COVID malaise, and more COVID-19 coping tips from the trenches

I write this now as both a time capsule and a vision of hope at the bitter end of 2020. At this point, a COVID-19 vaccine (the vision of hope) has been developed by several companies but has not yet received widespread distribution. Realistically, I know we are in for more quarantines, social distancing, and mask-wearing for at least another 9 to 12 months (sorry!).

My clinical work in psychiatry has gotten busier and more complex as COVID-19 ravages through everything. Patients are demoralized, describing a fairly consistent pattern of physical/emotional responses, which I will refer to as “COVID malaise.”  Disclaimer: these findings are based on an informal “grounded theory” of listening to hundreds of patient stories over the past year. I did not provide the patients questionnaires: I listened to their narratives and wrote down recurring themes.

COVID malaise may present on top of existing psychiatric symptoms or arise de novo in patients with zero psychiatric histories. It does not respect age, gender, ethnicity, socioeconomic status, or education. Once I started noticing it in patients, I saw similar symptoms in everyone! It does not manifest quite like clinical depression, as people are still functioning, but it does cause daily life to be much more of a burden. I hesitate to name it burnout, as these symptoms are more of a global weariness.

Patients were not tying their symptoms to fragmented social structures: they were whipping themselves harder and feeling guilty trying to be happy!

So, I will first summarize the symptoms the patients discussed and then attempt to place them in an existing psychological research framework. Finally, I will offer a couple of additional coping suggestions that have helped patients; maybe they will help you too.

Symptoms of COVID malaise

Physical: fatigue, lightheadedness, subthreshold symptoms of panic attacks, such as poor concentration, heart palpitations, and chest tension. Increased appetite for carbohydrates and sweets. Insomnia. Vivid dreams, often recurring, of being chased, not being able to contact/find a loved one, or feeling frozen/moving slowly or painfully.

Emotional: mildly-moderately anxious, and sensitized- life’s molehills turn into mountains. Rapid shifts in emotion, from crying/snappiness/irritability to hopefulness. Other panic attack symptoms not meeting the criteria for panic disorder, such as heart palpitations, feeling foggy, or spacy. Trying to cope by using alcohol/marijuana (most commonly used substances I noted).

Social: wanting to socialize but feeling burdened and wanting to withdraw. Feeling demoralized, flat, dismayed at humanity.

Spiritual: reevaluating life’s meaning and purpose, even contemplating suicide. Revisiting religion and its meaning-or lack thereof- in the patient’s life. The vast majority have no suicide plans, thankfully!

Prior research

Two specialists, in particular, have researched the effects of stress and trauma, and symptoms analogous to those observed with COVID malaise appear in some of their literature.

Roy Baumeister is an Australian psychologist who discussed the theory of “ego depletion,” which considers self-control a finite resource. It is subject to attenuation by too many choices, emotional stress/labor, demands for prolonged attention, hypoglycemia, and overwhelming tasks. Ego depletion manifests as an inability to make healthier decisions, such as swiping the cookie instead of the salad. Think of watching a mindless TV show after work instead of going for a walk. I think of some of the terms used in popular culture, such as “Zoom fatigue,” “not enough bandwidth,” and “How many spoons did you wake up with today?” and think of Baumeister’s research. We are all getting a crash course in ego depletion now!

Bessel van der Kolk is a Boston-based psychiatrist who has described multiple psychological and emotional responses to trauma throughout individuals’ developmental stages. Post-traumatic stress develops, he states, when individuals adapt to the traumatic life situation but cannot translate these adaptations to everyday life. Symptoms such as hypervigilance, “freeze” reactions, numbing, and irritability are ways the body manifests trauma responses. Van der Kolk discussed healing modalities of “breaking up” the trauma response and gently redirecting the mind and body into other channels, which I will discuss below.

Coping: How does the person quarantining at home adjust to this bizarre reality?

Some individuals are surviving “adaptively.” I don’t want to talk about “good and bad” trauma responses, which would create one more barrier where people feel they do not measure up. I prefer the term “adaptively,” as it is more neutral and leaves room for additional self-discovery. I discussed some strategies in an earlier article but have added more below as there has been no sign of COVID-19 receding.

1. Reach out and help others. Ample research suggests that charity significantly benefits the giver. Look into Volunteer Match and find an opportunity that works for you. I have been fostering animals through COVID 19 and love it.

2. Consider the “Face, Accept, Float, and “Let Time Pass” technique by Dr. Claire Weekes, a mindfulness practice discussed in plain language. I would recommend reading the book for more extensive detail and experiencing Dr. Weekes’ soothing, affirming writing style. Hope and Help for Your Nerves is widely available at online booksellers. (Caveat: Skip the medication discussions. They are out of date now.)

3. Use a meditation app such as Insight Timer, Calm, and Headspace regularly. Don’t worry about being a “beginner.” I have also told my patients that there is no “perfect” meditation: Meditate for one minute.

4. Gentle movement, such as dance, walking, tai chi, and breathing exercises are other modalities that may help redirect a traumatized mind.

5. Channel some of your traumatic energy into helping humanity and take Dr. Stephen W. Porges’, Dr. Sue Carter’s, and Dr. Jacek Kolacz’s COVID-19 trauma study. The survey takes about 30 minutes and is unpaid. Gathering societal responses to global trauma is invaluable!

Jiddu Krishnamurti states: “It is no measure of health to be well adjusted to a profoundly sick society.” Please be kind to yourself and others as we struggle through this collective mess. You definitely can take care of your corner of the world.

Alissa Kraisosky is a psychiatrist.

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