Is Our Collective Mental Health in the Toilet?

mental health

I’m a child of the 1970’s. I slimly missed being of age to attend Woodstock. Although I suspect there were teens of fifteen in attendance with or without adult supervision. I was not one of them. I would never have been allowed to go nor would have I known how to get there minus a thumb in the road. Although I did not live that far down the road. So I’m in this in-between Age of Aquarius and the Disco era when I can boast a “coming of age” – of age to do whatever I want without asking for permission. That also means in many ways I have only myself to blame for my own grief. Or does it. And what exactly is grief? What defines grief? I clearly remember the collective grief the day JFK was shot. I was barely ten years old. I also remember the sheer trauma of the Cuban Missile Crisis a short year before: living in New York put us in the trajectory of the bomb. 

I wonder now if I truly ever grieved anything. Although I always tend to be in a state of anguish. I ask myself  if I really grieved my father’s death when I was twenty-six. Or perhaps I did not allow myself to process what the loss really meant to me and that might be what grief means. The processing of loss, whatever the loss may be. If that is what defines grief, the processing of a loss, then I have grieved or may still be processing the accumulated heartbreaks, disappointments, and losses still unresolved. And remain in perpetual grief.

Can we as a society collectively grieve? Has society been grieving for fifty years? One hundred years? Two hundred? Maybe our society – the United States – has been grieving since the first Native American was slaughtered in the name of the New World? And now we Americans, or faux Americans unless you are a Native American, are living the karma of that grief. Then pile on the grief of the first black slave. And the insidious on-going anti-semticism that smolders inside the fibers of development. Grief upon grief is just another name for trauma.  

Can we survive the grief that the government imposes on women to overlook the right to decide the future of their body. How do we as a society measure future grief of a child not yet born nor wanted when the decision to release that spirit back into the universe was taken: stolen. A lawsuit and the wrong people are being accused of breaking the law. Those that stole the right should be the ones being cuffed, not praised behind photo ops and mahogany desks. 

Can we as a society survive the collective grief of continuous wars either won or lost. Though no war is ever won, the lives that never return are grieved by loved ones and then forgotten by the masses whose relief is ashamedly palpable because the grief is not their own. When in fact it is – we are not “man” enough and too weak to change the machine that was set in motion with that first death of that first Native American. 

We are merely spokes in a wheel that keeps turning and gathering dust, dirt, grease and grime. The accumulation of years of ooze that accumulates in the hub of our civilization: until it seeps out and we begin to collapse in a misery of our own making. We are guilty of systemic indifference to the suffering of so many and the increasing gaps between our neighbors. What is this doing to our collective and individual mental health? 

And now we have the pandemic. It’s not the first time in history the planet has been inflicted with disease. Nor will it be the last unless we as a species do not make it till the next time which is a chilling thought one would only hope to find in a science-fiction classic from a master like H.G. Wells. The trauma of Covid-19 is tearing us apart. We can’t even decide to “hashtag wear a mask” in good will let alone get vaccinated. 

What effects will the pandemic have on our already crumbling mental health? What will we have to grieve? 

How do people live together in peace when the world is not safe outside?

“Sheltering in place forces roommates together and raises the stakes on everyday squabbles: cleanliness is potentially a matter of life or death. You’re only as safe as your least-careful roommate.” 

In January of 2021 a panel of experts from Harvard had this to say:https://news.harvard.edu/gazette/story/2021/01/pandemic-pushing-people-to-the-breaking-point-say-experts/

“Long after vaccines have tamed COVID-19’s physical impacts, its mental health effects will linger, a panel of experts said Wednesday, citing increased anxiety and depression, accelerated retirements of burnt-out doctors and nurses, and continuing emotional fallout for low-wage workers who toiled despite increased risks at grocery stores, food processing plants, and other essential businesses.”

“Experts from the Harvard T.H. Chan School of Public Health, the National Alliance on Mental Illness (NAMI), and the Dr. Lorna Breen Heroes’ Foundation gathered for an hourlong online discussion of what may be one of the pandemic’s most painful if lesser-recognized effects.”

“COVID-19’s most severe physical impacts have been felt by the elderly, the experts said, but some of its worst mental health effects have emerged in children — isolated from friends and missing educational opportunities when they should be striking out and finding out about themselves — and young adults, many of whom are struggling with reduced wages and lost jobs layered on child-care and elder-care responsibilities.”

“COVID is impacting the older age group more, but anxiety and depression are being faced by the young adults much more, which is exactly the opposite of what we’ve seen in some of the earlier crises,” according to Shekhar Saxena, professor of the practice of global mental health and former director of the World Health Organization’s Department of Mental Health and Substance Abuse. “It’s the young adults and the children who are being impacted and the effects are going to be long-lasting.”

“Ken Duckworth, NAMI’s chief medical officer, said that data showed that about one in five Americans suffered from some sort of mental illness before the pandemic, and that number is now two in five. Virtually every country has reported disruption in mental health services, though in some cases, as in the U.S., telehealth services have expanded to fill some of the void.”

“It’s very clear through a very comprehensive CDC study, that that number is over two in five [Americans], for anxiety, depression, trauma. We’re seeing more kids visit emergency rooms and more kids receiving services,” Duckworth said, adding that, according to calls to the NAMI helpline, there’s also a substantial increase in people seeking help navigating the mental health care system for themselves or a loved one. “Across the board, we’re seeing that the pandemic has had a very substantial mental health impact.”

“The past year has been terribly damaging to our collective mental health,” Williams said. “There is no vaccine for mental illness. It will be months, if not years before we are fully able to grasp the scope of the mental health issues born out of this pandemic. Long after we’ve gained control of the virus, the mental health repercussions will likely continue to reverberate.”

That was nine months ago before the Delta variant. How do we reconcile the continued pandemic when we hoped to be over and done with it? 

“As COVID-19 rates are rising again and the Delta variant is spreading at dramatic rates in largely unvaccinated American states, partially vaccinated countries, and globally where access to vaccines has been poor, the fantasy of arriving at our “final destination” — the post-COVID-19 world — appears to be quickly slipping away.”

“It is not, however, just the wily variants or rising case counts that leave so many of us with a sense of vigilance and unease. It is also the lack of closure on the pain and difficulties of the past 17-plus months, which has in turn delayed collective healing and perpetuated our trauma.”

“Part of healing from trauma comes from stopping to mark what has been lost.”

“How do we heal our loss and trauma while the pandemic continues on? While there are no easy answers, clinicians, teachers, and policy makers have tools available to them. Trauma-informed care is an approach to people undergoing any kind of difficult event — past or present — that shifts the focus from “What is wrong with you?” to “What happened to you?” When we seek to understand the complete picture of someone’s life, we can begin the healing process. In health care, trauma-informed care has the potential to improve patient engagement, treatment adherence, and improve health outcomes. It also works to rebuild a foundation of trust, an invaluable gift in this time of increased distrust and acrimony in all directions.”

“Trauma-informed practices are also critical in the classroom setting. Anxiety and depression levels among children and teens are higher than ever in the wake of these many months of the pandemic. These unremitting mental health concerns will probably be coupled with an uptick in classroom behavioral disruption — a normal outcome of the “fight or flight” or stress response — especially for those children with fewer supports at home or in their community. Trauma-informed classrooms create spaces where children can cool or calm down, are dimly lit, use warm colors, and flexible seating. Teachers in these settings recognize that when a child acts out, it isn’t necessarily connected to anything that is happening in the classroom but rather attributable to a serious event that has happened in that child’s life. Indeed, a key role of schools is to create a sense of safety so that children can learn.”

The sad state of affairs is that we as a society were not mentally healthy before the pandemic. The pandemic just shined a spotlight on how unhealthy we were. Some highlights from the following website tell the unhappy story: https://mhanational.org/issues/state-mental-health-america

“Even before COVID-19, the prevalence of mental illness among adults was increasing. In 2017-2018, 19% of adults experienced a mental illness, an increase of 1.5 million people over last year’s dataset.””

“Suicidal ideation among adults is increasing. The percentage of adults in the U.S. who are experiencing serious thoughts of suicide increased 0.15% from 2016-2017 to 2017-2018 – an additional 460,000 people from last year’s dataset.”

“There is still unmet need for mental health treatment among youth and adults. 60% of youth with major depression did not receive any mental health treatment in 2017-2018. Even in states with the greatest access, over 38% are not receiving the mental health services they need. Among youth with severe depression, only 27.3% received consistent treatment. 23.6% of adults with a mental illness reported an unmet need for treatment in 2017-2018. This number has not declined since 2011.”

“The number of people screening with moderate to severe symptoms of depression and anxiety has continued to increase throughout 2020 and remains higher than rates prior to COVID-19. In September 2020, the rate of moderate to severe anxiety peaked, with over 8 in 10 people who took an anxiety screen scoring with moderate to severe symptoms. Over 8 in 10 people who took a depression screen have scored with symptoms of moderate to severe depression consistently since the beginning of the pandemic in March 2020.”

“More people are reporting frequent thoughts of suicide and self-harm than have ever been recorded in the MHA Screening program since its launch in 2014. Since the COVID-19 pandemic began to spread rapidly in March 2020, over 178,000 people have reported frequent suicidal ideation. 37 percent of people reported having thoughts of suicide more than half or nearly every day in September 2020.”

“Young people are struggling most with their mental health. The proportion of youth ages 11-17 who accessed screening was 9 percent higher than the average in 2019. Not only are the number of youth searching for help with their mental health increasing, but throughout the COVID-19 pandemic youth ages 11-17 have been more likely than any other age group to score for moderate to severe symptoms of anxiety and depression.”

Young people are among the most impacted by the coronavirus. Here are highlights from the Organisation for Economic Co-operation and Development: https://www.oecd.org/coronavirus/policy-responses/supporting-young-people-s-mental-health-through-the-covid-19-crisis-84e143e5/

“The mental health of young people has been significantly impacted by the COVID‑19 crisis. Prevalence of symptoms of anxiety and depression has risen dramatically among young people and remains higher than pre‑crisis levels even with the partial re‑opening of the economy, and compared to other age groups, even as economies partially re-open. The worsening of mental health can be attributed to disruptions to access to mental health services, the wide‑ranging impacts of school closures, and a labour market crisis that is disproportionately affecting young people.” 

“Young people’s (15‑24 year‑olds) mental health has worsened significantly in 2020‑21. In most countries, mental health issues among this age group have doubled or more. With adequate support and timely intervention, young people may be able to bounce back as we recover from the COVID‑19 crisis, but there is a risk that the consequences of the COVID‑19 crisis continue to cast a shadow over the lives of young people and their mental health;”

“The uncertainties and broad impacts of COVID‑19 have not affected all people to the same degree: young people were 30% to 80% more likely to report symptoms of depression or anxiety than adults in Belgium, France and the United States in March 2021. Higher levels of loneliness are also being reported by young people;”

“Mental health support for young people – notably in schools, universities and workplaces – has been heavily disrupted. Young people are turning to platforms such as mental health hotlines and youth centres for support, often enabled by online tools, while mental health services are offering teleconsultations and remote forms of care to maintain continuity of services;”

“Closures of educational institutions at all levels have contributed to weakening of protective factors, including daily routine and social interactions that help maintain good mental health. Young people from disadvantaged backgrounds are particularly affected by school closures;”

“The impact of COVID‑19 on labour markets is disproportionately affecting young people, reducing opportunities for part-time work and work-based learning for students, and leaving soon-to-be graduates and recent graduates facing an uphill task to find and keep a job, putting them at elevated risk of experiencing mental health issues throughout the life course.”

It’s the same in my home state of California as children now return to school. The state of mental health was bad before the pandemic, it’s only worse now. 

“California’s children were already in the midst of a mental health emergency before the pandemic began. Escalating rates of suicide and self-harm, now combined with stress, anxiety, and trauma from the pandemic, have resulted in what experts call a looming tsunami of unmet need among youth. And that tsunami is about to come crashing down.”

“The Little Hoover Commission, the state’s independent government watchdog, recently concluded its investigation into the impact of COVID-19 on children’s mental health. As members of the study subcommittee, we are calling on California to ramp up efforts to provide crucial mental health supports to its most precious resource – its youth.”

“It is no wonder kids are struggling: COVID’s impacts on young people have been devastating. They have been isolated from friends and mentors, not to mention deprived of events and activities – graduations, sports competitions, school clubs – that give their lives meaning and shape their identities.”

“Some youth also grapple daily with anxiety over the safety of family members who are essential workers or with stress stemming from their parents’ loss of income. Tragically, many struggle with grief over the loss of loved ones to COVID-19.”

“While a return to school will probably help many kids, others need more time and support to fully bounce back. Yet California’s mental health care system – a disjointed patchwork of various agencies and programs – is ill-prepared to provide the care they need at the scale required.”

“Before the pandemic, the state struggled to fully serve children with mental and emotional health needs. In 2018, California ranked 48th in the nation for providing needed mental health services to young people. Youth from minority and low-income communities, which are now bearing the brunt of the pandemic, accessed this crucial care at lower rates than their peers.”

Do we have a way out of this collective trauma brought on by covid-19 but really added on to because we were already a leaking ship? What about those who have lost loved ones to the virus? How is that grief measured against any other? How do we as a society and those individuals heal when we are still going through it? Is there a way out or through when we live in a country that does not value healthcare as right? Mental health is health and grief and trauma fall into the bucket of individual and collective mental health.

“The deaths of more than 586,000 people in the U.S. from COVID since the spring of 2020 have left many millions grieving. A sizable number of these bereaved individuals will find their anguish lasts an unusually long time, does not diminish and renders their life almost unbearable, mental health specialists say.”

“People who suffer this intense bereavement are frequently unable to keep their job, leave their home or care for other loved ones. Even those who are able to navigate some of everyday life describe their agonized existence as just waiting to die. Their continued high level of stress can damage the body, increasing inflammation and risks for associated illnesses such as heart disease.”

“This condition, a psychiatric state called prolonged grief disorder, typically lasts for many months after a loss—one year in the U.S. or six months per international criteria. The condition is much worse than normal grieving, says Katherine Shear, a psychiatrist at the Columbia University School of Social Work and founder of the Center for Complicated Grief. And the isolation surrounding so many pandemic deaths likely makes people more vulnerable to it. “There are so many aspects of the pandemic that are going to be risk factors for people having a hard time adapting to these losses,” Shear says.”

“The number of people with prolonged grief in the near future and beyond could be substantial. A July 2020 study published in the Proceedings of the National Academy of Sciences USA estimated that each U.S. COVID death leaves, on average, approximately nine close relatives bereaved. If 5 to 10 percent of the bereaved group develops this disorder—which is the standard rate under normal circumstances—this could put the prevalence of prolonged grief at an additional quarter of a million to half a million cases in the coming year.” 

“Because COVID deaths have disproportionately occurred among low-income communities and people of color, prolonged grief will likely have an outsized effect on those populations, Shear and other therapists say. What is especially worrisome is that these communities, and the U.S. in general, do not have sufficient mental health resources—therapists and facilities—to address a problem of this magnitude.” 

“The health implications of the disorder can be serious. It can exacerbate suicidality and substance misuse. It is also linked to systemic damage to the body. O’Connor found that people experiencing grief have higher levels of inflammation, particularly the cytokine interleukin-6, which has been linked to increased risk of cardiovascular disease and greater susceptibility to infections. O’Connor notes that long-term psychological and social distress leads to a harmful “weathering” in the body, a well-established state of prolonged biological stress that predisposes people to greater disease risk and earlier health decline.”

“Researchers say there are many aspects of the pandemic that are likely to increase the risk of the disorder. One cause may be the circumstances surrounding most COVID deaths.”

Then there is the upended grief of feeling like we lost a year and a half or more of our lives (because of the Delta-variant) even if we were spared the tragedy of losing a loved to covid. Although I do not know many who were spared that loss or many who escaped a positive test. There is grief to process all round. A grief stricken society for those with anything that resembles a heart. 

“The first few months of the pandemic, I spent a lot of time on television. With so much grief rippling through the world, media outlets wanted to talk about it — they needed to talk about it. Grief was suddenly on everyone’s minds. It wasn’t some unfortunate thing that happened to other people. It was happening to us. Here. Now. Every single day.”

“COVID unified us, in a way. With everyone hurting, it became easier to talk about grief. And we had to talk about it — we couldn’t escape it.” 

“But now, with vaccination rates rising in the U.S., and the warm summer months beckoning, the rush back to “normal” is upon us. We all need a break from the pain and uncertainty of recent months… and yet, the quest for normalcy could override our need to process what’s happened to us.”

“The kind of cognitive distancing we’re seeing now is a normal human trait. As humans, we manage emotional intensity by forcing some space from it. We tend to approach things as an oppositional equation: you can either focus on your losses, or you can celebrate the future. You can stay in the dark, hard moments of the pandemic, or you can celebrate your survival. Which one will it be?”

“We’ve been at these cultural crossroads before.”

It is the “cultural crossroads” that rendered us in the collective toilet. The inability to talk about grief and death and sorrow in polite society. That inadvertent and reflexive laugh when we have nothing to say, look away, and can’t find the words of empathy or compassion to utter when we hear bad news, so rather that awkward chuckle seeps out at the worst possible moment. 

“Jordan Raine, a PhD Researcher into “Human Non-verbal Vocalisations” at the University of Sussex, agrees that it could be the brain’s way of diffusing tension, or a defensive coping mechanism when you’re faced with something traumatic or distressing.”

We live in a “keep a stiff upper lip” world. Here are excerpts from an article that speaks to the dilemma we now find ourselves in the mid or post pandemic world: https://www.wbur.org/cognoscenti/2021/06/24/confronting-covid-19-pandemic-related-grief-megan-devine

“This “stiff upper lip” approach served to erase the reality at hand, forcing people to deny their own losses and the losses around them. This paved the way for more suffering, as veterans of WWII (and all successive armed conflict) became invisible, their obvious wounds acting as reminders of the pain of suffering we’re meant to repress.”

“These cultural and medical mandates to return to normal didn’t erase grief, they just made it harder to talk about. Each successive suppression drove us further from emotional wellbeing, helping to create the multiple, unfavorable health and relational conditions we have now. Even before the pandemic, loneliness was considered a growing public health crisis. Deaths by suicide were climbing, especially in younger populations and the medical fields. Addiction rates were soaring. It’s been true throughout all of human history: when we can’t talk openly about grief, it just finds another way to speak.”

“These last 18 months have been hard. What the pandemic gave us was a nearly universal experience of loss: no one was spared. Everyone carries something forward from the pandemic, whether that’s the effects of physical isolation, the dissolution of relationships, or the loss of people we love. And these losses will continue to unfold. Though it’s tempting to push forward and forget about the past, we can’t outrun this grief.”

“We have a choice now, as individuals and as a collective, to include these cascading losses as part of our story. We can talk openly about the hardships of this time, listening to each other, making space for grief to exist.”

We have a choice. We can come together as a collective and not flush each other down the toilet but we can flush the sludge that has built up in the hub of the wheel of which we are the spokes and choose to start with a shiny new way of revolving. We are responsible for ourselves and others, both. We can share our grief and openly talk about it. And as a society, treat mental health like the healthcare it so deserves to be. Without judgement.

Author: Sherri Margolin (Dark Matters)

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