Co-authored with Elena Perea, M.D., a psychiatrist and adjunct associate professor at the UNC School of Medicine.
Nine months into the SARS-CoV-19 pandemic, as the third, largest, most dispersed wave of transmission hits virtually every state in the country, the U.S is embroiled in ideological conflicts about public health measures to stop its spread. The country is experiencing complex trauma. That trauma is silently influencing how we think, how we make decisions, and how we act in powerful ways that are predictable to experts in psychological trauma, but often obscure to those in the midst of it. If we do not acknowledge and address the influence of trauma and cognitive distortion on the public narrative, we will never change the direction of this disease.
When COVID-19 hit in March 2020 and the Northwest and Northeast were pummeled by tragedies, the country came together. Communities rallied around doctors and nurses and called them “heroes,” recognizing the tremendous courage inherent in the simple act of going to work as they were trained to do. Congress passed emergency relief bills. Americans felt a wide range of emotions—pride, anxiety, fear, anger, and grief among them—and felt them together. Those were the heroic and honeymoon phases of this crisis. The relentlessness of the threat, though, has driven a prolonged period of trauma and disillusionment, which only intensifies the longer it lasts.
The trauma inflicted by the coronavirus, continually unfolding for months now, are obvious—deaths, missed milestones, isolation, financial distress, among others. What is harder to see is how those events twist perceptions, reactions, and decisions in potentially troubling ways. Experts in fields of psychological recovery recognize this cognitive landscape, but for most, the world just feels inexplicably fractious and confusing, frightening and oppressive. While most will emerge from the experience without permanent psychological scars, adjusting for the cognitive distortions that accompany prolonged traumatic exposure will help us plot a more rational course for the future in this pandemic, just as mapmakers manage distortions imposed by the earth’s curvature.
The U.S. has been an uncontrolled experiment in feral anxiety since March. Without clear, consistent guidance about how to stay safe, individuals have fallen back on their own coping skills. Some have run towards their fears, hoping to quell them through intense, repeated exposure. Some denied their fears, detaching from the trauma or dismissing the threat of harm (COVID is just the flu; most people don’t get “that” sick). Others expend great effort to avoid the anxiety—layering in masks, gloves, and goggles on the rare occasions they leave the house and disinfecting everything on return. Though the coping strategies vary, what is consistent is the conviction that one’s preferred approach is superior to others—pitting family, friends and neighbors against each other.
When friends, communities, or the world in general does not adopt the approach we think is safest, it can feel like a betrayal. Then it becomes easier to view those who betrayed us in a negative light. It is common to lose faith in previously held beliefs, to find trust in institutions eroding, and to quickly dismiss friends who disagree. Add the oscillating emotions that are part of trauma—intense anger one minute, dissolving to tears the next—and it is easy to feel increasingly isolated and misunderstood.
The other trick trauma plays is to foreshorten the future. The imminent threat to our survival now makes it hard to see ourselves later—in the future—and, as a result, we develop a fatalistic perspective of risk. What does it matter what we do? It’s unlikely to make a difference and we probably won’t be around anyway.
Black and white or all-or-none thinking makes the future and the changeability of the world hard to see: There is no tomorrow or “after COVID." COVID is the new normal; it is forever, not for right now. New York City is dead, and people will never return. But we know from previous experience that this is not the case. New York City survived the pandemic flu of 1918, and the cataclysm of 9/11. But the sense that the present is forever also drives decisions about opening the economy that are dangerous. If we can only see COVID as forever, and we see nothing as within our control to stop it, the urge to open the economy, sports, and schools to be spared some of the economic pain of the pandemic will be overwhelming.
The uncertainty of the future—of jobs, family, friendships, pastimes—is disorienting. The losses and grief and trauma of COVID-19 are relentless, and that trauma distorts our thinking. But taking a lesson from cartographers, if we take our distorted perceptions, cognitions, and catastrophic extremes into account, we can chart a more rational future, more tolerant of our distress. It is time to acknowledge our collective trauma and adopt trauma-informed approaches to mitigation and recovery.
