How Do Lockdowns Impact Mental Health? | Interviews

Many people, as this quarantine drags on, are feeling imprisoned. Some of them are feeling gloomy because they don't know when it's coming to an end. Human beings can tolerate a lot of stuff if they know that it has a definite end, but when it's indefinite, it feels infinite and can be very demoralizing and depressing. Hi, I'm Dr. Stephen Marmer. I'm a psychiatrist. I have my own private practice here in the Brentwood area of Los Angeles for over 40 years, treating a whole spectrum of different kinds of patients from teenage all the way up to the geriatric group, and I'm happy to be here. To start out, I would like to talk about the psychological effects of the lockdown. We've been in lockdown here in Los Angeles at least for about two months now. People haven't been working or working from home and children as well staying home. What is it like for someone being at home? What is the effect on them mentally? It's actually quite serious. It's like a blur of time. One of my patients said every day feels like Wednesday because all of the usual markers that tell us what day of the week it is, what we're doing and so forth, the geographical places that we pass when we get in our cars to go to work and so forth, that normal routine is disrupted and everything seems the same because the scenery never changes and because the expectations of what we do with our time are different. Many people, as this quarantine drags on, are feeling imprisoned, trapped. Some of them are feeling gloomy because they don't know when it's coming to an end. Human beings can tolerate a lot of stuff if they know that it has a definite end, but when it's indefinite, it feels infinite and can be very demoralizing and depressing. I've talked to some elderly people, a few of them who I've talked to about this whole situation, say, you know, I only have a few years left to live. Screw this quarantine. You know, I wanna go and live my life. How are the elderly, if you have elderly patients, how are they being affected specifically by this? It varies. Some of them are afraid of dying. Some of them are afraid of time passing and missing essential landmarks. You know, the grandchild's third birthday is never gonna come around again for them. And the importance of children and grandchildren, especially grandchildren for the elderly, is, you know, you can't rate it highly enough. A lot of them, that's their antidote to depression, their sense that there's some continuity in their lives and that what they stood for will live on. And to be deprived of visiting is a very, very hard thing. And then there's the question of the folks who are dying alone. And that's a whole other subject. I think that that's a terrible, terrible tragedy for the elderly to die alone. In terms of the grandchildren as well, I mean, we just spoke with a pediatrician who said that children are really suffering in this too, not just, you know, in their health, but in their mental health, really. When they're stuck at home all day, they're eating bad foods, they don't get a lot of stimulus. What are you seeing happening to any of your children patients or teenage patients? Children are hurt in several ways. First of all, they're being exposed to panic and an unnecessary level of anxiety. But it's being concentrated in a way that is inappropriate for them. They should have the feeling of fundamental security. Their parents should be able to reassure them everything's gonna be okay. Instead, they see their parents being anxious. They see their parents being anxious over their behaviors. They're being held on a tighter leash than usual. And the exuberance and spontaneity of children is being stifled by the quarantine. And then they're not getting enough stimulation from their peers. The fact that they aren't able to go to school, the fact that, you know, and yes, we have Zoom and we have Skype and we have FaceTime and all those other things, but it's not the same. Human beings are hardwired to need to be around other human beings. And our own emotions and our own sense of vitality gets kindled when we're on, when we're actually with other people interacting. Part of what you're supposed to go through in childhood is figuring out who you are in relation to other people and how to navigate different complex social situations. All of that is out the window. And so the kids are being deprived of a lot of stimulation and instead are turning to the blue screen, their handheld devices or the TV. So that's another area. With all that being said, these are obviously horrible circumstances for these children, but do you think with your experience of looking at this, do you think that this will have, and not just on children, but long-term effects on all the people who have been in this lockdown in this country? That this won't just be for a while the lockdown exists, but these mental health issues might continue to spiral out of control even when it's over? That's a hard one to answer because it depends on how long it's going to be. I think if things are lifted fairly quickly, it can be seen as an exceptional episode, especially for the young. But if it goes on and on and on, if, for instance, next school year is interfered with, then which one is the real thing and which one is the exception? Is fear and danger and reduced social contact the typical? I've had patients who grew up in war zones, especially some from the Middle East, and because it went on and on for year after year, they were permanently affected. I think we're kind of near to the time when it's going to shift from a short-term exception to this is the way the world is and is going to potentially have a much more serious effect. I think if we get out of the quarantine soon, I think that we can probably return to normal for most kids. In 2008, during the financial crisis, I know it's somewhat of a different situation, but there are similarities, of course, where people are losing their jobs or they don't have the financial means to support themselves or their family. We saw a huge uptick in depression, alcoholism, drug abuse, suicide. Based on your experience, would you anticipate that we will see similar things such as that with this situation? It's complicated. Just as the vulnerable, elderly, and with other coexisting conditions are more likely to have a really bad case of the COVID-19, whereas the otherwise healthy people are not, I think that those people who have a preexisting vulnerability either toward depression or hypochondria or anxiety or addiction, those are going to be the ones who are going to be tipped over the edge because they're already kind of close to the edge. For the robust individual, probably not that much of an effect, although not zero. I mean, we've been through terrible things, the Great Depression, World War II, and so forth. So I would say for the vulnerable population, it is a significant risk and it is something really to worry about. And I've gotten calls from people I hadn't seen in 10 years suddenly finding that their anxiety is overwhelming, they're beginning to get depressed. The loneliness is the number one thing and the fear of an uncertainty. What we don't know about this virus is more than what we do know. And furthermore, the information that we're getting is inconsistent and frequently contradictory. And that's very, very disturbing to people. If we can brace ourselves to know that the pandemic is going to last X number of months and this is what the outcome is going to be, and this is how your risk profile pans out, you can brace yourself, you can prepare yourself. But if you don't know, if it's all, if one day it's dangerous and the next day it's not, if one day wear masks, the next day don't wear masks, then wear masks again and all this stuff, it's very, very, very confusing. So when you're in a dangerous situation, you want to hang on to some ballast, to something that's real, to something that you can count on or is secure. And whether it's the lack of information or the public confusion or the deliberate misinformation that's being given, all of that is really, really hard on people. So I get a lot of my old patients who were doing really well, suddenly kind of breaking down in this tense environment. Yeah, I think the lack of control that people have of their own lives right now kind of scares a lot of people. They feel like they can't control the things going on, they don't know what's going to happen the next day and in turn that makes them depressed or lonely or anxious. With this video talking to you, I mean, we want to help people. If people are feeling like that at home right now, they feel lonely, they feel anxious, depressed, whatever it may be, what are some of the steps that they should do to try and remedy that themselves as much as they can? Well, try to live your life in an organized, scheduled way. Don't succumb to staying in your pajamas all day. Try to get up at the regular time that you would have gotten up if you were going to work. Try to go to bed at the regular time that you would have gone to bed if you were going to work. Get dressed, get dressed in your work clothes. Learn some new thing, come up with a project. One project that I think would be great would be to keep a diary. How many of us, if we came across a diary that our grandfather or great-grandfather kept during the Spanish flu, how interested would we be in being able to pick up that diary and figure out what they went through a hundred or so years ago? So something that anybody can do is to keep a diary of what they're experiencing now so that their grandchildren or great-grandchildren, if God forbid the next pandemic comes along, which it probably will, they would like to know what we went through. And that gives us a sense also that it will eventually come to an end and there will eventually be another generation that would be very interested in hearing our story. So those are just a couple of things. I remember one summer, my daughter had nothing to do and she decided to watch all of the Alfred Hitchcock movies in the sequence in which they were made. And there's 50 movies, and so she was able to fill the summer with that. It was maybe not a Nobel Prize-winning venture, but it was an organized activity that had some systematic progress to it that she could measure her time by. So there's no reason why everybody can't find something like that. So try and put some organization and trajectory into your life. And then, of course, try to have contact with as many of the people who are dear to you as possible. Do you think that it's more worth it to continue the lockdown and potentially save lives if that's even what the lockdown will do at this point, or is it more worth it to open the country back up so that these people who are experiencing these mental health problems can get the help that they need? I think that the lockdown was the correct decision at the initial time that it was made. We didn't know what we were dealing with. We didn't know how bad it was gonna be. We heard all kinds of horror stories from both China and Italy. And so to use a blunt instrument to get everybody's attention, I think was the reasonable thing to do given where we were in the middle of March. But by the middle of April, I think we knew that the virus was in general selective for bad cases in the elderly population and with preexisting conditions. And for the rest of the population, it wasn't so bad. And I think at that point, the cost-benefit analysis was to begin to open things up as early as mid-April and allow young folks, healthy folks to go back and resume their activities, even to go back to work. So for example, I don't see any reason why people can't go and play golf. That's a natural social distancing sport. I don't see why people can't have family picnics if they have some reasonable compromise of social distance with or without masks. I think that probably in crowded places with poor ventilation, we need to be a little bit more cautious, but we need to do it on an individual basis for the risk factor for the person and the likelihood that they're going to be a spreader to someone else and what the circumstances are. It's not such a black and white on and off thing. There's a huge middle ground that nobody's talking about. When I read and listen to arguments on both sides, there's the absolutists on one side who say we must not expose anybody because we can't lose any lives. And then there's the other side that says, this is ridiculous, we're taking away personal autonomy and so on and so forth. There's a huge middle area. And I'd like to hear both the medical profession and the political establishment try to work on the middle zone. How much can we loosen and what are the long-term benefits of that? We have the illusion that in life, we have a choice between something really, really good and something really, really bad. In fact, most of the time, our choices are between good and better or bad and worse. And if we are saying that we're comparing everything to perfect, then everything is a failure. And that's not the way real life is. One more thing on this. We don't live in a risk-free world. There are risks everywhere. We usually don't think about them. We usually don't think about the risk when we get in our car and drive on the freeway. We figure that the reward of being able to propel ourselves wherever we want to go, need to go, is worth the risk. If we only focused on the risk, we would never get in our cars. If we only focused on the risk, we'd never get on an airplane. So we have to balance risk and reward, and we're not doing a very good job of that. I think the personal responsibility part that you brought up is, I mean, really the most important thing. I mean, just for example, in Sweden, we had people who, you know, they didn't really put the social distancing laws in effect like we did in America, but they kind of did it by themselves and we haven't really seen a huge uptick in cases there because they kind of social distance themselves. Last night on the phone before this, we were also talking about hypochondria, and I know you wanted to talk about this. Could you elaborate on that as well? Yeah. We live in a world filled with germs, and we have to be respectful of them and we have to take precautions, but many of my patients are so terrified of contamination that they have almost developed an obsessive-compulsive attitude toward it, and a good friend of mine worried that her daughter wasn't even going to be willing to be six feet away from her to wish her a happy Mother's Day because she was worried about contamination. So yes, realistic precautions are good, but to be looking for the germ around every corner is excessive, and to be panicked about whether you're going to get sick all the time is definitely, I mean, it makes the kids nervous. It makes the grownups nervous. It means that opportunities to be with other people that you could do safely are being avoided. For example, we know another family that we're very close to. They've been observing the same kind of quarantine precautions that we have. Why can't we get together with them? They've been safe for eight weeks. We've been safe for eight weeks. We haven't been exposed. They haven't been exposed. Why can't we get together? Worry, excess worry about contamination is interfering with people thinking through, how can we still try to squeeze a little bit of normality and a little bit of old-fashioned companionship into an otherwise dangerous thing? I'm not saying go out and hug everybody you see at the mall, but I'm saying that if you use common sense and you think it through, and you're looking for opportunities to expand, they exist, and I would urge people to do that, to look for them and to implement them. I totally agree. Thank you so much, Dr. Marmor, for doing this interview with us. We really, really appreciate it. If you guys enjoyed this interview, make sure you share with your friends. Comment your thoughts down below. We're gonna see you in the next one. Thank you.