Thank you, dear readers, for the positive feedback on the new title of this newsletter!
“Are You Okay?” is the question I’ve found myself asking every single one of my patients during COVID. It assumes the obvious: That none of us is okay—and that regardless of our pandemic story, we’re all struggling in some way.
Asking patients up front if they’re okay gives them permission to be human. To not be okay. After all we’ve been through, how could we be?
Here we are in August. As we savor the last bits of summer, many of us are anticipating a frenzied back-to-school (or work) season. New variants are on the horizon. But when? The current vaccines protect us from serious COVID outcomes. But for how long? A new COVID vaccine is coming in September. But for whom? Disruptions to work and school are inevitable. But how bad will it be??
This moment of limbo reminds me of the many times over my career where I’ve had to deliver hard news to a patient—that emotional abyss where we know just enough to be worried but not enough to reliably predict the future.
The gulf between incomplete bits of knowledge and our desire for certainty can be exquisitely painful. It’s where panic buttons get pushed. It’s where “what-if” thinking and catastrophizing run wild. It’s where stomachs churn and hearts race. It’s where primitive coping mechanisms—like denial, anger, and the desire to self-medicate—can overtake our rational brains.
Uncertain times also test our ability to be fully present. Worrying about the future can be preoccupying—as if endless loops of anticipatory anxiety are somehow productive when, in actuality, they actually only remove us from the moment at hand.
Anxiety around uncertainty is completely normal. It can also take on a life of its own. The emotional, physical and behavioral manifestations of what I’ll call “limbo brain” can sometimes be worse than the worst thing we’re anticipating.
So this moment of transition begs us all to ask ourselves:
Where do feelings of vulnerability live in my body?
How could I better manage my anxiety about the future?
What could I do to have more agency over my health and well-being?
If you already have the answers to these three questions, bravo!
But if you’re anything like me, you need to periodically check in with your body, update your coping mechanisms, and refocus your energy on things you actually have control over.
Here is my advice:
Scan your body when you’re anxious.
Is your neck tight? Is your jaw clenched? Is your back stiff? Are your palms sweaty, heart pounding, breaths more shallow? Is your abdomen gurgling, bloated, or achy? Do you feel like taking a nap even though you just woke up? These are some of the physical symptoms of anxiety. Emotions live in our bodies. When we connect the dots between our emotional and physical states, we can 1) remind ourselves that we’re normal, 2) worry less that our body is malfunctioning, and 3) direct our attention to the anxiety itself instead of coaxing our body not to react to the way it’s designed to.
Refresh your coping kit.
Maybe it’s time to re-enroll in yoga (even if it's not the beloved in-person class that vanished during COVID). Maybe it’s time to pull out the business card for the therapist that’s been collecting dust in your pocket. Maybe you’d benefit from scheduling a weekly walk with your neighbor, friend, or work colleague at lunchtime. Maybe putting away your phone before dinner would help you sleep better and quiet the “what if” hamster wheel thoughts in your brain.
Your kit doesn’t have to include paid professionals. It can be an app (like Reframe to help you manage your relationship with alcohol and Calm to help with mindfulness). It can consist of a loyal pup, a set of friends, AA or overeaters anonymous, and/or your rabbi—none or all together—to give you the structure and support you need. Whatever you did to healthily survive the last 29 months, make it a double.
Reclaim agency where able.
Last year I wrote a piece for The Atlantic about acceptance and agency, titled A COVID Serenity Prayer. The concepts still apply! Why? Because health is about having agency. There is so much we cannot control in life (i.e. loss, uncertainty, viruses, other people). It’s intrinsically uncomfortable to not feel in control of our thoughts, feelings, and behaviors. We feel ashamed—and more anxious—when we stress eat, binge drink, or act out in anger.
Anxiety festers when we try to control the uncontrollable, fix the unfixable, and predict the unpredictable. Anxiety thrives when we give it a home. So instead of perseverating on future unknowns, we must accept fixed unpleasant realities and direct our energy toward improving the things we can control. Whether it’s resuming an exercise routine, meal-prepping on weekends, or taking time to meditate before bed, being intentional about how we spend our time and energy can refocus ourselves on the present moment. By focusing on the things we can control, we can reclaim agency over our everyday habits and relationships.
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My podcast guest this week is living proof that agency is critical for our health. I’m thrilled to welcome investigative journalist and author Keri Blakinger to today’s episode of Beyond The Prescription.
Keri has an extraordinary story. She was a child figure skating star with Olympic dreams who struggled with disordered eating, suicidality, and heroin addiction. Arrested for drug possession her senior year in college at Cornell, Keri spent two years in prison where she was forced to reckon with her mental health and the atrocities of the U.S. prison system.
Her recovery has been a journey of self-awareness, acceptance, and reclaiming agency. Her best-selling memoir, Corrections in Ink, came out in June. On this episode of Beyond the Prescription, Keri talks candidly about her journey from addict to advocate—both for herself and for criminal justice reform.
As always, my newsletter subscribers get early access to the pod every Monday night before the official Tuesday launch. Give it a listen now on Apple, Spotify, or wherever you find podcasts! Oh — and please rate and review!!
I will see you next week. Until then, be well.