It's 2020. Do You Crave Normalcy?
Why that's normal—and dangerous.
Posted Oct 19, 2020
It was early March 2020 and like many in America, I couldn’t sleep. I lay awake in the pre-dawn hours calculating my heart rate and hoping to find reassuring monotony. But the cadence was too fast and my thoughts returned to their cognitive magnet: the novel coronavirus. In a few hours, I would be starting my first emergency room shift since the virus had infiltrated our local community. In fifteen years as an emergency physician, I had never experienced this level of fear, uncertainty, and foreboding. I ached for a sense of normalcy.
There have been many sleepless nights this year. Whether due to economic turmoil and uncertainty, the urgent call for racial justice and the resulting civil unrest, the upcoming election, or the COVID-19 pandemic and its confusing manifestations, 2020 has been a record-breaking year for anxiety.
Americans are psychologically suffering. Two recent surveys, one commissioned by the Commonwealth Fund and one published by the Centers for Disease Control and Prevention (CDC), captured this reality. According to the results published in the August 14th edition of the CDC’s Morbidity and Mortality Weekly Report, the prevalence of anxiety and depression in American adults in June 2020 was three to four times higher compared to spring 2019. A disturbing 41 percent of respondents reported adverse mental or behavioral health conditions, with nearly one in three reporting anxiety and/or depression.
We seek normal. We yearn for a world in which we can see a smile rather than a mask, safely hug our parents and grandparents, and in which we don’t have to obsessively estimate six-feet distancing. We long for balance in our internal milieu, our homeostasis. And while this is a psychological imperative, it is also a biological one.
We know that when people abruptly move from temperate to hot environments, they go through a rapid series of biological changes that are called acclimatization. Most of us have experienced this—a winter vacation to the Caribbean requires several days of adjustment and adaptation, not to mention a lot of sunscreen.
These adjustments to environmental heat start right away—more blood flow is sent to the skin to help shed heat. Sweating increases and core temperature actually drops. Our heart rate ticks down a few notches, as does our blood pressure, and our kidneys hold on to water and electrolytes. There are at least 25 measurable changes that happen to our bodies and they all start within minutes and reach a new steady state within a couple of days. Physiologically, this process reduces the risk of serious heat illness and allows our bodies to remain active and survive despite environmental changes.
We know how our bodies adjust to different climates and altitudes—but we don't really understand how our brains acclimatize to abrupt and profound changes in reality, such as the emergence of a novel, invisible, and deadly virus, or an unexpected result in a presidential election.
Rewind to the aftermath of our last presidential election. For me and likely for many others, consistent sleep was hard to come by for months after November 8th, 2016. Early morning would greet me rudely—heart galloping and mind perseverating—a windmill of disbelief and uncertainty. Ronald J. Pelias published a paper in the journal Qualitative Inquiry on the phenomenon, entitled “On not being able to sleep: After the 2016 Election.” He opened the piece with: “Following the 2016 U.S. presidential election, I find myself struggling, wanting to find a narrative that will let me sleep, but I am unable to find any comfort in the current political landscape.”
It is now October 2020 and, mostly, I sleep soundly. Occasionally the night after I’ve treated a patient with COVID-19, I may wake up a few times and deeply inhale the scent of my own arm (as you may have heard, loss of smell, anosmia, is one of the most predictive symptoms of COVID-19). But my heart doesn't race anymore. I still have fearful moments, but less often, and less severe. If I were recovering from the death of a loved one, one might say that the clouds are softening and the gloom is lifting.
Except for that, they shouldn’t be. All but the most doomsday fears that kept me awake in November 2016 and March 2020 seem to me as if they have come to pass. The violation of norms, decorum, truth, and basic decency cascade so rapidly that it is impossible to process all of their off-colors onto the same canvas.
This return to normal sleep function was a biological imperative. The reality is that regardless of fear of a virus or the shock of an election result, we really have no choice but to normalize. If we don’t, we will eventually succumb to the cortisol, stress, distraction, and insomnia. If depression doesn’t get us, substance abuse or psychosis will.
Unfortunately, and tragically, we live in a moment in which our individual imperative for normalcy puts us at collective risk. While we adapt to our own personal existential threats, on a larger scale we face a combination of variables that put the ethos of our country at existential peril, not to mention the threat to the survival of our planet as we know it. For many, the toll of the virus, its concomitant economic disruption, and a government that seems to have failed us (due to incompetence, disregard for science, and worse) are too much to handle. Our comfort is to seek normalcy.
The solution to this paradox is to compartmentalize the abnormal into digestible aliquots. Avoiding television and social media will likely help—a study of stress reactions after 9/11 associated levels with the extent of television viewing. But of course, we can’t stick our heads in the sand to avoid confronting pain and discomfort.
Instead, we can control what we can control in our environments and advocate for what we believe in. Avoid despair but avoid giving up. In order to truly return to normalcy, we need to always remember that we are not living in normal times. On election night 2016, author Amy Rose Spiegel tweeted “Tomorrow, I hope we are all still as sad and disgusted as we are right now. The day after, and next year. Hold on to this feeling tight.”
While our biological imperative will not permit us to actually hold the feeling tight, we can choose to hold our principles tight. The antidote to our current acclimatization crisis is to do whatever we can to change our reality.
The opinions expressed here are mine and do not necessarily reflect the views of affiliated organizations.