I wrote about some basic skills for families last week, it can apply to anyone young and old during these strange times. After talking with a lot of clients, friends and family I have been noticing some themes coming out in conversation. It is very clear that the pandemic is not only a physical illness crisis, but a mental health one too. We are all disrupted in our routines, which help regulate our nervous systems. There is a tremendous amount of change and a constant stream of new information, which dysregulates our nervous systems. Anyone with pre-existing conditions, both physical and mental, are hit the hardest; and everyone is stressed in one way or another. There is nowhere to truly hide from the new reality facing us globally. In this post, I tackle issues of coping with the unknown, understanding the trauma of our situation, dealing with disappointment, and how to support those with pre-existing physical and mental conditions.

HOW TO COPE WITH THE UNKNOWN:

I find the overriding topic presented is coping with the unknown. People are spiraling with the, “what ifs.” Some are worried about their health, others health, financial strain, education, timelines, future plans, housing, food scarcity and the list goes on. Humans don’t do particularly well with the unknown. Our brains are designed to keep us safe; planning is part of that. We create routine and structure as a way to contain the larger existential woes: we are not guaranteed anything, including our days, we will all die one day. It sounds depressing to explicitly state this, but it is a fact. When global uncertainty hits like this, it is glaring. We are called to do several things.

1. COME INTO THE MOMENT: Come into the moment as much as possible. The truth is the moment is the only place we have anyway. I wrote several ways to do that before. I will literally wiggle my toes and say to myself, “I am at home, I am wiggling my toes, I am safe right now.” This isn’t about solving the crisis; it is about rebooting our brains so we can be clear. You will need to do this with much repetition, the more you do it, the more it works.
2. KNOW WHAT YOU CAN AND CAN’T CONTROL: Make lists of all of your fears and concerns. Look at the list and circle the ones you can control. You can take actions on those, being proactive can help. When your mind goes to the ones you can’t, remind yourself, “this is out of my control.” Go back to step one.
3. REDIRECT THOUGHTS: One thing you can control is how you think about things. Victor Frankl was a psychiatrist in Auschwitz during WWII. He went on to write, Man’s Search for Meaning, an excellent read on Existential Psychology. In it, he spoke about how in horrific conditions with no agency of his own he realized he had to control how he thought about the situation. He kept up simple routines he could control. He made sure to still incorporate play and joy through jokes and art. He would see a weed growing in a crack and relish in life and beauty. He would keep hope alive in his mind by dreaming of what he would do when the war was over. He maintained human contact and connection, kindness and his humanity in inhumane conditions. He learned a great deal about himself and what was important and not important in that process.
4. SPIRITUALITY: Whether this is religious belief, nature, art, or anything that brings you a sense of awe, being interconnected in the world, and a peaceful sense of being small in a larger picture, now is the time to cultivate your heart and soul. Even atheists can rely on humanistic and scientific frameworks at this time for a sense of some kind of order. We have to rest into something larger than ourselves, a container that can hold the unknown. If you don’t know how you do this, now might be the time to seek it. Looking at our core beliefs and values is essential during crisis to help guide us.
5. GRATITUDE: I see looking at death as an opportunity to live. If all I have is this moment, then I want to really be in it. Humans don’t hold duality well, but we can. We can even learn to do it well. As Brene Brown discusses in her research, our ability to be with sadness is directly related to our ability to feel joy. Even on our worst days we can acknowledge the sunshine, or our dogs snuggles and hold joy. On our best days we may have a backache. It’s all happening at once. Now is no different, it’s just amplified. Trying to find the good in things is critical while balancing coping with the stress. It is a practice and also brings us into the moment.

WE ARE IN A COLLECTIVE TRAUMA

I am an anxiety and trauma specialist, so I often use that lens in life. Much like 9-11, we are experiencing collective trauma. I have watched the world start with denial and minimization, where there is often irritation or frustration, “People are freaking out, it’s no big deal.” Then minimization, “It’s just a bad flu, I’ll be fine.” It turns into some concern but containment, “I think I will wash my hands a lot.” Finally, it dawns on folks that this is a thing and the worry and stress set in. “What do I do, what should I do, what are others doing?” Next is anxiety, shock and even panic, “This is actually happening; we have to do something now!” Last there is resignation, “I can do this, I’ve got all I need now. Time to settle in for the unknown.” We will all continue to ride waves of all of the above as we work with the truth that we are indeed in a pandemic and have no idea how long we will be dealing with this or how.

We often think of trauma as being a onetime big event, and it often is. It can also be smaller things like a relational trauma of a fight or ongoing like a pandemic. The heart of trauma is grief. There is life before an event, and life after an event. There can be a quality of surrealness, or out of body. There is irritation and anger for the disruption and unfairness of it. Some experience denial and a lack of ability to move or motivate. There can be anxiety and an urge to do something, anything. Because part of trauma is helplessness, this is something happening outside of your control. Being very gentle and kind with one another and ourselves is of upmost importance. All of our moods are going to swing around at this time in one way or another and for different triggers. I have been noticing online some folks wanting to come together in community and some folks tearing one another apart. I have seen a regression in many people, needing more emotional or physical help than usual. This is all normal as people act out their various coping mechanisms from the stress. With trauma I generally have a rule of 3:

1. OXYGEN MASK ON YOU FIRST: Much like the airlines tell us, we cannot be functional and help others if we can’t breathe ourselves. Your number one job right now is helping yourself so you can be there for your loved ones. This might even, and maybe especially mean, you need boundaries. You might need time to yourself, or to tell someone you love you don’t have enough bandwidth for them right now. I know I have said that exact phrase several times this week to loved ones as I take good care of myself so I can help a very large caseload cope with the unknown. Also, as I suggested in my last write up, have a mental health plan for how you and your family copes with stress. That way if you can’t be there in that moment, your loved ones know what they need to do.
2. GROUND: I cannot emphasize the importance of this enough.
3. BE GENTLE: This means naming the stress and being compassionate toward yourself and others. This doesn’t mean putting up with bad behavior, again, set boundaries. Understand we are all coping and stressed.

HOW TO DEAL WITH DISSAPOINTMENT

This leads to the next part, dealing with disappointment. None of us planned for or wanted any of this to happen. Disappointment is almost always about expectations, whether we ever stated them explicitly or not. With many of my clients, I have been talking about the unrealistic expectations our culture in the US gives us often and how it causes stress. Before the pandemic, people have been coming in struggling with not reaching financial, personal, or relational goals. We live in a time where there is an Instagram perfect life, we think we need to obtain. The pressure for perfection and a certain brand of success is always nudging our insecurities. I talk about knowing what your rubric of success is and having realistic expectations a lot.

Along with that, many people have real life goals that have been disrupted. Weddings, major events, once in a lifetime travel, sports, education, so many important and nourishing things have come to an abrupt halt. Many say they are delayed, and no one knows for how long. It is heartbreaking. Humans love goals to live for, it keeps us going. Here are some suggestions of how to cope:

1. ADJUST EXPECTATIONS: I suggest one expectation we all have right now is how to healthily cope. Yesterday, I pretty much was only able to cope. It was a day of basics, of getting through. It was a win. It was a win because my number one expectation is healthy coping. Beyond that we all can go back to that sense of control and creating a new sense of normal.
2. KEEP DREAMING: Do not allow despair to squash your dreams. Somehow humanity makes it through always. One way is dreaming. Keep the seed alive somehow, even if it has to look different. Even if it looks very very different, how can you take what you had wanted and make lemonade from lemons? Sublimation, or creating something new or meaning out of an experience is healthy.
3. LEARN MORE: Take this opportunity to learn more about your dreams. I can’t do any sailboat races; they are all canceled. But I can watch YouTube videos about them, refresh rules and sail trim tactics. I can visualize in my mind and prepare for the next races. Since we can’t be out and about doing what we want we can always shift our focus to the inner process. You were going to have a wedding? What about working on the resiliency of your relationship? Build even greater connection. Talk to your loved ones more 1:1 through facetime and bond.
4. FIND NEW GOALS FROM HOME: My sincere hope is that maybe a global pandemic means greater creativity and community. Maybe we all create a new framework to live in, one that is even better than prior to the pandemic. In trauma we call this post traumatic growth and resiliency. I’m not saying we are there yet or will be anytime soon. We are in the thick of the trauma now. In many ways, it’s just beginning as hospitals start to fill in the US. But I want to paint a picture of how we can cope as we continue to ride the waves. One way I am doing this is by writing blogs for all of you.

PREEXISTING PHYSICAL AND MENTAL ILLNESS

People with existing illnesses and trauma are both having a harder and easier time in this. It is harder because we are deeply triggered. It is easier because we have a lot of skill sets. If you have prior trauma and grief and loss, those will most likely come up. My friends and I with autoimmune disease are having to play this extra safe. I’ve been in quarantine for almost two weeks. It sucks. At the same time, I have extra skill sets and understanding of how to support my immune system from years of practice. This is also true of mental health. I haven’t struggled with my OCD symptoms for a very long time, about 15 years. They are triggered and back with a vengeance as they are deeply and classically rooted in germs and illness. Thinking of touching people sends a deep shock through my spine and skyrockets my nervous system. I have amazing skills to shift this: to stop, breathe, work with my mind through naming that this is OCD and I do not allow it to control my actions, then redirect my behavior. I am lucky to be able to do this and very practiced in it. It’s also exhausting, and I am upping my meds. I always use myself as an example because I can legally, I think it’s important to model health and destigmatize mental illness, and because I know many others struggling in similar ways at the moment.

For folks with chronic physical and mental illness I talk about spoon theory. It is a metaphor for how much energy people have. Neurotypical healthy people wake up with a certain number of spoons, activities in the day uses them, and at the end they have spoons left over. Folks with illness wake up with a shortage of spoons and have to prioritize how to use them. Everyone has fewer spoons right now because of the pandemic and stress. People who generally have more can share them with their loved ones who have less by doing acts of service. In fact, we all need to be sharing spoons at this time. My brother cooks and does a lot more cleaning for me. I have friends that listen to my struggles and give empathy and encouragement. Here are some suggestions on how to support those folks in your life:

1. ASK: Always ask how they are doing and if they need anything. Know that this impacts us more and we have higher risk both mentally and physically. Naming that with us helps.
2. ALLOW: Let us vent to you and let us even teach you. Honestly, this is the time to tell us how amazing we are in our resiliency and soak in the wisdom we have if we want to share it.
3. EMAPTHY: Most of us usually just want empathy anyway, this is a time to connect. One friend said to me, “I always knew you struggled with the fear of getting sick, I never understood why you had to wash your hands so much, now I get it.” I felt deeply understood in that moment. The difference is my brain has been in pandemic mode since 1990 all on its own.

For those of us who have chronic illness, do your thing. Ask for extra help and support. This is really hard on our nervous systems and bodies. I know for many of us, some of our main coping skills have changed. Especially for those of you who need groups and socialization for your wellness. I know many of us tend to isolate, this is the time to fight that urge and reach out or ask people to reach out to you. We have the internet, use it wisely to connect in healthy ways. You are not alone. Others of us love the space alone and find some stressors of being around people are less. Notice that relief, maybe there is some insight to be gained for after the pandemic. There will be an after folks. We don’t know how or when, but there will be. We are all in the same boat and will be surfing all of these emotions for some time to come. I hope everyone stays well out there. More posts to come I am sure as this unfolds, I hope this has been of benefit.