nearly 50% in one week this month.
“People with significant mental issues, isolation is the worst thing because you live in your head, you don’t have feedback,” Siegel said. “You don’t have someone making sure you’re OK and not letting you go off the deep end.”
Bradley-Windell is trying another approach with the people she sees, encouraging them to focus on the positives by keeping a daily gratitude journal of things for which they are thankful.
And Dr. Michelle G. Craske, director of the Anxiety and Depression Research Center at UCLA, has put together a weekly online COVID-19 care package with advice on coping with these stresses. Among her suggestions: stay connected, exercise regularly, limit the amount of coronavirus news you consume and practice random acts of kindness.
“Different people with different life situations certainly could be experiencing different types of stress and degrees of distress,” she said. “These stressors could also manifest differently from person to person. Some people may experience little to no severe mental health consequences whereas others may experience symptoms of depression, anxiety or stress.”
Combating that is made more difficult by the fact there is no definitive end to the quarantine. Although California’s stay-at-home order is scheduled to expire May 15, Gov. Gavin Newsom said lifting it will probably happen gradually and will depend on the state meeting certain criteria, including the availability of testing and hospital capacity — all things outside our individual control.
“Sometimes I kind of am despairing in the uncertainty around it all,” said Melissa Whitson, a professor and coordinator of the community psychology program at the University of New Haven. “If I knew it was a certain amount of time, I’d be like ‘All right, I’ve just got to power through.’ But we don’t know how long it’s going to be.”
Whitson said some of the things she’s seeing in the current crisis remind her of what she’s seen in people dealing with post-traumatic stress disorder.
“What we know about trauma is the symptoms associated with it tend to be worse when we feel hopeless. And when we feel like we don’t have control over anything,” she said. “This certainly lends itself to that situation.
“And then there also this grief," she added. "Grieving the life that we had, grieving not being able to do things that we normally would be able to do.”
That grief, in part, has led protesters in more than two dozen states, including California, to call for an end to stay-at-home orders, a move health experts say could spark another wave of coronavirus infections and deaths.
“They’re being very reactive because they don’t know what else to do. But from a psychological perspective it’s based out of fear because they feel out of control,” Bradley-Windell said.
Financial insecurities will make all those issues — isolation, boredom, uncertainty and fear — worse. With more than 20 million Americans filing for unemployment benefits in the last five weeks and the lines outside food banks growing daily, that’s something that won’t be solved simply by letting people out of the house.
“This current crisis really highlights a major weakness in our society: that this vulnerable, massive class of people will struggle if their income stops for a few months,” Siegel said. “We shouldn’t be in a situation where we can’t respond to a medical crisis without people losing their ability to buy food and shelter.
“In L.A., people who don’t have food and shelter has become the new norm."
After years of unsuccessful searches for ways to get people off the streets, the COVID-19 crisis has offered a solution, with the county leasing more than 2,000 hotel rooms and searching for 13,000 more to give homeless people a place of their own in which to shelter.
“Where’s the silver lining?” Siegel asked of the pandemic. “If we can come out of this with a mentality that says a bunch of us can be a little bit less rich so that a ton of us can be a little less poor, it would almost make COVID worth it.”