Hope and Caution Aren’t Mutually Exclusive
Transitions are always hard, particularly for people who like predictability and sameness. So as we emerge from the Omicron wave on the heels of two years of a pandemic, it’s no wonder people are a little undone. We’ve all experienced loss in some way. Whether we’ve lost a loved one to COVID-19, a job, or the mere sense of normalcy at school, loss is loss.
Of course some people have suffered more than others. The virus has disproportionately affected historically underserved populations, and we’ve seen worsening economic, social, and educational gaps along racial lines during the pandemic. We have a lot of work to do, not only to protect people from COVID-19 but also to solve larger societal problems, from structural racism to affordable childcare to paid family leave.
Not to mention the existential crisis of war. The images and videos out of Ukraine bring me to my knees. The trauma to Ukrainians is unspeakably tragic and puts everything in perspective. I know I’m not alone in my feelings of sadness and helplessness sitting on this side of the world.
We’ve also all been subjected to unprecedented levels of uncertainty and fear—also, of course, in diverse and varying ways. Some of my patients—like my organ transplant patients, for example—face the highest risk for serious outcomes from COVID-19. (These are the patients for whom I can now prescribe Evusheld, a twice yearly injection of monoclonal antibodies as a preventative—plus the oral antiviral Paxlovid if/when they get COVID). Other patients of mine have suffered from non-COVID issues during the pandemic—from domestic abuse, substance use issues, and/or the sheer stress of parenting in a world of social restrictions—that escalated during the pandemic.
In other words, regardless of our lived experience, each of us has had to manage our everyday emotional health as we grapple with working, parenting, caregiving, and simply being human during a global health crisis.
It’s no wonder many of us are burned out. The combination of grief, loss, and ongoing uncertainty can be paralyzing—even if we’re relieved by CDC’s new guidance and by watching the Omicron case rates and hospitalizations plummet.
We are not done. We’ll actually never be done protecting the vulnerable from COVID-19 and protecting ourselves from the myriad potential threats to our health and well-being. Managing risk is part of the deal of being human.
Which is why I was honored to testify last week in front of the Energy and Commerce congressional committee (which oversees public health—who knew?) at a hearing entitled “Lessons from the Front-Line: COVID-19’s Impact on American Health Care.” Here is the recording of the full hearing. And here is the Twitter thread I put together with some shorter clips of my testimony. In sum, I spoke about the critical importance of:
Balancing the risk of COVID-19 with the harms of the mitigations themselves
More appropriately calibrating our public policies (and our individual health decisions) to the actual level of risk of disease
Improving the CDC’s data collection and distribution—alongside more nuanced messaging—on vaccines, masks, and underlying health conditions (among other things) to help restore TRUST in public health
Improving access to primary care providers to serve as people’s medical home—as a hub for problem-solving, a place where physical and mental health can be addressed in tandem and where we apply broad public health advice to the individual’s unique medical vulnerabilities, lived experience, and risk tolerance, and
Putting mental and behavioral health in the doctor’s office where it belongs, scaling up and improving access to mental health services given the parallel pandemic of mental health in crisis.
My sweet dad was my date. He sat behind me the whole time. He gave me strength!
It’s never been more clear to me that people are struggling. Look at the politicization of science, the polarization of public (and private!) discourse, and the surging rates of overdose deaths, depression, and anxiety symptoms.
While you’re at it, it’s a good time to take stock of your own level of stress, anxiety, and feelings of vulnerability—plus your relationships with food, alcohol, and other people. Crack open a journal. Write these things down. Take an inventory of your interior world and how it relates to your everyday habits and health. For me at least—and for the vast majority of patients I see—these things got a little wobbly at best over the last two years.
So, what do we do now? How do we grapple with existential crises like war, climate change, and structural racism while managing our own everyday risks for disease and despair? Is it even possible to have hope amidst chaos?
As I wrote about last week, we can walk and chew gum at the same time.
We can emerge from the worst of Omicron and still protect our highest risk patients and populations.
We can be relieved that our vaccines protect us from the worst outcomes from COVID and feel sadness that too many Americans lack access to honest scientific information and a trusted guide.
We can celebrate the lifting of mask mandates for our kids and respect people’s ongoing need and desire to mask up.
We can work on our own health habits—like sleep, exercise, healthy eating, and our relationship with alcohol and other substances, for example—and not be rigid or punitive in our approach.
We can enjoy the spring weather and hold space for people suffering in Ukraine.
We can have hope that the worst of the pandemic is behind us and process our grief over what we and other people have lost.
We can resume some semblance of normalcy and advocate for a better “normal” for all.
We can feel sad and mad and hopeful all at once.
I do.
There’s actually a name for this. It’s called “holding paradox.” It means thinking about some (but not all) things as “both-ands” instead of “either-ors.” It’s about abandoning absolutism and black-or-white thinking. It’s about approaching our internal and external worlds with honesty and curiosity instead of the impulse to win every argument.
The art of holding paradox is the birthplace of civil discourse. It’s where creativity and social change happens. It’s also a necessary skill in these highly polarized times. It can help you sleep at night. (It does for me.)
On the subject of venn diagrams and exploring the “gray,” exactly a year ago I wrote a number of opinion pieces about the inseparability of physical and mental health, the universality of suffering, and the critical importance of addressing mental health as “ground zero” of our whole health.
To remind: We all have mental health. It’s not a feature of humanness that we can opt out of. Just like we all have cardiovascular health and gastrointestinal health, we all have thoughts and feelings that drive our behaviors. Our behaviors directly inform our physical health and our medical outcomes. Protecting our mental health helps prevent mental illness. It also helps improve our health from the inside out.
Why do you think I’m so interested in mental health? Because it’s part of the human condition, therefore it’s part of my job to address it—alongside every other organ system—and to advocate for things that are harder to measure but no less important to our overall health and well-being.
As I wrote last year (alongside trauma researcher Roxanne Silver, PhD), taking care of our mental health is not a luxury. The trauma of COVID-19 is having immediate effects on people’s emotional and physical health. From worry, hopelessness and panic to breathlessness, chest tightness and sleep disturbance, our bodies and minds have been on high alert and exhausted at the same time. And when we feel this vulnerable, behaviors like self-medication, substance abuse and self-harm can ensue.
Unfortunately, the trauma will persist even if we’re able to resume some sort of normalcy. Large-scale crises like the COVID-19 pandemic have lasting effects, particularly when trauma is repeated and prolonged. The emotional, physical and behavioral ramifications of PTSD have been well-studied. In the aftermath of SARS in Hong Kong, for example, nearly two-thirds of survey respondents expressed helplessness, and nearly half reported moderate or severely deteriorated mental health.
Not only does trauma affect us emotionally; there are also compounding physical ramifications. Patients who have experienced adverse childhood events are at significantly higher risk for developing subsequent health problems like obesity, diabetes and heart disease. Individuals who were acutely stressed by watching the 9/11 attacks and their aftermath on TV were more likely to develop heart problems over the ensuing three years.
We need to get comfortable talking with our doctors about mental health. Primary care providers have never been more well-positioned to help. Although assessing raw data like weight, blood pressure and cholesterol is important, the role of health care providers should also include recognizing, affirming and incorporating the emotional and behavioral factors that give way to the medical outcomes that directly inform our human experience. Health care providers need access not only to our data but to our true selves, inside and out.
I will see you next week. Until then, be well.