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Paula Joan Caplan's Authors Guild Blog

Is Covid-19 Making Everybody Crazy?

Originally published at https://www.madinamerica.com/2020/07/covid-19-making-everybody-crazy/ 

 

The coronavirus pandemic has provided a golden opportunity for some psychotherapists, Big Pharma-funded entities, and others, who have sounded an alarm, claiming that massive numbers of people are "mentally ill" because of fears of the virus and reactions to social distancing.

 

Media producers have promoted these warnings during May, which was deemed Mental Health Awareness Month. A recent Washington Post article headlined "A third of Americans now show signs of clinical anxiety or depression, Census Bureau finds amid coronavirus pandemic" made that claim. And in a recent New York Times article, psychologist Andrew Solomon, reporting data that nearly half of respondents said the pandemic harmed their "mental health," shockingly equated this with mental illness becoming "universal reality."

 

In a June 5 press release, the American Psychiatric Association (APA), a lobby group for psychiatrists, reported an increase in psychiatric disorders during the pandemic that it based on an anonymous, online screening tool. Screening tools that allegedly tell the test-taker whether they have a "mental illness," including this Mental Health America (MHA) tool, are usually based on a list of feelings and difficulties that most people feel sometimes, and the cutoff points they give for when you should seek professional help are not scientifically based.

 

This tool includes instructions to take their Depression test if you are feeling overwhelming sadness. Do we really want to call overwhelming sadness in response to the isolation, fear, and unknown future occasioned by the pandemic a mental illness? They say to take their Anxiety test if worry and fear are affecting your daily functioning. Who these days doesn't worry whether their mask is adequate, whether they have washed their hands enough times and in hot enough water, whether to stay away from a beloved, elderly relative for fear of communicating the virus and thus increase their loneliness or go see them, wearing mask and gloves and staying six feet apart but still worrying because we might find out later that six feet of distance was notenough?

 

Such claims promise a vast expansion of the market for therapists, but such claims carry great potential for harm, adding to the burdens of people with upsetting but understandable, deeply human feelings by informing them they have psychiatric disorders. Anyone having upsetting feelings deserves love, help, understanding, and support, whether from family and friends or, if they choose, from clergy or therapists. But people also deserve to know about the dangers of classifying all upset as mental illness.

 

There are two common meanings of the term "black box," and both apply here. One meaning comes from the Food and Drug Administration's black box warnings to alert potential consumers to a product's dangers, and as applied here, people should be warned not to rush to call their upset "mental illness."

 

When people are struggling, suffering, or responding in unusual ways, they frequently fear their feelings mean they are "mentally ill," that they should be "doing better" than they are. One of the most helpful things that therapists can do is to let them know that their feelings are deeply human reactions, not signs of illness.

 

A hard look at four facts makes it clear that caution is warranted before pathologizing reactions to the current pandemic:

(1) Little is known about COVID-19 or how to protect oneself from it, and its effects can be fatal, so feeling confused, frightened—even terrified, powerless, and helpless—should not be classified as psychiatric disorders but rather as a normal and understandable reaction to extremely unusual events.
(2) As poet Heather McHugh observes, in our daily lives under ordinary circumstances, we tend to avoid "our fundamental terror at our own deaths," but the pandemic's massive concentration of so many deaths at once, and the fact that our own death is now more likely to be imminent, "makes the burden of the knowledge of mortality weigh" heavily on us. McHugh cites Audre Lorde's poem, ""A Litany for Survival," which ends with the line "we were never meant to survive." Suddenly to be confronted with something so terrifying for many people that they usually drive it out of awareness is a shock and disorienting in its own way: The fleeing doesn't work as well now, so how to begin finding other ways to cope with our mortality?
(3) Physical isolation from others interrupts the participation in community that is proven to be healing; but social distancing and stay-at-home policies drastically reduce participation in community. Connections via zoom calls have skyrocketed and can be helpful but have drawbacks. Many include numerous participants, which can inhibit deep conversations about feelings and creation/maintaining of meaningful relationships. Further, there is some strain involved in monitoring who is speaking and when to jump in, and it requires extra energy to remember to stay within camera range, monitor when to mute and unmute oneself, and project enough to be heard. No zoom call can replace human touch, which promotes security, happiness, and belonging. Being unable to hug a loved one without fear of unknowingly transmitting or getting the virus seriously interferes when we want to see people with whom we do not live—grandparents, elderly parents, grandchildren, friends, neighbors.
(4) Many people are grappling with increased loneliness, alarm about losing jobs and work identity, new financial crises, and child or spousal abuse. Asians and Asian Americans have been targets of discrimination and abuse because of claims that COVID-19 originated in China. Many African Americans and Latinx people and people in nursing homes, prisons, and psychiatric hospitals know that their risk of getting the virus is higher than that of others, compounding fear, suffering, and anger about the reasons for the increased risk. Upset due to any of these causes should not be called mental illnesses. The same applies to frontline healthcare and other essential workers and people who have suddenly had to provide constant care for family of all ages and education for offspring or those grieving loved ones' deaths. As with military veterans traumatized by war, or victims of all forms of oppression and violence, the last thing such people need is to be told their reactions are proof that they are psychiatrically disordered; the message that they should be "coping better" only adds to their burden.


No wonder so many people are feeling upset!

 

People who are suffering emotionally from the effects of COVID-19 deserve help, but it must be real help, such as lifting their economic burdens, protecting them from violence, and increasing community support, including all of us showing we are willing to listen to what they are going through and acknowledging how common these struggles are. Importantly, we must let them know that their suffering does not warrant classifying them as mentally ill (as psychiatrist Dainius Puras, Special UN Rapporteur, notes).

 

An increasingly pervasive pattern is the leaping to recommend "therapy" or "mental health services" when attention is drawn to human suffering. This relates to the older meaning of "black box" as something whose inputs and outputs can be viewed but whose internal workings are unknown. The terms "therapy" and "services" are black boxes, so vague that they can include the entire range of good and bad therapists and approaches. Often, well-meaning friends and family, and certainly legislators, feel they have done their bit by sending someone to therapy or voting to increase funding for such services without ensuring that the therapists are caring and effective or that the services actually help. Some therapists are terrific, and some approaches classified as "mental health services" help some people, but some therapists cause harm.

 

Likewise, psychiatric drugs sometimes help but very often harm, and their use has skyrocketed early in the pandemic, perhaps due to people assuming they would need them, but has now declined to around pre-pandemic levels. Other approaches can cause harm, and some services actually increase suicides. Furthermore, as soon as a person is diagnosed as "mentally ill," their own focus and that of professionals tend to veer sharply away from nonpathologizing, low-risk and no-risk approaches that are known to be effective.

 

More than two dozen of the latter, such as involvement in the arts, physical exercise, meditation, having a service animal, doing volunteer work, and having a listener, can be seen here (these are from a conference about veterans but can be helpful for anyone) (see also here). But entities like the APA do not tend to mention such approaches but only focus on therapy and drugs, and the MHA screening tool they cite urges people to see a mental health professional.

 

Lauren Tenney, Ph.D., a psychologist with expertise in trauma and human rights violations, says that "emotional responses people are having to the unnatural and traumatic circumstances created by the pandemic are not signs of supposed 'mental illness.'" She stresses that people who are "experiencing a range of emotions outside of their comfort zone ought to see these emotional upheavals as par for the course and attempt to embrace the depths of feelings social isolation can create."  She urges those who are suffering: "Actively work to connect with others who are having similar experiences" and suggests that "People should be supported in finding resiliency in the face of environmental adversities."

 

Even Google is getting into the act, partnering with the National Alliance on Mental Illness (NAMI) to post an "anxiety self-assessment" tool. The announcement of the partnership included description of NAMI, which is heavily funded by Big Pharma, as a "grassroots" organization and uses a tool that is based directly on a psychiatrized description of anxiety and is titled with a psychiatric disorder's name. Furthermore, they will "provide access to resources"—there's that black-box word again, "resources," developed by NAMI.

 

A major source of confusion is that when the terms "mental health problems" or "mental health conditions" are used—instead of, for instance, "emotional upset" or "suffering"—it is very often taken to mean "mental illness." As a result, media reports of increases in which understandable reactions to the pandemic are described as "mental health problems" are easily assumed to indicate increases in psychiatric disorders. Compounding the confusion is that psychiatric disorders are widely—but wrongly—assumed to be scientifically validated entities, so in the face of claims of increases in mental illness, rarely is the basic question, "But isn't 'mental illness' defined unscientifically and by whoever has the power to define it?" Instead, the assumption is made that it's clear what "mental illnesses" are and that they are rising.

 

One example is a recent warning that the pandemic will increase "postpartum depression" and "perinatal mood and anxiety disorders." The author, a psychiatrist, comes nowhere near to questioning the validity of these categories and simply alleges that they are partly neurobiologically caused, and she pathologizes expectant mothers' totally reasonable fears the pandemic provokes, despite acknowledging that social supports (harder to get in the coronavirus era) are crucial to preventing what would more properly called postpartum isolation, fearfulness, and sadness rather than psychiatric disorders.

 

Curiously, the World Health Organization's Director-General Dr. Tedros Adhanom Ghebreyesus warns that the "pandemic is highlighting the need to urgently increase investment in services for mental health or risk a massive increase in mental health conditions in the coming months," despite noting that pandemic factors like "social isolation, fear of contagion, and loss of family members is [sic] compounded by the distress caused by loss of income and often employment."

 

The psychiatrizing of America has been so efficacious that many professionals and laypeople readily assume the traditional mental health system can and should solve all emotional problems. Evidence of the limitations of that system include high and increasing rates of suicide and death and high and increasing rates of long-term disability of people treated in that system. Good therapists—and laypeople—can help normalize feelings and explore useful ways to cope.

 

But therapy must not be seen as the only option or as the one that will definitely help. What has been proven helpful to suffering people has included freedom from economic pressures, poverty, violence, oppression, and inadequate physical health care; a safe place to live; and meaningful human connections. Even the authors of a recent British Medical Journal article warning of a "tsunami" of "mental health cases" note that the people most at risk are those with "precarious livelihoods" and "poorest health," and fortunately, some groups are assuring people that their upset is understandable in light of the strange, new, massively and abruptly changed circumstances and being torn from their usual communities and sources of support.

 

Controlled studies of approaches aimed to reduce emotional suffering are nearly impossible to create, but an interesting contrast of the effects traditional, pathologizing approach and those of nonpathologizing ones is reported in a recent articleabout two neighboring Ohio regions. Although more information is needed from similar contrasts, the report from these two is of interest.

 

The Richland County Mental Health Board, which has encouraged the traditional use of counseling and crisis hotlines, reports a recent increase in suicides. Nearby, Ashland Mental Health and Recovery Board executive director Steve Stone, whose Board advocates nonpathologizing approaches, or what he calls "self-care" and "natural support systems," reports that their crisis services have not increased and in some respects have slightly decreased, and there have been no suicides and no increase in new people seeking help. He cited peer support programs as crucial to keeping their numbers low, including a sewing group, in which community members made hundreds of face masks, and a writing group that will write letters to patients in state hospitals during the pandemic. Stone is quoted as saying that they rely very little on state hospital and inpatient programs, and he "thinks the need for professional mental health services will remain low based on common sense approaches of people taking care of themselves as well as each other."

 

It will add to the tragedies caused by the current pandemic if all hope is focused on the mental health system and is diverted from the many things that reduce suffering and that do so without calling all suffering mental illness.

 

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A book review of "Acceptance: The Defining Voice of Validation"

First published March 13, 2020, at https://www.madinamerica.com/2020/03/acceptance-book-review/

 

Happily, above the flood of books about whatever the author decides to call—or accepts as defining—"mental illness," with traditional recommendations about what is helpful, usually these days amounting to psychiatric drugging, a humane, nonpathologizing, truly useful volume has appeared. It is psychologist Evelyn Sommers' book, Acceptance: The Defining Voice of Validation, whose writing is clear as a bell and whose voice is consistently of one who walks with the reader who wants to move past earlier, upsetting matters and become "unstuck" in order to get on with a more productive, forward-looking life.

 

As with her previous books—Voices from Within: Women Who Have Broken the Law and The Tyranny of Niceness: Unmasking the Need for Approval—the writing of Dr. Sommers, a Toronto-based clinical psychologist, is an easy pleasure to read and is deceptively simple. In her new book, she identifies a universal problem that at first glance might seem too minimal to warrant serious consideration but that in fact often causes emotional troubles ranging from transitory discomfort to an inchoate uneasiness that can last decades to major psychological paralysis and confusion about what is real.

 

This is no goody-goody book but one that compellingly draws our attention to what in our hurried, overburdened lives too easily gets lost, that is, the essential human need for acceptance and validation. Validation, she says, "is a joining with the distressed person to reflect or give voice to that person's feelings accurately."

 

Early in the book, Sommers writes that a great deal of necessary attention is being paid to the role of trauma in creating emotional suffering, but she makes a powerful case for also focusing on what may seem like minor events that in fact constitute powerful barriers to self-acceptance, self-confidence, and an ability to focus on the future and make choices rather than being stuck because of an event or a comment that the world hasn't recognized as hurtful.

 

Better yet, Sommers offers thoughtful solutions that are easy to understand and begin to practice. She makes us notice things we need to see, that we might have overlooked, and that, once seen, we can use to help ourselves and to avoid causing unnecessary harm to others.

 

Some of the examples in Sommers' book are about children, and one might be tempted at first to think that we cannot create perfect worlds in which no child ever has to navigate dealing with an incident of invalidation, but it is crucial to recognize that one of the few things that psychologists know for certain is that acceptance through validation is what helps developing human beings grow a core of strength and resilience.

 

Furthermore, surely few of us even as adults can say honestly that if, in a work meeting or family gathering, someone is dismissive or demeaning of our point of view, our reactions don't range from feeling unsettled and unsure of ourselves to feeling humiliated and inclined either to silence ourselves or to lash out.  And anyone who has lost a loved one or returned from a war zone can give examples of the devastating—though of course clueless—exhortations some people have offered them to "Move on with your life. You can't grieve forever." Or, as a well-meaning friend urged me about six weeks after my dear father died, when he saw that I was grief-stricken, "You're still so upset. Don't you think you should see someone professional about this (as though the grief were not normal and only a professional could help) and get a little something (psychiatric drugs, of course) to take the edge off?"

 

Precisely because people who speak the invalidating words are rarely aware of their harmful effects and often consider themselves to be doing something for the other person's benefit, it may never strike the person whose reality was upended that that is what has happened. The invalidated person often just feels somehow insecure, ashamed, confused, or frightened and cannot figure out why.

 

Sommers starts with an example from her own life that may at first strike the reader as too trivial to think about: At eight years of age, when spring had arrived but snow had fallen, she one morning resisted her mother's reminder that she put on her boots before heading to school. The child felt clumsy and confined by the galoshes and longed to don lighter shoes and run freely outdoors. When she said, "I hate the snow," her mother, whom she hastens to describe as loving and having good intentions, responded by saying, "No, the snow is pretty" and reciting a poem about it.

 

She doesn't take the easy and too-common way out of pathologizing or even blaming her mother, instead speculating that her mother was "trying to help me accept what couldn't be controlled." But the child not only was not comforted but felt angry at her mother, with the dual consequences of creating tension between them and doing nothing to help the child come to terms with her disappointment and go on to enjoy the day. Had her mother said, "I know you're sick of wearing those boots, but I'd hate for you to sit all day in school in wet sneakers and socks," the child would have had her feelings validated. It wouldn't have taken much to do that, but Sommers acknowledges that, as a parent and grandparent herself, she understands the various pressures of time (have to get the kid to school soon) and emotion (I don't want her to be upset) that can get in the way of stopping to think about how—quickly—to validate the child's feelings and then move on.

 

If that seems like a trivial example, consider that it's never pleasant to feel tension in a relationship that is the most important in one's life, and when one is a child, having the adored adult act as though one's feelings are just plain wrong can—especially if it happens more than once and perhaps even more when it is clear that the adult's intentions are good—make one start to doubt one's perceptions and consider one's emotions and thoughts to be weird or even bad… or invisible to those who matter most to them. Furthermore, children, Sommers writes, "are often unable to articulate what is happening to them, and so instead act out their suffering in ways that make no sense to adults who expect them to be rational." At worst, she says,

 

"Lacking validation of their basic feelings, children learn to view the world as a place dominated by denial of their reality, and they begin to see their worth as conditional on social acceptance. In reaction, they either over-comply with or resist adult demands and then grow into adults who cannot move out of those stuck ways of relating. As a result they may never feel free to make up their own minds about their lives. Still others unconsciously resign themselves to the belief that they can never have validation and give themselves over to the demands of others."

 

Being seen for who we are, especially by those closest to us, is essential to developing a core sense of ourselves at any age. Sommers writes that "Validation is an inferred sense of being seen." In fact, even when we feel joyful, if those around us seem not to share our joy, we can feel uneasy, "overly expressive," embarrassed about our legitimate feelings.

 

Importantly, Sommers broadens the view of sources of invalidation beyond parents, siblings, teachers, friends, and other individuals, writing:

"Governments that create programs and structures that fail to meet individuals' needs are guilty of invalidating people who require them. Similarly, corporations that create myths about people's needs in order to market their products effectively are also guilty of invalidating individuals. The media cannot be forgotten in this list because messages abound in "news," advertising and promotion that lead people to doubt themselves. The corporate source of invalidation is not accidental. Instead, although corporations or governments would not express it in these terms, the implicit intention is to create enough invalidation, self-loathing and insecurity to weaken people in order to then convince them that they will be better off (and validated) by following the advice, programs or pitches that each entity might propose."

 

Helping us to recognize the various, common forms invalidation can take, and reflecting how her approach ranges from the individual to the societal, Sommers names and discusses clichés (e.g., "She's in a better place"); trivializing of suffering ("Don't cry. You didn't fall that hard."); diminishing of the person; diversion from real problems (politicians who claim that gun violence is due to "mental illness"—my example); certain comments presented as "jokes"; established, unquestioned practices (doctors who implement "treatments" that have no proven usefulness and may even be dangerous, because that is the standard of care); and celebrating of diversity while perpetuating in-groups (dominant groups endorsing festivals to celebrate racial and ethnic diversity but being more likely to accept people who look like "the Caucasian ideal").

 

Because she cares about making the world a better place, Sommers packs her book with eminently do-able solutions, beginning by pointing out blind spots that make it hard for us to notice when we commit invalidation and roadblocks to validating another's experience. In that connection, she quotes a client who sent her this note about how she helped him identify his blind spots:

 

"One of the most striking recent discoveries I've made […] in the process of working with you, has been to realize the absolutely awesome power and responsibility a parent has to quietly validate the most microscopic of emotional wounds in their child, and to do this in real time. Critically, these wounds are healed by the child itself, not the parent—and the child possesses equally awesome power to heal itself […] All that's needed is one critical gift from the parent: to strengthen the child's emotional immune system by providing the recognition that the wound actually exists […] Wounds that are not validated by the parent […] accumulate, get infected, fester […] grow in proportion and severity, and can gather unfathomable destructive momentum as the child ages and becomes an adult. If only the parents realized that they, too, just like their children, inherently deserved to exist in a state of healing."

 

Once Sommers describes the common roadblocks to our validating others, it's much easier to catch ourselves committing invalidation. One roadblock is difficulty in staying present, "both physically and emotionally," and she makes useful suggestions for staying present under difficult circumstances, such as when the other person is crying or yelling.

Other roadblocks include but are by no means limited to the use of psychiatric diagnosis, which nearly always leads to the discounting of the experiences of people who are so labeled and even overlooking of their real physical problems such as terminal illnesses; sexism that leads to the dismissive treatment of women's and girls' reports of sexual harassment and assault; ageism that leads to the ignoring or minimizing of old people's suffering; and the unresolved presence of the invalidator's own "fears, preconceptions, and needs."

 

Throughout the book, Sommers reminds the reader that "validation, understood to be acceptance of feelings, is central to being able to progress emotionally by moving through distress," and lack of validation produces "stuckness." Her avoidance of jargon and obscuring verbiage is combined with her deep exploration of nuance and variation in how people can learn to recognize invalidating tendencies quickly and how to correct for them.

 

Should readers wonder whether validating someone means always agreeing with them and supporting them in their choices, she writes that "Validation is at once simple and complex, an acceptance of where someone is in the here and now" and explains that "If you believe someone is misguided you can simply and clearly express your disagreement" after you make clear that you see and understand how they feel. "If you believe someone is doing harm by acting from their beliefs you can still validate [their] being without endorsing or validating views and attitudes with which you don't agree or that cause harm," she says.

 

I cannot do justice here to the depth and subtlety of the insight and guidance Sommers provides, but I can say that after reading Acceptance, I have become more aware of how many times each day I notice that have many chances to validate, ignore, or invalidate the experiences of others—including people who do repairs in my building, cashiers at the grocery store who are often the butts of customers' frustration when the self checkout machines fail to work, family members and friends of all ages—and find that Sommers' suggestions about how provide validation add to my own enjoyment of life.

 

Near the end of her book, she writes:

"The mechanism for validating someone is rather straightforward, hinging on acceptance of the other's emotional state and allowing time for the distressed—or sometimes the happy person—to take in your words. The real challenge is to manage your own emotions and to tolerate others' beliefs or ways of seeing a situation and feelings that differ from your own."

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