The concepts of days, weeks, and months have all but lost their meaning during the times of coronavirus. This became all too clear when I found myself weeks into June before realizing that we were in the second half of 2020. The world has been in the grips of COVID-19 (the disease caused by SARS-CoV-2) for over half a year, and the end is still not in sight. Even more chilling is the fact that the virus’s effects will continue to be felt by humanity for years to come.
Dr. Juliana Tseng
By now, most of us have been affected by COVID-19, whether directly or indirectly. Consequently, we’ve seen that the psychological toll the pandemic takes is as wide ranging as the disease caused by the novel coronavirus itself. Confusion, denial, fear, anxiety, depression/sadness, and emotional dysregulation have become all too common an experience. Many mental health experts have even likened our psychological response to COVID-19 to that of trauma survivors.
In early 2020, triggered by two separate but related threats. In addition to concerns regarding COVID-19, we also began to experience fear for our physical safety as anti-Chinese sentiment began to rise across the country and the world. Discrimination and acts of violence toward Chinese people worldwide began to spread almost as rapidly as the virus itself. Anxiety and fear became a common daily experience of countless people, myself included.
In late March, amid coping with existing stressors, my situation became significantly worse when my brother, a New York City firefighter, contracted COVID-19 while working on the front lines. Shortly thereafter, my parents, both aged 60 years and older, with whom my brother shares a home, contracted the virus as well. My anxiety triggers related to the spread of the virus and xenophobia suddenly became a distant memory. I now found myself grappling with the much greater fear of losing my entire family.
At the time, the availability of testing was very limited, even for those working on the front lines. Although not without a short delay, my brother was able to access testing through Fire Department of New York connections. After about 3 weeks in self-isolation at home and with the use of over the counter pain relievers, he made a full recovery and returned to work. My parents, on the other hand, were placed at the end of a weeks-long line for testing, during which time their conditions deteriorated. Nine days following the onset of my mother’s symptoms, her condition had gotten so bad, she required hospitalization. Six days later, my father followed suit.
Being in the epicenter of the COVID-19 outbreak, New York hospitals were severely overwhelmed. Upon admission, my mother was held in the ED and other temporary open spaces in the hospital for nearly 24 hours because there was a lack of available patient rooms. During this time, she was packed into small spaces with dozens of other patients afflicted with the same disease. Four days later, she was transferred to a different hospital 10 miles away to make room for new patients. Decisions needed to be made rapidly and often with limited communication, which made for a roller coaster of emotions that would not relent.
Confusion. One of the few things we know with certainty about coronavirus is how much we don’t know. The Centers for Disease Control and Prevention data indicate that older adults with underlying health conditions have worse outcomes. Yet my mother, who is younger and in better physical health than my father, became much sicker in a drastically shorter period of time. Furthermore, my parents’ symptoms were completely inconsistent with one another’s. Based on their symptoms alone, it appeared as though they were suffering with different conditions entirely. My mother experienced body aches and gastrointestinal symptoms, whereas my father developed the typical cough and fever associated with COVID-19. In addition to confusion regarding their symptoms and, therefore, in determining the best at-home supportive care prior to their hospitalizations, the lack of available testing made the very question of whether they even had COVID-19 an uncertainty.
Denial. When my family members first became symptomatic, I found myself in a state of denial not unlike that of individuals experiencing grief. I frequently engaged in both internal and external dialogues in which I would attempt to convince myself of the reasons why my family did not have COVID-19.
“My brother wears PPE while at work.”
“My father’s cough was mild.”
“My mother does not have a cough or a fever.”
Despite knowing better, I was initially unable to accept that everyone in my family had contracted a disease that had already claimed the lives of tens of thousands globally.
Fear. In order to prevent the spread of infection, many hospitals made changes to their visitor policies, placing greater restrictions on who can come and go. This has meant hospital patients who have died from COVID-19 complications have done so separated from their loved ones. After transporting my mother to the hospital ED, I was politely but firmly asked to leave per the new visitor policy. I felt as though there were cinder blocks attached to my feet as I reluctantly walked away, not knowing if it would be the last time I would see her. I experienced a fear and sadness so intense, it continues to elicit an emotional response today as I think back on that moment.
Anxiety. The difference between fear and anxiety is fear is an emotional response to a known threat or danger, and anxiety is a response to an unknown threat or danger. The days that followed my parents’ hospitalizations were riddled with anxiety that would come in waves. How were they doing? Could they breathe? Do the overwhelmed hospital staff have time to take care of them? What can I do to help? Is there anything I can do to help? The worrisome thoughts and unanswerable questions were incessant and seemed unresponsive to my efforts to quell them.
Sadness. To feel sadness is to be human. In my work as a psychologist, I emphasize the value in experiencing this emotion when therapeutically beneficial. This technique is used as part of acceptance and commitment therapy (ACT), which emphasizes the value of being present or in touch with one’s thoughts and emotions, instead of working to eliminate them. During these scary times, I leaned into this notion more than ever. I gave myself permission to not feel okay, to cry more than I had in a long time, and to be unapologetically sad. I flip-flopped between states of near-despair and hopeful, with the switch usually following a call from a member of the hospital care team with updates on my parents’ conditions.
My parents’ road to recovery extended far beyond their discharge from the hospital and was not without incident, but with support and appropriate follow-up care, they have since made full recoveries from COVID-19. Although the relief and happiness this brings me is immeasurable, the experience has left a lasting impression on me as both a person and a psychologist. Speaking as a person, I cannot overstate the value of relying on one’s social support network while coping with stressors related to COVID-19. Whether you are directly or indirectly affected by the disease, the emotional effects can feel equally intense. As in times of happiness and celebration, times of sadness can and should be shared by those who are equipped to provide support. This can be tricky in an era during which isolation is prescribed for our safety, but we have more options today for connecting virtually with others than ever before, including video conferencing, email, and that old friend, the telephone. Furthermore, identify and assert your boundaries. Sometimes, saying no to others is the best way to say yes to yourself. Certain work, chores, and social obligations that can wait, should wait.
As a psychologist, my experience has given me a renewed appreciation for the power of the therapeutic use of self in psychotherapy. The factor with the greatest effects on psychotherapy outcomes is the quality of the therapeutic alliance, a concept introduced by Sigmund Freud in 1912. I believe a therapist’s willingness to show that we, too, experience life’s ups and downs strengthens our ability to demonstrate empathy and further promote a sense of alliance. Therapists are not immune to the effects of COVID-19, and to acknowledge this fact allows us to relate to our patients on a basic human level, which is more important now than ever.
Dr. Tseng, a licensed clinical psychologist, is in private practice in New York. She disclosed no relevant financial relationships.