COVID-19 Q&A: Dr. Debra Kaysen on Individual and Collective Stress & Grief

The COVID-19 global pandemic is not the first event –good or bad -- to be shared by the entire world, but in this age of technology and social connection when information travels the earth at lightning speed, we are all living the full impact of this collective experience, in real time. The countless individual tragedies of the virus come together in a cumulative and mutual loss to which few of us are immune. In this Q&A, Dr. Debra Kaysen, Professor of Psychiatry and Behavioral Sciences with the Public Mental Health & Population Sciences Division, helps us better understand our communal grief and how to deal with the societal stress of COVID-19. Dr. Kaysen specializes in the treatment of trauma and PTSD and is the President of the International Society for Traumatic Stress Studies (ISTSS).

Dr. Debra Kaysen

The COVID-19 global pandemic is an event unparalleled in scope for most of us, save for those who lived through the Great Depression and World War Two. In terms of public mental health, is it accurate to think of this as a collective traumatic event causing some of the same injury as a personal trauma?

Dr. Kaysen: That is a wonderful question and one that comes up for many people right now. I would instead say that people are experiencing a collective stressor rather than a traumatic event, but that some people are also experiencing traumatic events caused by the COVID-19 pandemic. Stress is an uncomfortable emotional experience that causes tension. Traumatic stress is more specific. It involves exposure to actual or threatened death, serious injury, or sexual violence or repeated or extreme exposure to the awful details of traumatic events as a result of one’s occupation. For many of us the events associated with COVID-19 are things like economic stressors, isolation, over work, boredom, being quarantined, struggling with multiple roles, feeling losses around our “old lives”– these events would be stressors. COVID-19 is also associated with traumatic stress for example in cases where there is the sudden death of a loved one, for individuals who are in the ICU or intubated, paramedics or mortuary workers who are dealing with overwhelming numbers of deaths, individuals, and frontline healthcare workers in extremely difficult environments where they may also worry about infecting their families. For those individuals those specific events are potentially traumatic events.

Not all of us have suffered the virus, the loss of a loved one…or the loss of our livelihood, so can the lucky ones also feel the mental impact of COVID-19 without having suffered a personal loss?

Dr. Kaysen: Individuals certainly can feel mental health effects associated with COVID-19 related stressors even if they are not affected as directly.

How do we know if we’ve been traumatized, in the clinical sense, by current world events? What are the symptoms, beyond the general worry and angst many of us seem to be feeling?

Dr. Kaysen: I wouldn’t use the term traumatized, in the clinical sense, as these are, for most people, not traumatic events. People may feel a range of psychological effects associated with this type of stress. You might see symptoms like feelings of sadness, loss, worry, anxiety, sleep disturbance, or irritability. People may be grieving the loss of their routine or their normal experiences and their pre-COVID life. All of these are symptoms that have been reported by individuals exposed to COVID-related stressors.

With traumatic stress you might see the symptoms listed above but you might also see Intrusive memories, thoughts, images, dreams, about the event or emotional or physical reactions to reminders of the event. You might see avoidance of trauma related cues or reminders. Individuals may experience arousal or being on the lookout for danger, or being easily startled or jumpy. This also could include monitoring themselves or others for physical signs of infection. Individuals also may find themselves second guessing decisions they made during the event or ways they think the event could have been prevented.

I would say that if you are spending lots of time worrying about current events, it may be helpful to schedule that time. It sounds funny but worry tends to take over our time and energy and something as simple as scheduling 20-30 minutes a day as “worry time” can help corral it. When worries come up you can remind yourself that it’s not their time. The other thing you can do that is helpful is to limit media consumption to no more than an hour a day. Although it is tempting to try to track all of the information, it is also overwhelming and is likely to drive up distress, rather than help it. And for being informed, it is likely that there is little value added in being constantly plugged in.

It is also important to remember though that most people are resilient. That means that for many people, although they are distressed now, this does not mean that these reactions are likely to be chronic. That is true for those who are experiencing stressors and for those who have experienced traumatic events related to COVID-19. It’s also important to remember that resilience isn’t a trait – it isn’t something we either have or don’t have. Resilience is something we can acquire, especially if we are able to use more helpful coping strategies when we are faced with stressors or traumas.

If you do find, though, that symptoms are increasing, are keeping you from functioning at work or at home, or that the symptoms aren’t improving, it may be time to think about finding a mental health professional. Many of these symptoms improve quite quickly with the right kinds of supports and tools.

How do we deal with grief as a community? It could be grieving the loss of people, normalcy, activities, rites of passage and experiences…of what was…and prepare for an unfamiliar “new normal?”

Dr. Kaysen: I do think that one of the big challenges with COVID-19 has been collective grief. For those who have lost friends, coworkers, and loved ones, COVID has interrupted our grieving rituals and processes. When someone is ill, we want to be with them. When someone dies, we often grieve by gathering together as a community, by comforting each other with touch and with our physical presence. All of these things are problematic during this pandemic, which can make grief harder to bear and can also make it more difficult to feel a sense of finality about the loss. In processing the grief, it may be helpful to identify new achievable rituals. This could be a virtual memorial service or having an online space for people to leave notes or messages. It could be planting a tree in their memory. It is also important to more actively reach out for social supports and comforts since people may not be able to physically gather together.

For those of us who are grieving the old lives we had, who are grieving the milestones that have been interrupted, or the anticipated events that aren’t happening or aren’t happening the way we expected, these are also losses. For these experiences it can be helpful to give yourself permission to have feelings about these losses. Anticipating what may trigger feelings of sadness and loss can be useful. And it is helpful to develop adaptive coping strategies around these experiences. It could be practicing gratitude, reaching out for social supports, going for a walk, journaling, or other positive coping activities.

Uncertainty about the future must be a core element in the ongoing trauma of the pandemic, so how do we reawaken, or cultivate anew our innate trust in life and positive results?

Dr. Kaysen: I think it may be less around having an innate trust in life and positive results. I’m not sure that is always helpful either. It may be instead practicing acceptance of uncertainty. There are many people who hate not knowing what will happen, who feel like if they know what is coming they’ll be more prepared, or who want to be ready for the worst. It gives us an illusion of control over the future. But the reality is that the worrying or attempts to control the future don’t typically make things more predictable or change the outcomes. Instead it may be more helpful to remind yourself that we may have some things related to COVID-19 that we can predict and can do to reduce potential harm to ourselves and the people around us. There are other things that are out of our control, and we have to accept those things and let go of what we cannot predict.

As we prepare to re-enter social life while the pandemic continues, we face balancing risk and fear, safety and living life. How do we approach these seemingly conflicting or competing goals?

Dr. Kaysen: That is a challenge for most of us right now, especially since there are still many unknowns! I think in general it is a matter of thinking through what is a manageable risk, not just for you, but for people around you. Are there things that you can do to mitigate that risk? How essential is the goal for your life or well-being? If an activity is potentially high risk and there is not a large gain, it may not be worth the risk - not just for you but for those around you. On the other hand, if an activity has large potential gains, and is relatively low risk or the risk can be reduced by using good public health precautions, then it may well be worth it.

How should we gauge the collective mental health of our community, and society at large in this unique time…and how does our own personal emotional health weigh in on public mental and civic health? How do we become a positive force for ourselves and our world?

Dr. Kaysen: COVID-19 has given us an opportunity to look at our social values as a society. Globally, the communities that have been most deeply affected have been those who are most disadvantaged. It has exposed the gaps in the safety net in healthcare and in employment security. In places where people have to work to be able to survive, people have little choice about social distancing or about whether to go to work when they are ill. People who have limited access to healthcare often have comorbid illnesses that place them at greater risk for illness or death when exposed to COVID-19. In places where healthcare systems were already maxed out, COVID-19 is overwhelming those systems. Places with more robust social safety nets do appear to be doing better, and those societies are generally more resilient when faced with this stressor. As a global community we have choices about how we care for one another and whether we are willing to make sacrifices to protect the vulnerable. It remains to be seen how various communities and governments will respond to this challenge.

For each of us as individuals, this is also an opportunity to take stock and think about what is important to us. Are there ways we each can contribute, to the extent that we are capable, to buffer those with fewer options and resources. By doing so, that may in and of itself be helpful for our own mental health.

On the mental health end, this pandemic may force us, as well, to deal with the mental health gap. Pre-COVID-19, mental health was one of the main drivers of the global burden of disease. And there is a huge gap between those who need mental health services and availability of those services. COVID-19 is likely to add to that burden of disease through increased rates of anxiety, depression, PTSD, and substance use. However, being forced to scale up and to explore novel ways of getting treatment to people such as telehealth services or digital mental health approaches may help close that divide.

Are there any resources you’d like to share?

Dr. Kaysen: Definitely! If you are feeling overwhelmed or want to explore potential coping strategies there are some helpful free apps.

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