The Legacy of the Pandemic on Mental Health

One year ago, we were teetering on the edge of life as we knew it. ‘As we knew it’ meant attending weddings and bar mitzvahs, going to Broadway shows and birthday parties. We didn’t yet know that in a matter of weeks, we would be largely confined to our homes and ordered to don masks in public places. Or that “ventilator” would become part of our everyday vocabulary.  We didn’t know collective grief and loss as intimately as we do now. The good news is that we’re extraordinarily adaptable. This means that eventually when life returns to more of a normal state, we will assimilate back into our traditional jobs, resume eating in restaurants and shaking hands with our insurance agent. In order for us to make the smoothest transition, we have to ask ourselves questions like: What will the legacy of the pandemic be on our mental health? What is the cost of isolation and fractured social communication? How will these experiences reshape our perceptions, fears and anxieties in the future? Perhaps if we can bring greater awareness to these challenges and the emotions that accompany them, we will be better able to manage their impact on our lives. 

The pandemic brought a new dimension of stress to people around the world, from financial insecurity to concern for the health and safety of our families. Even going to the grocery store has devolved into a land mine of emotions, where customers aren’t merely shopping for groceries--they’re weighing the consequences of touching too many things or getting close to another person. There is an undercurrent of tension and stress, and our nervous systems can resonate with and absorb the emotional state of everyone around us without even trying. When anxiety is high, oftentimes it has a domino effect, triggering poor behavior and emotional outbursts. If you’ve found yourself standing in line, waiting to pay for your groceries and witnessed another customer lashing out at an employee because she doesn’t want to wear a mask, you know what it’s like to feel their tension in your own body. The experience isn’t happening to you, but it’s having a significant effect on you. So how does this happen? 

Evolution has shaped many neural networks to read the behaviors, intentions, and inner emotions of those around us. These networks receive and send social communication that regulate our own emotions, moods, energy level, psychological and physical health. Through these mechanisms, strong emotions like hope, anxiety and fear become contagious. As demonstrated in the example above, the anxiety of those around us is transmitted via mirroring, imitation, and resonance systems, alerting our muscles to respond, and our fear circuitry to go on alert. The same is true for resonance with positive emotions of others, something that we will depend on as we work to restore our collective sense of safety and emotional well-being after the pandemic is over. 

As social creatures, we rely on meaningful social input to remain physically and mentally balanced. Through positive interactions with others, our brains get regular doses of oxytocin, endorphins, dopamine and serotonin, which help to buffer against the inevitable stressors of modern life. While voluntary solitude from time to time can be good for us, prolonged isolation weakens our emotional resilience and ability to cope with stress. In addition to putting us at greater risk for loneliness and depression, isolation is literally processed in the brain as physical pain. Isolation has also been shown to result in reduced autonomic regulation, cardiac health and immunological function (Steptoe et al, 2005). COVID-19 has challenged us to change our association with isolation from something to be avoided to an essential component of our collective health and survival. However, this has not lessened the negative impact of isolation on our mind, body, and social instincts. In a time of unprecedented loss, we also lost our greatest protective factor: each other. 

Another consequence of COVID-19 is the way that it fractures social communication. Safety measures such as social distancing and wearing a mask, while important, have compromised the networks of communication that allow us to comfortably navigate social interactions. As we move through the world, we make rapid evaluations of where to go and what to do by reading the state of others through facial expressions, gestures, blushing, pupil dilation and other signals that tell us whether to approach or avoid a given situation. When we are in the presence of an unfamiliar face, our brain’s fear centers become activated, scanning for cues to determine if a person is safe to be around (Dubois et al., 1999). 

Masks and social distance muddle these messages, leaving us to fill in the gaps of lost information. In the absence of adequate social cues, we are more likely to fall victim to our own fears and insecurities when making guesses about what those around us are thinking and feeling about us. This could further reinforce feelings of loneliness and social disconnection. Our brains may also have previously formed negative associations with masks that could put us on alert when we are surrounded by them in public places. The fear processing that might be triggered by masks and social distancing is not a choice, but an automatic survival response. Although these impulses are outside of conscious control, we can gain control over how we respond to them. 

The activation of fear and anxiety is a survival strategy that helps keep us alive. At the core of the neural structures involved in our experience of fear in the brain and body is the amygdala. The amygdala aims to keep us safe by taking inventory of our experiences and cataloguing everything as positive or negative, creating an unconscious roadmap of how to navigate the world. If stimuli is deemed to be dangerous, it will be paired with an automatic fear response. Take the previously neutral stimulus of a sneeze, which, due to the pandemic, now has a strong negative association as a potential signal of the presence of a life-threatening virus. This association might help us avoid getting sick in some scenarios, but the difficulty is that once the amygdala has categorized something as dangerous, it can be hard to undo the association. 

Whether you are in the middle of a crowded grocery store, or on the couch with your spouse in the safety of your own home, the sound of a sneeze can trigger a fear response. This doesn’t mean that we can’t override this initial impulse to be afraid. When we can identify a reaction as an automatically triggered fear response, we are able to consciously evaluate its relevance, and react appropriately. We can remind ourselves that our spouse has allergies and we are safe in our home, or if we are in a public place, we can take the appropriate steps of moving away from a stranger who is sneezing and promptly sanitizing our hands. When we make unconscious processes conscious, we have the power to make choices based on the relevant context and our best judgement, rather than operating on a fear-based autopilot. As we consider the implications of the fear responses established due to the pandemic, it goes far beyond sneezes to include fundamental human experiences such as closeness with others and contact with new people and places. Identifying and monitoring pandemic-related triggers will allow us to have greater control over them, rather than the other way around.

With a potential end in sight, we are increasingly hopeful that this dystopian period will soon come to an end. What we’ve outlined above only begins to unpack the myriad of ways that our experiences may manifest in strengths or weaknesses in our future. The legacy of mental health after this pandemic is going to be largely dependent on our ability to process the ways that this challenging experience has affected us. While it may seem daunting, by doing so we give ourselves the opportunity to learn from it and gain greater agency as we move forward. Within our minds, hearts and relationships, we have the ability to reconnect, rebalance and repair some of the things we have lost during the pandemic.