Category Archives: Covid-19 Crisis

Mr. and Mrs. Smith

Not everyone will emerge, post COVID, with biceps and abs, the great American novel, a third language, the work pivot, or other fabulous accomplishment. Most of us strive for the greatest accomplishment of all, survival. It’s all too easy for us to look to our colleagues, friends, neighbors, and family and feel like we have accomplished nothing while, somehow, they appear to be flourishing. One client writes me frequently. What am I doing wrong? Am I making the right choices for my family? What should we do next? What is going to happen to us?

The feeling of failure is pervasive.
Keeping up is a myth.

For most of us, the Covid life laid bare things we haven’t looked at in a long time. What are relationships really made of? What do we want to do as a partner/friend/parent? What are our goals, when the everyday structures are removed? Did the old ways even work, or were we fooling ourselves?

Looking through the window of what seems to be the perfect household is highly deceptive.
Mr. Smith is terrified. His company has already laid off employees. His Zoom keeps freezing in meetings. He can barely pay attention anyway. He’s tired of virtual meetings and even more exhausted when he has to go into the office. His Whiskey and Adderall habit is heavier than ever before, but it’s doing nothing to help his abysmal sleep. His boss is annoyed, his wife is annoyed, and his kids are certainly annoyed. He can’t do anything right. He and Mrs. Smith snap at each other about every small thing. There is rarely any intimacy, affection, let alone moments of levity.

Mrs. Smith is exhausted. She is buried by simultaneously being a mother, full time chef, house manager, therapist, and cleaner. She has a little gig on the side called a full-time job, that won’t leave her alone. White wine is her sanity. It starts at 9 am when she works from home. She has noticed that she “randomly” has anger outbursts, or is frequently in tears, for no specific reason. She wishes she could watch the movies everyone seems to be talking about. Her final precious minutes at the end of the day are for scrolling IG, disappointed by the number of her likes, and watching Netflix if she can manage to stay awake. Mr. and Mrs. Smith very rarely sleep in the same bed.

The kids are going out of their minds. No school was fun for a minute, but this is a bit much; masks all day, curt teachers, stressed out parents, not being able to relax at lunch, and no idea what’s going to happen next. They are hanging out with friends and not so secretly take off their masks.

We are all still in personal survival mode. From financial hardship, to medical concerns, loneliness, work worries, uncertainty, and nonstop parenting, there is no current decision that is easy. When you look at others who seem like they’re thriving, believe it when I tell you everyone is struggling. Including Mr. and Mrs. Smith.

What I Learned

I was recently interviewed for a piece on mental health for VerywellMind about things I have learned from the pandemic.

The question was:
As both one who is living through this and helping others live through this, what are the lessons that most come to mind for you?

Seven things I learned from the Pandemic
1. There was no ‘Normal.’
We say, I wish we could return to normal, I miss the old days. When will things go back?
The old days weren’t so great. We have seen businesses go under, people who were barely getting by already go over the precipice, huge upticks in mental health and substance abuse problems, how separated and isolated people feel, and how difficult it is to ask for and receive support. I believe The greatest lesson of these times is the absolute necessity for a paradigm shift. The concept of a paradigm shift, originally based in physics, refers to a major change in the worldview, concepts, and practices of how something works or is accomplished. Recently, people have sometimes referred to it in employment terms as the Pivot.  Why return to a supposed normal that never worked, completely fell apart under duress, neglected the vulnerable, and is certainly not equipped to address any future challenges?

2. Nothing is more important than connection.
People have deeply hungered for love, touch, intimacy, and affection during these difficult times. It is an essential part of being human. Those who felt most isolated suffered the most challenges to their mental health. I recently wrote a piece about loneliness as a marker of danger to mental and physical health. A recent study equated deep-rooted loneliness as the equivalent of smoking chronically, with regard to the impact on longevity and wellness.

It’s literally a killer.

3. Mindfulness matters.
Groundhog Day happens. Over and over again, I have heard people say they have lost track of time. ’It feels like it’s going by so slowly, and yet so quickly’. Each day can feel the same. Learning mindfulness strategies anchors our perception of reality. We cannot live in a blur, and it’s very easy to succumb to that. Before we know it, it’s September 2021. Also see this helpful post on a mindfulness practice.

4. Pain cannot be avoided.
We can numb our feelings of fear, resentment, anxiety, grief, and terrifying uncertainty. They are still there. How to cope without being overwhelmed requires numerous strategies. I was sent a photograph from a recent trash recycling day in DC, where house after house was lined up with dozens of empty bottles; liquor, wine, beer, soft drinks. Our pain is honorable and a marker of experience. It’s not going to go away just because we want to anesthetize.

5. Looking after your health is absolutely essential.
Health care that is consistent in the middle of chaos is one of the hardest things to do. When you’re just trying to juggle bills, care for children and family, deal with virtual learning, work from home, metabolize constant health alerts and daily fears, confront financial hardship and job changes, and combat isolation and ennui, survival needs take over. Self-care often goes on the back burner. And yet, it is the absolute foundation.

6. It takes community.
In previous work, I have referred to the pandemic as the ultimate #compassionproject. In short, thinking about ourselves and our immediate circle has never worked, is not working now, and will not work in the future. Only if we pull together with our amazing range of strengths, talents, skills, and vulnerabilities, are we going to make it through.

7. Creativity can thrive under fire
I have seen innovation, creativity, flexing, and hustle like never before. In line with number six, above, I have seen projects large and small making the world a better place. Resolve, Love, and Hardwork are unbeatable.

FOGO and Mental Heath

Patient with Social Anxiety: “ I have been preparing for quarantine my whole life. This is easy for me.”

We have become familiar with FOMO, or fear of missing out. It’s a term that has been coined often with regard to social media, such as feeling pangs of jealousy or loss when we are not included in what looks like a series of wonderful activities, relationships, and vacations enjoyed by friends and family members.  We also know that the apparent fun is often greatly exaggerated.

One thing that has come under a necessary spotlight during this pandemic is the importance of our well-being. Not just physical, but also our mental and emotional well-being. A key component of building healthy relationships with friends, colleagues, and employers is creating psychological safety and trust, whether that be at home, social events, or in the workplace.

FOGO, or fear of going out, has become one of the main concerns that my patients now bring to me.

Like most aspects of anxiety, symptoms can range from milder contextual worries, to a potentially debilitating and disabling disorder. 

Recently, a close friend resigned from an organizational position because of safety concerns regarding corporate upper level management’s insistence on large gatherings, IRL. Similarly, one of my patients had to fight for her need to work (actually very efficiently), from the home, because she did not want to expose elderly parents and vulnerable family members to potential harm. In both of these cases, the goals of the organization could easily have been met by working virtually. At times, family members can also put pressure on individuals to attend weddings or events where they don’t feel comfortable with illness exposure, but don’t feel like they can say no.

So, how do we create organizational and personal cultures that support others, both internally and externally?

Some of the key factors:
-What are the goals, and how can they be met?
In a culture of extroverts, many people assume that face-to-face meetings are the only way to facilitate communication and camaraderie. While I see half my patients virtually and half in the office, all have expressed satisfactory therapeutic experiences.  finding creative ways of getting goals met shows care, facilitates trust, and increases teamwork.

-Reciprocal Communication.
You cannot overcommunicate about health and safety. Being able to express and respond appropriately to fears on personal matters such as health worries and/or immunosuppressed family members makes a huge difference in building trust and teamwork in any organization.

-Perceived Support
Be supportive of fears or concerns in helping individuals transition back into schedules that work with individual needs. For example, I have several clients in the hospitality industry who believe that they have been rushed back to work, and felt that money is more important than people in their particular organizations.

-Reassure
Reassure employees as often as needed, and provide information on all the potential supports and resources they have access to. This should be an ongoing process.

-No ‘one size fits all’
Even though we are ‘all in this together’, we are going through different experiences and concerns. Many frontline staff in the health, service, and hospitality industries have felt tremendous pressure and anxiety. There are few things more scary than feeling that you will be terminated from your job if you don’t show up, thereby potentially jeopardizing your health.

– Destigmatize
One of my work colleagues who tested positive for Covid reported that she felt a tremendous sense of shame, as if she had somehow done ‘something wrong,’ despite her precautions. Patients have also told me that they were “outed” at work, and their health was discussed freely, without their consent.

FOGO is real. We already know that over the past year, there has been one of the most significant spikes in anxiety disorders and clinical depression this country has ever seen. From organizational and collegial support, expectations of productivity, to access to mental health services, these concerns cannot be ignored. Fluid situations require mental flexibility. 

Home alone, or a socially distanced holiday that is meaningful

Loneliness can peak over the holidays, and especially so if you are feeling isolated from friends and family. But there ARE some things that you can do that help create a time that feels personally significant.

Planning
Even if you have no plans, make a plan. Waking up to a feeling that there is nothing to do can increase feelings of loneliness. I would even suggest working out a sample schedule.
8am: Wake up and meditate, stretch, breathe.
9 am: Go for a walk or spend some time in nature. Observe the beauty of the trees and plants in winter. You don’t usually have a chance to revel in the luxury of observation.
10 am: Cook a scrumptious breakfast. Make a frittata, Crab Benedict, shrimp etoufee, something you would not normally make for yourself. You can spoil yourself, it’s not just something you need to make for others.
11-100pm: FaceTime or call loved ones. 
1pm: Watch a movie in bed or read a great book, wearing pajamas
3 pm: Take a nap, no more than an hour, you don’t want to sleep the day away and later feel like you did nothing special.
4 pm: Start to prep dinner
5 pm: Have a good cry or journal; it’s ok to let it out.
6 pm: Open a really nice bottle of red wine etc.
7 pm: Eat dinner. Savor.
9 pm: Take a bubble bath; listen to soothing podcasts or audiobooks.
10 pm: Slather on your most decadent lotion, wrap yourself in your softest blanket, hug yourself. See my article on the power of the self hug.

You Do You
This is the best day possible that you can fully treat yourself to doing anything and everything just for you. Have a spa day at home, listen to your favorite music, spend time reading, reflecting, relaxing.

Decorate Your Space For The Holidays Anyway
A festive atmosphere goes a long way, even if you’re alone.
Get festive-smelling candles to fill the house with the scent of whatever you associate with the holidays. Our olfactory senses are most tied to memory, so candles can really help wrap you in the joy of past gatherings.

Reach Out
A lot of people are going to be on lock down this holiday so be proactive in reaching out to friend’s to see what their plans are. You may not be the only one feeling lonely.

No Pedestals Required
Stop putting “the holidays” up on some sort of pedestal like they’re supposed to be this amazingly perfect, beautiful time of the year. Yes, the holidays are a wonderful time to connect with friends and family but that doesn’t mean they HAVE to be just about that. There’s this idea that the holidays are supposed to be perfect. Try not to mythicize it all.

Plan A Virtual Get Together With A Friend Or Two
Watch a movie together while distanced; eat a meal together; have cocktails together while listening to some great music together. You can take turns picking songs.

Volunteer
If you can, try to find a soup kitchen or charitable organization that is accepting volunteers. This will take some proactive advanced planning due to Covid restrictions but the work will be worth it. Many organizations and shelters are very grateful for people who put together packages of goods to drop off, or even give out at the site.

How You Can Support a Loved One Going Through a Hard Time

People need one another, and saying the right words is one of the most important things you can do when your loved one is struggling.

Photo, 2018, Outer Banks North Carolina, Sanderling Hotel, Duck

Ideas to consider include:
1. “Thank you for all you do for me/us, but now is a time to take care of yourself as well.”

When someone is going through a difficult experience, they might not be able to justify a much-needed break. Help them by letting them know that you’d like to take over some responsibilities while they tend to their needs. I know someone who orders food, makes appointments, and checks in daily with somebody going through a hard time. It makes a big difference.

If you’re far away from a loved one, and can’t be there in person, consider sending a care package with food or some of their favorite things, in addition to a personal message of support.

2. Remind your person of something kind they did for you.
They have probably been there for you when you were going through hard times. Remind them of this when they’re in the same boat. They’ll be happy to know they made you feel better. More importantly, hearing about how they helped you may make them feel a little bit better.

3. “I’m proud of you.”
These are powerful words.

Depending on the nature of your relationship with, there’s a good chance this important person would love to hear that you’re proud of the way they are dealing with a painful experience.

4. “My job is to make your life easier right now. This is how I’m going to do it. Does that work?”

People need to support each other when one is in pain. However, if you only ask a loved one “How can I help?” when they are struggling, they might not actually let you know. Instead, offer to make their life easier during this painful time in specific ways.

What to Say to a Friend Experiencing Hard Times
Friends aren’t just people we share fun times with. They’re also the people we may turn to when life is difficult. If you know a friend would like to hear from you right now, get in touch to share one of these messages:

5. “I hate that you’re going through this, but I know that you’ve got this.”
People want to know their friends don’t just like them but admire them as well. Tell a friend going through a tough time that you know they have the strength to overcome it.

6. “You’ve got a lot on your plate. Can we set a time to chat every week?”
You can suggest a specific time each week when they can call you to vent. Some of my patients tell me this gives them an area to vent, cry, and be able to process their week.

7. “Remember when you were there for me? It’s my turn to do the same for you.”

Most friends going through hard times often feel better when someone reminds them that they’ve been a big help in the past. It’s easier to except help when you realize that you are not a victim, and that you have been strong in the past.

Let your friend know you want to support them by reminding her of a specific time when they did the same for you. This will boost your friend’s odds of actually accepting your offer to help.

8. “You’re my best friend. Helping in any way I can is my top priority right now. Please believe that.”

Go the extra mile by wearing your heart on your sleeve. Tell your friend what their friendship has meant to you, and why helping in any way possible is very important to you.

What to Say to an Acquaintance or Colleague Who’s Going Through a Rough Patch

When I had a beloved dog who passed away, I had colleagues at work who pulled together to help me with all of the vet appointments and the loss itself. 

9. “Here’s how we’re going to take care of your work while you’re away.”
A colleague going through a rough patch may need to take a step back from work for a period of time to address other needs. This may be true if your colleague is in mourning, struggling with an illness, or otherwise dealing with a life challenge that consumes a lot of their time.

Your colleague might stress about work and wonder who will be handling all the responsibilities until they get back. You can help your colleague in a very big way by coordinating with supervisors and coworkers to divvy up responsibilities. Get in touch and show your colleague you have work responsibilities under control.

10. “If you need a reference, networking help, anything like that at all, let me know. Happy to help!”

A colleague may be going through a tough time because they got unexpectedly laid off. There’s a chance you might be able to help by serving as a reference or introducing your colleague to others in your industry. Offering to help in these key practical ways could make your colleague feel safer and better.

Eight tips to fight loneliness during holidays

Tis the season when we presumably spend our days sipping hot cocoa, eating delicious food, gifting, and doing all sorts of holiday fun-ness with our loved ones, these days, virtually. It’s the jolliest time of year. At least, that’s the lovely picture we’re all marketed for the holidays. The unfortunate reality is this sentimental holiday scenario is anything but the norm.

For many people, this time of year can be a painful reminder of the things they’re not surrounded by. Loneliness happens. And the painful feeling may grow, until you’re convinced you’re destined to be a lonely hermit whom no one wants to be around.

Part of that reason is simply because of our cultural expectations around what the holidays SHOULD be like. When we set our expectations to be one thing, and the reality is something different, we can see it as less than.

Think, for instance, about all of those holiday Hallmark family films that focus on the heartwarming ~feels~ that come from quality time with the fam.

The reality is, though, your IRL or virtual version could easily not match what you see on the screen or with what your neighbors with their beautiful lights and decorations might be experiencing. Coping with the loneliness and holiday blues can be challenging.

Mental health tips:

Recognize how much stress you might be under
Since the holiday season is short and goes quickly it creates a sense of urgency and overwhelm, making you feel like there’s so much to do and so little time to get everything done. Expectation is also a huge cause of stress during the holidays. Everything from holiday decorating to shopping and gift giving come with expectations that are most often unrealistic which causes you to stress about measuring up to those expectations whether they are your own or ones held by family and friends. When people get stressed or feel overwhelmed they can begin to feel alone in their struggles.

Comparison is the thief of joy
People can feel less than, especially when they see everyone else seemingly ‘happy’ and having everything under control. Social media can be a huge culprit of making it seem that everyone else has it all together except you with those happy/perfect pics. Even though social media is for “connecting” with others it can actually do the opposite and make you feel less connected and more alone especially when you compare your life to those you see. Try limiting time on social media.

Don’t isolate yourself, no matter how tempting
When people feel lonely, sad or are struggling they may tend to isolate themselves or feel unmotivated to reach out or interact with others. They may also feel unworthy of someone’s time and that they would burden or inconvenience others by asking them to participate in an activity or by sharing their feelings. They get caught up in their low self-esteem and negative thoughts, and choose to isolate instead of virtually socialize or reach out. The best way to stop and change negative thoughts is by choosing to see them for what they are-as mental distortions, rooted in fear, self-doubt and low self-esteem. Their purpose is to keep us from pursuing relationships and opportunities.

Self compassion
Please ask yourself if this is a kind thought you are telling yourself. Flip the negative self statement to a positive thought, for example if you are struggling with worth and feelings of deserving ask yourself “Who am I not to deserve this?” Start repeating “I am worthy” multiple times throughout the day and you will begin to believe it and act from a place of feeling worthy and deserving. The more you practice positive thinking, the more empowered and less lonely you will feel. I actually have my patients write this down on index cards and carry it around to look at throughout the day. 

Process and be in your feelings
It’s okay to feel sad and to let yourself feel lonely. Everyone has bouts of loneliness at times and often it’s because family may be far away or maybe right now you don’t have a significant other or kids. Spend some time fully feeling your feelings until they dissipate. You can do this by practicing mindfulness. Mindfulness teaches you how to be aware of your feelings, to feel them in your body and to allow and accept them without creating a narrative around them. It is OK to cry or feel an intensity of emotions, and in accepting and inviting these feelings to be present they dissipate and more calm and peace prevails.

Engage in the practice of opposite action/emotion
Practice opposite emotion and action, derived from Buddhism, to change your mood by engaging in behavior that is opposite to what your current emotion is pulling from you. For example, if you are angry and feel yourself tensing up, then try to open your posture and uncross your arms. Stretch your body for release. Similarly, if you are feeling sad and lonely and want to withdraw, then make a point to reach out to friends or watch a funny or well loved movie to help mitigate sadness.

The theory behind the skill I teach in my clinical practice to patients that I call OPPOSITE EMOTION is that every emotion is accompanied by an urge to engage in certain behaviors and these behaviors perpetuate the emotion. For example, the most common action urge for anxiety is avoidance. The more you avoid something you fear, the more intense your anxiety will become, and so approaching what you fear will help reduce anxiety both because you learn the situation is okay and because you aren’t continuing to reinforce your fear by avoiding the situation. It is important to note that the goal is not to push away your emotion or suppress it, but rather to work on cultivating another emotion.

Community service and volunteering
Use your energy and resources on behalf of people who need your help. Volunteer to tutor students, as many are struggling with virtual learning; help at a homeless shelter or soup kitchen, make food for an elderly neighbor, or volunteer at an animal shelter.

Appreciate what you have
Send cards or a personal note to everyone who means a lot to you. Thanksgiving is about showing gratitude. Make your holidays a spiritual growth time, such as creating a personal ritual, prayer, meditation, or virtual gathering with close friends. I have several friends who have a personal altar at home, and engage in prayer to their ancestors and loved ones who are not present. Find something for you that is meaningful. 

Love and Boundaries: Coping With the Holidays

The holidays are upon us, which usually means family and friends.

Either way, in the current state of the world you’re bound to have someone in your life who is just not taking the virus (and the precautions to slow the spread of it) seriously. And while you might feel like you have to avoid them or cut them out of your life until the pandemic is over, there are a few things you can try before resorting to more extreme measures.

Since this is a problem all too many of us (myself included) are dealing with, I was recently asked by the Virginia Psychological Association to give advice on how to manage this stressful dynamic. What should you do, when people around you are not taking the virus seriously? Please also see my article on cognitive dissonance which discusses why it’s hard for many people to change their mind. 

Set boundaries.
Remember that setting boundaries is essential for your mental and physical well-being. You can set boundaries around everything from what you will talk about and engage with, to what you are willing to physically do with someone who is not taking things seriously. Setting a boundary with family members and loved ones may feel uncomfortable at first but it is a healthy way to let others know what they can expect from you. When you let friends and family members know your expectations, it’s likely they will feel confused or even upset or angry at first. But it’s important to communicate your needs and expectations in a way that is respectful but firm.

If you don’t want to spend time around people who don’t wear masks in public, tell that person that you really value them in your life and want to spend time with them, but in order to continue doing that you either need them to wear a mask or you’ll only connect with them over Zoom or FaceTime call if they won’t. Or, if you live with family members who aren’t wearing masks in public, tell them you will keep your distance from them (to the extent you can) while you are both at home.

You can only control yourself, you can’t control others, so establishing those boundaries helps to protect your mental health and reduce your stress. You don’t have to take responsibility for educating family members on safety measures, and you can take that energy and time and use it for self-care activities such as exercise, breath work, meditation, sleep, walking outdoors.

Try to avoid getting angry or using critical language when you bring up concerns. I have one patient who has told me that when he sees people without a mask, he becomes enraged. He, and his parents, with whom he resides, have underlying vulnerable health issues, and the apparent selfishness of others not wearing a mask makes him incredibly angry. Unfortunately, people don’t listen to you when you’re angry. Leave out the criticism in your conversations.

In sum, it’s not your responsibility to educate your family members, friends, significant others, or roommates on safety measures. But if you do want to share information with them or discuss safety measures, you can do so in a way that communicates your concern without criticism.

When speaking with a loved family member about concerns such as COVID, it is always best to start from a place of love and support. Ask what you can do to help instead of criticize. When was the last time you felt like doing something someone asked if it was delivered in a tone that was condescending or negative?

It’s much better to say, may I buy you a cute mask, instead of: You’re going to die or kill someone, if you don’t wear a mask. I personally have several really pretty masks that have been made for me by clients who are talented, in addition to my regular PPE.

It’s also helpful to use “I” statements when communicating with friends and family, so they understand where you are coming from. For instance, saying – Hey, I am worried about your health, and so I don’t want to potentially expose you to the virus if I come over, or “Hey, I’d love to come to your baby shower or wedding, but I don’t want to take the risk that I might get you or someone else sick.

Remember, that some people are resistant to change. So know when it’s time to stop pushing them. It isn’t your job to preach to others about what they should be doing; you can only control what you are doing. With that in mind, if you still are not comfortable with how your family or friends are dealing with things, you can respectfully decline to spend time with them physically until things are better.

It IS your duty to protect yourself and your health and well-being. Let them know what you are and aren’t comfortable with, and if that’s a Zoom call instead of an in-person dinner party, tell them. If they really respect you and want to spend time with you, they will do what it takes to see you, even if it’s not IRL.
I’m heading to a zoom baby shower for my niece tomorrow, please be safe.

Happy Thanksgiving week.

Cognitive Dissonance and Mental Health

Cognitive Dissonance is the motivational mechanism that underlies the reluctance to admit mistakes or accept scientific findings even when those findings can save our lives. The cognitive dissonance theory, most strongly developed by social psychologist Leon Festinger, states that many people are deeply unwilling to change their minds. Similarly, many find it impossible to admit to or apologize for inappropriate behavior.

This dynamic is playing out during the pandemic among the many people who refuse to wear masks or practice social distancing. Cognitive dissonance causes feelings of unease and tension, and people attempt to relieve this discomfort or anxiety in different ways. Examples include “explaining things away” or rejecting new information that conflicts with their existing beliefs.

When the facts clash with preexisting convictions, some people would sooner jeopardize their health and everyone else’s than accept new information or admit to being wrong. This clearly manifests itself in the echo chamber of social media and the comment sections, I’m right, you’re wrong, it is someone else’s fault, vaccines are a government hoax, and so forth.

Coping with the nuances of contradictory ideas or experiences is mentally stressful. It requires energy and effort to sit with seemingly opposite things that are non binary. Festinger, in his research, argued that some people would inevitably resolve dissonance by blindly believing whatever they wanted to believe.

Although it’s difficult, changing our minds is not impossible and nor should it be. We need to accept that science and data is fluid. As is life. Mental flexibility is painful, and dealing with uncertainty even more so.
The end result is dissonance, but the actual problem is uncertainty and the stress it causes; we crave certainty because it feels safe. Rarely have we as a society been in a time of such uncertainty, and in times of uncertainty our survival instinct drives us to crave certainty.

Regardless of inherent beliefs, it is important to recognize dissonance and recognize that we need to continue to work on flexibility. In short, we need to cultivate curiosity and accept that something we thought to be true might have been right at the time, but wrong now. Don’t try to explain away problems or reject new information; rather, accept that uncertainty exists and understand that we are in uncharted territory.

As we head toward the fall and into the winter season, I am consistently hearing from my patients and local businesses that uncertainty is their biggest challenge. This manifests itself with individuals as well, and data from mental health providers shows an increase in both substance abuse and clinical depression/suicidal ideation. Most mental and medical health providers are at capacity with a 30-40% increase from last year and with long wait times to get an appointment.

It takes great courage to recognize that it is not COVID, it is not mask ordinances or future vaccines, and it is not government or international conspiracies that are our greatest challenge; rather, it is the inherent anxiety and stress that uncertainty causes. Admitting we are wrong requires some mental flexibility, which involves living with dissonance for a while rather than jumping immediately to conclusions.

COVID-19 and Neuropsychology

My practice in my company offices includes very strict protocols, including daily housekeeping services, using Covid approved cleaning products. I use two full office suites, so that cleaning can be happening in between every single patient. I have created a large garden with seating areas and beautiful flowers so that anyone who accompanies a patient can be seated outdoors, if they choose. I own copious amounts of hand sanitizer. We have been blessed with beautiful weather here in the Washington DC area, and often I meet outdoors with my patients. I have masks, bottled water service, and I wear PPE while working.

On COVID-19 infection and mental and cognitive health: In addition to mood disorders, common symptoms include fatigue, headaches, memory loss and problems with attention. There may be a number of reasons for these brain changes, including inflammation and cerebrovascular events (describes a syndrome caused by disruption of blood supply to the brain).

Research suggests that the virus may gain access to the brain via the forebrain’s olfactory bulb, which is important for the processing of smell. Loss of smell, as well known, is a symptom in many patients with COVID-19.

As part of the system responsible for your sense of smell, the olfactory bulb sends information about smell to be further processed in other brain regions including the amygdala, orbitofrontal cortex and the hippocampus, all which play a major role in emotion, learning and memory.

As well as having extensive connections to other brain regions, the olfactory bulb is rich in the chemical dopamine, which is important for pleasure, taste, intimacy, motivation and action. It may be that COVID-19 alters the levels of dopamine and other chemicals, such as serotonin and acetylcholine, in the brain, but we can’t say for sure yet. All these chemicals are known to be involved in attention, learning, memory and mood. It doesn’t matter if people get sick and supposedly recover. We know empirically that both HIV and Lyme disease have a strong effect on the brain and functioning. The effects of COVID may also be very long lasting, based on emerging neuropsychological research.

Photo, Washington, DC Arboretum, 2019.
(statistics, courtesy of the Lancet medical journal and Embolden Psychology). 

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