The motto of the House of Stark from Game of Thrones is “winter is coming.” The meaning is a warning to remain vigilant as there are troubling times ahead. This motto applies to both mental illness and the COVID pandemic. There was a brief time where we saw improvements in case numbers and deaths. People began to see small snippets of normalcy again. It gave everyone false hope that normalcy was within reach. But experts warned not to get complacent because winter was coming. As soon as we let our guard down, COVID began to surge again. This is exactly what is about to happen in the coming weeks with mental illness, the other Pandemic.
At the beginning of the pandemic, we stressed the importance of self-care and healthy coping skills. Some of our healthy coping skills were limited due to COVID regulations, but we were still able to implement many of them by and large. It will be even harder to employ many of our coping skills with winter coming, especially those that revolve around getting outside. To make matters worse, we just had a time change. Leaving work when it is dark is hard, limiting how much time we can spend outside. Seasonal affective disorder (SAD) is also common during the winter months. In addition to the depression and anxiety so many are already experiencing because of COVID, that will make for a difficult season.
I am particularly worried about health care workers, especially physicians. Physician burnout is at an all-time high. Physicians were already vulnerable to loneliness and isolation due to their job’s very nature, but it has worsened because of COVID. Isolation is a known, major risk factor for suicide. Physicians are already a group with greater rates of suicide. COVID has caused an increase in the Physician suicide rate. We have heard of so many Physicians who have taken their lives due to the increased stress of COVID. The stressors related to COVID have not gone away. They are more present than ever, and I worry for my colleagues because winter is coming. Because of the time change, many physicians will now work in the dark and leave work in the dark. The amount of time spent outside getting sunshine and vitamin D, essential to healthy mental health, will be reduced dramatically. The holidays are also a difficult time for many but especially physicians. Many times, physicians do not have control over their schedules. While the rest of the world is enjoying the holidays, many physicians will be working and likely working more than ever. COVID will still be surging, and now we are entering the flu season. Hospitalizations will rise and place increased stress on Physicians. Many physicians already have PTSD from the first surge of COVID, making it even more difficult to care for patients in the winter months. But they are expected to press on despite their struggles. Physician burnout will continue to soar, as will mental illness amongst physicians.
But the good news is that we are more prepared this time. We know what to expect with this virus, both physically and mentally. We can prepare now. We MUST prepare now. Physicians need to begin implementing self-care and coping skills now. Consider investing in a sun lamp or visor for the (SAD) symptoms. These are proven to help with symptoms of depression. Make sure to invest in a lamp that can provide at least 10,000 lux of light. Use the lamp within an hour of waking for at least 20 minutes. You can even use the lamp while doing notes. I even have a physician friend who keeps her Christmas tree up and lit but changes the décor to Mardi Gras to keep that light in her home.
Socialization is also critical to good mental health. But socialization outside of home and work has been difficult throughout the Pandemic. Doctors’ lounges seem to be a thing of the past, but they served a much-needed purpose. They fostered meaningful conversations amongst physicians. And while doctors’ lounges may no longer exist, you can still commit to meaningful conversations with co-workers. This is not conversations about patient care. Take the time to learn more about your co-workers and their lives. Engaging in meaningful conversation reduces loneliness that is so prevalent amongst physicians. Also, focus on things that you can control to reduce anxiety. The COVID Pandemic has been a period of nonstop change and lack of control. This has led to an increase in anxiety. We get anxious about change and lack of control. So, practice focusing on things that you can control, such as exercise and eating a healthy diet. Having control of certain aspects of life can reduce anxiety. And when you have a bad day, journal about it or talk to someone about it. Just journaling your feelings can be cathartic.
As far as the holidays, remember that it is more about togetherness and family than the actual date. Work with family to find a date when you do not have to work to celebrate the holidays. Lastly, if you have implemented good coping skills and are struggling, seek help. Getting involved in therapy can be particularly helpful. Medication management and therapy is the gold standard for psychiatric treatment. If already on medications, you may need an adjustment during this season. If you are not on medications but continue to struggle despite therapy and coping skills, seek medication management with a psychiatrist. But please do not wait until you are struggling to begin implementing coping skills. I challenge you to begin using them now as a preventative measure. It is critical to put the plans and coping mechanisms into place now. Be prepared because “winter is coming.”
Katherine Gantz Pannel is a psychiatrist.
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