Trauma in The Time of Coronavirus
How Coronavirus is traumatizing us and how to feel better despite the fear and anxiety.
Antonieta Contreras, LCSW-R, CCTP, BCN
This week I received an invitation to join a volunteer program that provides brief pro-bono EMDR treatment to front line medical professionals working with COVID-19 patients right now. I immediately enrolled, feeling good about having the opportunity to help those who are dealing with critically ill patients all day every day, using the most effective, evidence based modality for trauma (Eye Movement Desensitization and Reprocessing).
But while waiting for the first call, it occurred to me that traumatization could be happening to many of us as well, especially to those in isolation who may not have anyone to support them emotionally.
Right now, we are all experiencing escalating fear and anxiety as we evaluate the risk and danger of a global pandemic. I am part of the team of therapists responsible for the Trauma Studies Program at the Institute of Contemporary Psychotherapy (ICP). Our clinicians see hundreds of clients weekly that suffer from PTSD and/or complex trauma. We know that people with previous trauma very often have less resilience and get dysregulated more easily, and that they are more susceptible at this time. Now, we are getting many more calls since many citizens don’t know how to manage the amount of uncertainty and the level of anxiety that this situation provokes.
There are many stories that could be used as examples of traumatization happening outside hospitals or the homes of those testing positive as we speak. I want to share three of them, first to share in their pain, and then to address ways in which we can all alleviate the short, medium, and long-term traumatization resulting of this crisis:
Lisa is a sex-worker from Queens who provides for her son and her mother living abroad. She has not worked for several weeks now, not because she doesn't have clients, but because she's scared about getting COVID-19. She's so terrified every time she reads the news that she believes she may never go back to work. When Lisa entertains those thoughts, she then imagines her mother and son getting infected, and not having enough money to pay for their treatments. She feels overwhelmed, hopeless and paralyzed.
Frank is a successful investment banker and first generation college graduate, married with three children. He recently bought a house in the suburbs and registered his children at a private school. He's been extremely stressed over the last three weeks, because his decisions made his company lose millions of dollars during the current financial market crisis. His personal investments have been reduced nearly 40%. Though his kids are home, they can’t stop themselves from going out and playing with the neighbors. Frank is becoming intolerant, angry, sleep-deprived, and unfocused. He’s having nightmares about seeing his house foreclosed upon, having his kids shamed at school, and burying his wife. His scary dreams mimic some of the stories he reads or sees on the news.
Mary is a 47 year old mother of a 7 month-old who was born prematurely. She spent years of her life in treatments to be able to get pregnant, and her health suffered from it. Now she can’t stop thinking about her baby dying of the virus, or about the life of her baby if she dies. Mary has been avoiding her mother and friends lately and is not eating, she is not sleeping either. She obsesses about how she'll protect herself and her baby, and she cries when she hears the news about how the president is failing to protect everyone. She has been feeling so down that she has no energy to take care of her incessantly crying baby.
These three people are already presenting PTSD symptoms. Their situation could easily escalate and worsen. The same way that veterans feel the war in them even after coming back home, the symptoms developed during the war against the coronavirus could stay present in many lives even after the coronavirus disappears or becomes controlled. The hyper alertness will make many feel at risk for a long time for a myriad of other reasons, because the traumatization won’t allow them to see reality as it is. People need to be helped now emotionally if we want to recover stability soon.
When we think about people developing trauma and PTSD in these moments, we imagine terrible events, like being connected to a respirator in a tent with people dying all around, seeing a doctor who has multiple patients dying, or watching a family lose several loved ones. But are those emergency cases the only ones who are traumatized due to the coronavirus? Some will find it unfair to compare the suffering of a medical professional that is working directly with infected people to those privileged enough to afford isolation or that escaped cities like New York to find safety and comfort. But we should consider the suffering and vulnerability of everyone right now. Traumatization has to do with our subjective evaluation of danger, more than the actual risk of dying. Right now, people from all walks of life are fearing for their lives and the lives of their loved ones, while also suffering from the idea that they will not survive, not in terms of life or death, but in terms of being able to continue living their lives in the same way they used to.
Survival is the continuation of life or of existence, and it is probably the number one priority of our brain. Is it as important for our “mind”? If we had the chance to decide between staying alive at whatever cost and experiencing happiness, what do you think we would choose? Research has proved that people value happiness over money, power or success (Whillans, A. et al, 2019), and that we associate happiness mostly with having good relationships (Waldinger, R. 2015), and being healthy physically and emotionally (Kubzansky). If we have the ability to choose between several options, we could make decisions based on what we value most. But if an extreme event like a pandemic happens — jeopardizing our existing state of affairs and putting our lives at risk — “happiness” may become less relevant than guaranteeing the continuation of life. In terms of survival, the brain overpowers the mind, and survival becomes more important than well-being, not because it chooses, but because our brain and nervous system decides for itself (the brain being part of the nervous system). And that’s when the traumatization could start.
We get traumatized because there is a mechanism that acts without our consent, generating all sorts of changes in ordinary functioning if our brain understands our fear as an indication that there is the possibility of “not making it” — not only staying alive, but also maintaining a status quo of health, social position, family, jobs, assets, freedom, autonomy, stability, etc. When I say "acts without our consent", I mean that it will act automatically unless we stop it voluntarily. Becoming aware of these non-consensual reactions can stop them from intensifying and harming us.
When we feel scared after a subjective evaluation of the risk we face—like when we hear the word coronavirus and make an automatic connection with suffering, loss and death— our innate survival mechanisms will trigger a series of responses with the sole purpose of keeping our system running. As a matter of fact (and I apologize for the irony), what is causing deaths right now in the pandemic is not the coronavirus itself, but the fact of our immune system trying to stop the virus from multiplying. Dr. Yoko Furuya, an infectious disease specialist at Columbia University Irving Medical Center explains that when the COVID-19 attacks someone, the immune system response to this invader can destroy lung tissue causing inflammation, ending in pneumonia. In a similar manner, the survival response of our autonomic nervous system can cause a series of modifications that will end up making us emotionally/psychologically sick and the end result is PTSD. Pneumonia will put the life of a person at risk unless there is help, oxygen, medication, hydration, etc., to avoid the collapse of the lungs and other organs. In a parallel way, stress and fear will keep us in survival mode unless we develop awareness, recover our decision making capacities, practice regulation techniques, and so on, and stop the emotional system from collapsing into trauma.
Let me explain the survival mode with examples: if we go into survival mode, we will keep a state of hyper-alertness in order to quickly identify any type of risk. One of my clients, Kathy, a very smart scientist in her 40’s who is respecting the quarantine in isolation, mentioned that she has begun hearing noises day and night, as if something was there, ready to attack her. Every little sound startles her. That’s how illogical our survival mechanisms are; even when she knows it’s impossible to “hear” viruses, her nervous system is activating her sense of hearing so that she doesn’t miss any possible danger even while sleeping.
In a similar way, the widespread insomnia and lack of concentration that many of the people are suffering from is connected with the excessive activation of the alert system: the brain assigns more energy to the parts of the brain that prepare us to detect and confront danger, taking that energy from parts of the brain that it considers to be of less value in those moments —like the parts that think, make rational decisions, assess danger, control impulses, and have empathy. Instead, the brain will assign that energy to produce hormones and alterations that make us more capable of quick reaction, which in this moment of coronavirus translates into increased anger and anxiety –something we can already see in the rise in domestic violence, or the simple desire to escape to a different place. People are still taking flights, and craving substances to forget, escape or relax, and holding gatherings even when doing so may increase the chances of contracting the virus. Survival and logic don’t act together.
The nightmares are another clear symptom of the traumatization process while in survival mode. Nightmares manifest because the nervous system is making sure we remember or imagine those horrible scenes and circumstances that could threaten our lives, in order to make sure that we keep fighting for subsistence. Frank’s dreams of seeing his house going on foreclosure are there just to make sure he doesn’t forget he could lose his house if he doesn’t pay his mortgage. The brain couldn’t care less about the financial market situation — it only cares about Frank being super alert about not losing what for him represents safety.
If that type of activation —the famous fight-flight response— is considered not enough to make the sense of danger disappear, and we stay scared, anxious, and emotionally overwhelmed, the nervous system will continue adapting our normal way to operate and feel. When we see a picture of Dr. Fauci covering his face in disbelief of what Trump is saying during his briefs, we can feel helpless and consider the possibility of ending up in the hands of the virus and dying in the hallway of a hospital without a ventilator or a doctor to assist us. That overwhelm will keep sending the message to the brain that says: you are incapable of controlling the situation. That consideration will be assumed by the brain as an instruction to keep making changes because the previous ones were not enough to keep you alive.
Depressive symptoms will appear right after reaching this level of helplessness: changes like the self-production of opioids to reduce pain, the slow-down of basic functionality like digestion or sexual drive, the numbing of emotions to avoid suffering, etc., will end up making us feel unmotivated, hopeless, shutting down and depleted of energy. These are just symptoms of depression, not the illness itself, but those emotions will add up if added to the previous anger and anxiety, driving us crazy and making us feel lost. Our tolerance will be highly compromised, and we will start reacting in unpredictable ways mostly because our emotional brain will overpower our rational brain to an extreme. If the cascade of reactions keeps going, we could end up sick even physically. When we feel exhausted, we are experiencing the depletion of our internal resources, the ones that help us keep acting as usual. If we don’t stop it and give space for our system to recover, our body –together with our sense of self— will collapse as well. PTSD will then be a new normal in our daily functioning. We will keep living in survival mode indeterminably.
So how can we stop that from happening? So far I’ve given you all the bad news on how primitive our survival mechanisms can be. But now we need to talk about the good news: our brain also has extremely sophisticated mechanisms to empower us, to motivate us, to keep us safe and thriving.
Social engagement is the first resource our system relies on in order to evaluate safety and feel safe. If we make human contact, our system calms down and the survival mechanisms don’t override our will. The isolation that has been imposed, especially in NY where so many people live alone, is making this valuable resource unavailable. But we are living in privileged times where we have so much technology to assist us. One of the sophisticated mechanisms of the less primitive part of our brain is imagination. We can “pretend” we are having warm social connections through a screen, which will lead the nervous system to relax, and fear to subside.
We also have the capacity to bring energy back to the parts that we need to use in order to calm down (instead of the other places our energy can go, like I described above). If we stimulate our rational brain with positive thinking, with realistic assessments, with sticking to hopeful outcomes (even if only imagined for now), the “survival mode” will stop because the brain will believe we are doing well and things are OK.
We can also use our cognition, determination and will power to override the survival responses. We can decide to tolerate the uncertainty and to manage our anxiety, for example, by reducing the amount of news we watch or read, by appreciating the positive aspects of our lives, and by focusing on whatever makes us feel better. We need to surround ourselves with faces that convey care and that provide comforting words. Not the face of a reporter that is trying to beat the competition by exaggerating the reporting of the situation, but the face of a serene person that is more resilient and has not allowed the survival mechanism to rule his or her life, even if it’s that of an actor in a romantic movie.
This is the time to build resilience, to reach out, to entrust our strength and the strength of elected officials, of the doctors, of society. This is the time to gain control of our thoughts and emotions and to learn how to take control of illogical reactions of survival.
We still carry today the responses of our evolutionary brain around survival and fear. Even when times are easy, the primitive brain can take over. This situation makes it even tougher to avoid that from happening. But we always have a choice because our evolved brain understands hope and trust. We can grow out of this situation stronger, motivated by our immediate need to feel better. By working at it, we can emerge from this stronger than ever. It won’t be easy, but it’s better to start the effort to stop long term traumatization now, so that we may make ourselves more available to help those that are currently suffering from physical illness. Let’s help each other by helping ourselves first.