Covid Malaise and More COVID-19 Coping Tips from the Trenches
I am writing this piece 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. I am cautiously optimistic about the effectiveness of the vaccines, but realistically, I know we are in for more quarantines, social distancing, and mask wearing for at least another 9–12 months (sorry!).
I have continued my clinical work in psychiatry and, unfortunately, it has continued to get busier and more complex as COVID-19 ravages its way through absolutely everything. Patients are demoralized and describe a fairly consistent pattern of physical/mental responses that I feel may need more normalizing now.
I will refer to this distinct constellation of symptoms as “COVID malaise”. Disclaimer: these findings are based in 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 as best I could and wrote down recurring themes.
COVID malaise seems to present on top of existing psychiatric symptoms or may arise de novo in patients with zero psychiatric history. It does not respect age, gender, ethnicity, socioeconomic status, or education level. Once I started noticing it in patients, I also saw similar symptoms in friends, family, and colleagues (as well as myself). It does not manifest quite like a clinical depression, as people are still functioning, but it does cause social, occupational, and daily tasks to be much more of a burden. I hesitate to call it a burnout, as the symptoms are more of a global weariness that patients have difficulty articulating.
Many of these souls were not tying their symptoms to fragmented social structures: they were whipping themselves harder and feeling guilty trying to be happy and “normal!” This would be like attempting to close a gaping wound with a single stitch! There must be something out there to soothe things a bit.
So, I will first summarize the symptoms the patients discussed, then attempt to place them in an existing framework of psychological research, and finally, offer a couple of additional coping suggestions that have helped patients…maybe they will help you as well.
Symptoms of COVID Malaise:
Physical: fatigue, lightheadedness, subthreshold symptoms of panic attacks, such as poor concentration, heart palpitations, and chest tension (these seem to be most frequent). Increased appetite for carbohydrates and sweets. Insomnia. Strange, vivid dreams, often recurring. The dreams often have a theme of being chased, not being able to contact/find a loved one, or having a type of impairment where the person is frozen or moves slowly and/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 symptoms of panic attacks not meeting criteria for Panic Disorder, such as derealization and feeling foggy/spacy. Trying to cope by drinking more alcohol or using more marijuana (most commonly used substances with COVID malaise).
Social: wanting to socialize but yet feeling burdened by it and wanting to withdraw, feeling flat. Feeling demoralized and dismayed at humanity as a whole.
Spiritual: seriously questioning life’s meaning and purpose, even contemplating suicide or, “Is it worth it, why bother?” Revisiting religion and its meaning-or lack thereof- in the patient’s life. The vast majority of people 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 as a finite resource. It is subject to attenuation by too many choices, emotional stress/labor, demands for prolonged attention, low blood glucose, and overwhelming tasks demanding completion. Ego depletion will manifest 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. Isn’t 2020 a huge in vivo experiment in ego depletion? 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 the ego depletion that is 2020!
Bessel van der Kolk is a Boston based psychiatrist who has spent over 30 years studying trauma. He is the New York Times bestselling author of “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.” He has described multiple psychological and emotional responses to trauma throughout the developmental stages of individuals. 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 all 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 trying their best to quarantine at home adjust to this bizarre reality?
Some individuals are surviving “adaptively” to 2020. I don’t want to talk about “good and bad” trauma responses, as that would just 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 published on KevinMD: https://www.kevinmd.com/blog/2020/08/10-covid-coping-tips-from-the-trenches.html but have added more below as there has been no sign of COVID-19 receding now.
1. Reach out and help others. There is ample research suggesting that charity significantly benefits the giver. Look into https://www.volunteermatch.org/ and find an opportunity that works for you. I have been fostering animals through COVID 19- something which has kept me grounded and even brought some joy in this brutal year!
2. Consider the “Face, Accept, Float, and “Let Time Pass” technique by Dr. Claire Weekes. This is a mindfulness practice discussed in plain language. I would recommend reading the book for extensive detail, and experiencing for yourself Dr. Weekes’ soothing, affirming writing style. “Hope and Help for Your Nerves” is widely available on online booksellers. Caveat: skip the medication discussions, as they are out of date now!
3. Use a meditation app such as Insight Timer, Calm, and Headspace regularly. Do not worry about being a “beginner.” I have also told my patients that there is no “perfect” meditation: if you can only meditate for one minute, just do that!
4. Gentle movement, such as dance, walking, tai chi, and breathing exercises are other modalities which 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 PTSD study at https://www.besselvanderkolk.com/blog/steve-porges-covid-19-ptsd-study. The survey takes about 30 minutes and is unpaid. Gathering societal responses to global trauma is invaluable!
I have also included the resources I discussed (below). As Jiddu Krishnamurti aptly 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, and you definitely can take care of your corner of the world.
Resources:
van der Kolk, B. (2015). The body keeps the score: Brain, mind and body in the healing of trauma. New York: Penguin Books.
Baumeister, R. F.; Bratslavsky, E.; Muraven, M.; Tice, D. M. (1998). “Ego depletion: Is the active self a limited resource?” (PDF). Journal of Personality and Social Psychology. 74 (5): 1252–1265. CiteSeerX 10.1.1.353.2704. doi:10.1037/0022–3514.74.5.1252. PMID 9599441.
Weekes, C. (1969, 1990): “Hope and help for your nerves.” New York: Signet Publishing.
Alissa Kraisosky is a psychiatrist.
