Mental Health in the US is Suffering—Will It Go Back to Normal?
‘Covid-19 has left lots of people feeling anxious and depressed. But it’s hard to untangle whether this is a normal response to a difficult situation or actual pathology.’
AFTER A PARTICULARLY devastating transport, Rosemary, an emergency medical technician who works in the Boston area, realized that she was struggling emotionally. She needed to talk to someone. That day, she and her paramedic partner had arrived at the house of an older man who had symptoms of Covid-19, and they needed to get him to the hospital immediately. It was early May, and, at that point in the pandemic, families were not permitted to visit patients at the hospital, nor could they accompany their relatives in an ambulance.
“So we realized that we had to tell his wife that she couldn’t come with us,” recalls Rosemary, who asked to be identified by only her first name. “And it came to be revealed that this couple had been married for over 60 years. It was just absolutely soul-crushing for us to realize that. We knew there was a good chance that, if we took him into the hospital, he wasn’t going to come back out. So we were in the position of having to tell this woman, ‘You need to say goodbye to your husband.’” Once they had arrived at the hospital and safely passed the patient on to the doctors and nurses there, Rosemary went to a deserted corner of the parking lot and cried. “That was very, very difficult,” she says. “That one almost broke me.”
Rosemary reached out to Project Parachute, an initiative run by the online therapy platform Eleos that provides free therapy for frontline health care workers. Since it was founded earlier this year to support health workers through the pandemic, Project Parachute has connected over 380 frontline workers to pro bono therapy. Rosemary, who has previously experienced depression and anxiety, met with a Project Parachute therapist for four sessions, “just to talk to him about things, get stuff off my chest,” she says.
Rosemary is just one of the many people who has experienced worsening mental health during the pandemic—an increase that officials at the World Health Organization warned about back in May, when they wrote that countries would “risk a massive increase in mental health conditions in the coming months” if they did not sharply increase investment in mental health services.
Recent data seem to show that the warning was warranted: According to survey results released by the Centers for Disease Control and Prevention on August 14, 30 percent of respondents reported symptoms of anxiety and/or depression, versus 11 percent during the same time period in 2019. (The CDC survey, which was conducted at the end of June, also reported that over 20 percent of essential workers seriously considered suicide that month.) KFF, a nonprofit that conducts a monthly tracking poll of health indicators, found in July that 53 percent of respondents indicated that pandemic-related stress had affected their mental health, up from 32 percent in March. Dawn Brown, director of community engagement at the National Alliance on Mental Illness, which runs the free NAMI HelpLine for people seeking support and information, writes that, between March and July, they’ve seen a 65 percent increase in calls. Some callers have preexisting mental health conditions and reached out because of concerns about accessing medication or treatment during a pandemic, she writes; others did not have anxiety or depression diagnoses but were beginning to experience symptoms.
Some experts have worried that these challenges will add up to a “second pandemic” of mental illness. Back in April, four registered nurses, two of whom are professors at the University of California, Los Angeles, published an article in the Journal of the American Psychiatric Nurses Association that invoked a wealth of evidence to argue that Covid-19 patients, their families, clinicians, and those suffering from fear and loneliness at home could end up with serious psychological issues. And in June, psychiatrist James Lake warned of such a second wave in Psychiatric Times and anticipated that, left untreated, the psychological effects of the Covid-19 pandemic could have serious consequences for years to come. “Our mental health system is not prepared to deal with what may become a global mental health pandemic,” he wrote.
Ronald Pies, professor emeritus of psychiatry at SUNY Upstate Medical University, is not quite convinced that we are seeing a second pandemic of mental health issues—after all, someone who reports a symptom or two of depression doesn’t necessarily meet the full diagnostic criteria for the disorder. But if someone is experiencing enough pandemic-related distress to meet a clinician’s threshold for a diagnosis, Pies thinks, they do in fact have a mental disorder. “If a person develops a condition that meets full diagnostic criteria for MDD [major depressive disorder] during the pandemic,” he writes in an email to WIRED, “then, in my view, they have MDD.”
Yet others, like Tamara Browne, a lecturer in health ethics at Deakin University in Australia, caution that Covid-19 isn’t necessarily sparking unprecedented rates of diagnosable mental health concerns, even if some people do express enough symptoms for a diagnosis. To the contrary, stress, fear, and sadness may be completely explicable reactions to difficult situations, not signs of a pathology. “If you’re bereaving someone who’s died from Covid, or you’re really anxious because you’re working in a health care setting with loads of Covid patients and it’s like fighting a war, if you’re stressed about having lost your job, or you’re sending your kids to school or a daycare and you don’t know how safe they are, or you’re trying to look after them full-time while also trying to do your job full-time, because your job doesn’t allow for childcare—all this seems like understandably stressful situations that will cause you to feel anxious and depressed,” she says. “It doesn’t strike me as a dysfunction.”
This difference of opinion represents a long-running debate among experts on mental health that has found new relevance in the pandemic. Is the prevalence of disorders like anxiety and depression actually on the rise as a result of Covid-19, or are clinicians just seeing short-term reactions to stressful conditions? Which side experts come down on has a lot to do with what they think matters most: Is it a person’s symptoms, or is it their situation?
For Browne and some others, symptoms alone are simply not enough. “The risk of the symptoms approach is that we tend to not look at the causes,” says Şerife Tekin, assistant professor of philosophy at the University of Texas at San Antonio and an expert in the philosophy of psychiatry. Looking at the causes of someone’s distress is crucial, she believes, because causes can be changed, or at least responded to, in order to provide relief. Someone who is feeling depressed because they haven’t been able to see their friends during the pandemic could find a lot of relief through engaging in more virtual events or forming a social bubble. Once the pandemic is over and they can move around freely, they may feel completely back to normal. “When it comes to helping these individuals, I’m assuming the goal of diagnosis is actually to help the patient, to help the individual who is suffering,” Tekin says. “Just looking at the symptoms may not really get us there. We may really have to engage and look at the causes.”
Jerome Wakefield, a professor at the NYU Silver School of Social Work, agrees that context must be a crucial consideration when making a psychiatric diagnosis. “If the environment doesn’t allow you to do what you’re naturally designed to do, is that a disorder?” he asks. “Of course not. I mean, you’re designed to breathe. But if you’re underwater and can’t breathe, that doesn’t mean you have a disorder.” Just like a surfacing swimmer, someone struggling with the emotional consequences of the pandemic may find relief as soon as their situation changes. “Probably, when things go back to normal, this isn’t going to continue,” Wakefield says. “Your feelings will go back to normal.”