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For the past few weeks amidst the current crisis I've been mulling over what to write in this space. Regardless of the timing of recent public health proclamations, it’s been apparent to me for several weeks that we were headed into the throes of a pandemic (a global epidemic) - one that it is clearly both biological and psychological. The biological pandemic is of course the spread of the Covid-19 virus and its direct effects on individual human health, which ranges from mild (almost no symptoms in many people) to severe (death in a small percent of cases, chiefly among the elderly and medically compromised).
The psychological pandemic is an indirect effect of the biological pandemic: It is the toll on the emotional and behavioral health of human beings, which ranges from mild (“What’s all the fuss about?”) to severe (panic, hoarding, paranoia, aggression). On the societal level we are witnessing these psychological effects transformed into shortages of basic store items, daily convulsions in the stock market, and isolated (thankfully so far) incidents of violence. Also at the societal level, the argument over what is an appropriate level of precaution versus inappropriate fear has already become highly politicized: In the US, liberals blame conservatives for underplaying the severity of the pandemic in its early stages leading the country to be unprepared; conservatives blame liberals for irresponsible fear-mongering contributing to panic and economic turmoil. Forces beyond our shores are doubtlessly already taking advantage of these new political battle lines.
If you’ve been paying attention you will have recently seen memes proliferating on social media that poke fun at these divisive positions while also insidiously reinforcing them. The origins of these posts may not all be as innocent as they seem; at least some could be the product of sophisticated operations purposefully seeking to weaken our society and its geopolitical power by exploiting these new fault lines.
What to write in a blog entitled ‘Healthy Prescriptions’ focused on promoting mental well-being?
My answer: If there’s a silver lining to this pandemic it lies in the opportunity to collectively reaffirm the central value of ‘Social Vitamin C’. I don’t mean ascorbic acid; I’m talking about Courtesy, Consideration, Caring, Community, and Compassion.
I work in in a community approximately midway between San Francisco and Silicon Valley. My office is part of a large multi-specialty medical center, most of my patients are solidly middle or upper-middle class individuals with good medical insurance provided by their employers. Many work in the highly competitive and success-oriented computer-tech and biotech sectors that have driven our local economy to astronomic levels in recent years. That same economy also drives some of its participants a little bonkers sometimes, which is where I come in.
Patients who come to see me most often are suffering from depression or anxiety. As I talk with them a theme that frequently comes up is whether their problems are genuinely psychiatric or simply ‘situational’. I hear this refrain all the time: “I know I’ve got a problem but it’s because this area is so competitive. My job is toxic but what choice do I have? At the same time my family life is suffering…” A patient once told me she knew she didn’t really have any psychiatric problems because even though she definitely needed pills to function around here, she once spent a month meditating and eating raw vegetables in an ashram in the Philippines and all her problems went away. I told her she was absolutely right: so long as she could live the rest of her life in an ashram in the Philippines she didn’t need to take psychiatric medications. Similarly, when a well-to-do patient asks me: “Doctor, what’s the best way to stop taking my antidepressant medication?” I typically answer: “While vacationing on Maui.”
The point, of course, is that all psychiatric problems have a ‘situational’ component. My medical specialty recognizes this by including, in any formal diagnostic formulation, a list of the particular ‘psychosocial stressors’ (ie. situational factors) contributing to a patient's illness.
The broader point is that the choices we make as a society can keep us mentally healthy or drive us insane, both individually and collectively. Those of us who participate in modern democratic industrialized societies enjoy tremendous benefits that were undreamed of by our ancestors and that are the envy of many people today who don’t enjoy the same privileges. But each of us, individually and collectively, have implicitly made a certain bargain along the way by virtue of our participation in this society. That bargain includes a loosening of some of the institutions and a reduction in some of the values that traditionally kept our ancestors emotionally healthy, well-balanced, and happy. At the extremes, ‘career’ takes time and precedence away from ‘community’, while ‘competition’ takes the place of ‘courtesy’, ‘consideration’, 'caring', and ‘compassion’ for our fellow human beings. Among the consequences of this bargain is that if it gets too far out of balance and finally goes sideways, individuals become depressed or anxious and wind up in the office of a professional like me.
The Covid-19 pandemic constitutes a major ‘psychosocial stressor’ for everybody on Earth at the same time—it thereby increases the prevalence of emotional problems across the board. As the virus has become a global epidemic and spread, so too has anxiety, fear, panic, paranoia and antisocial behavior. The ‘vaccine’ for this aspect of the pandemic is to reaffirm and strengthen the bonds that tie us together. Now is the time to remember the 400 year-old meditation of John Donne: “No man is an island entire of itself; every man is a piece of the continent, a part of the main.”
The psychological contagion caused by Covid-19 can be overcome by remembering that we are all in this together. That includes following the advice of public health experts about ways to prevent viral spread, including ‘social distancing’. But it also includes remembering that this is one time when you really don’t want to ‘be first’, so make an effort to be especially courteous to your fellow human beings when you are at the grocery store, out in other public spaces, or driving on the road. Have consideration for others when using a public or private facility – even if you’re not symptomatic and don’t think you’re infected, do your best to keep the area clean and hygienic for those who come after you. If you do encounter someone who may be infected, be courteous, considerate, caring, and compassionate.
Before this is over, you may very well find yourself in their position, relying on the caring and compassion of others. At the societal level, we should similarly not only be thinking about ways to reduce spread of the virus by tightening borders and restricting travel, but also about how we can act compassionately to help people in our own community and in other communities that are more affected; there are many places in the world where a greater proportion of the population will die due to inadequate public hygiene and poor access to advanced health care.
The Covid-19 pandemic is a challenge to individual lives, as well as to our health care system and the global economy. It is also a challenge to our mental well-being, as individuals and as a society. And it is an opportunity to re-emphasize core values that are easy to overlook when all is going well. So please at this time make a daily effort to inoculate yourself and others with Social Vitamin C - Courtesy, Consideration, Caring, Community, and Compassion – and we’ll all come through this better together.
