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2020: The Year of Living in an Effin' Submarine.

Combating a mental health pandemic, continued: The home front

A month ago, when I decided to write a COVID-themed post, I didn't expect to ever write another—the thought never crossed my mind. But like everybody else, I've had to adjust expectations over the past few weeks.

Within days of the San Francisco Bay Area shelter-in-place order, my workday shifted from a full-time office practice to a full-time telemedicine practice. I'm lucky enough to still be working full-time, but for several weeks now I've been seeing patients remotely from home, sharing the wifi with several other family members who are working or schooling on the web.

If you had asked me beforehand which patients I expected to have the biggest challenge adjusting to this situation, my first concern would have been for my anxious patients. That's a professional expectation I've had to adjust: While the immediate public health crisis amped up anxiety for some of these patients, others experienced a paradoxical reaction. When I asked them how they were coping with the rapid pace of change, some said: "You know what, Doc? That's just my normal life." Or: "I always have trouble relating to other people. The fact that everybody else is going crazy right now barely registers on me." Ironically, what has been a period of immense stress for many has felt like "more of the same" for some with pre-existing mental health conditions.

But that was all just during the first two weeks of the shelter-in-place order. Recently, I've noticed a shift in attitude as patients, family members, friends, acquaintances, and I are grappling with being cooped up for weeks going into months with no end in sight. As one of my most eloquent patients expressed it, "I'll tell you what, Doc: It's like living in an effin' submarine!"

Andrey Kuzmin/Shutterstock
We all live in an effin submarine!
Source: Andrey Kuzmin/Shutterstock

So that brings me to today's topic:

"10 survival tips for life in the COVID-19 submarine."

1. Keep a schedule. The first thing many of us chuck out the window when we're stuck inside the house is our daily schedule. What difference does it make when we do things if we're sleeping, eating, recreating, and working all in the same place?

But just as living at a 24-7 all-you-can-eat buffet wouldn't be beneficial for your physical well-being, living a "smorgasbord lifestyle" isn't beneficial for your mental well-being. Like it or not, everybody does better when there is a structure and rhythm to daily life. Make a daily schedule, and stick to it.

2. (a) Get up and go to bed at a set hour every day. Your wake-up and go-to-bed times are the first entries you should make on the schedule from tip number one. Sleep is one of the pillars of mental health (see my previous post "Four Simple Things You Can Do For Your Mental Well-Being"). Having a solid period set aside for sleep (generally at night) and a separate solid block of time to be alert, active, and productive during the day is therefore paramount.

(b) Separate where you sleep from where you are awake. If you have the space, sleep should be done in a room apart from where you spend the rest of your day. If you don't have enough room for that, then at least move as far away from your bed as possible when you're awake.

3. Wash, groom, and get dressed every day. Don't spend your whole day unwashed, scruffy, and in your pajamas. Remember, that's what severely ill patients in the hospital or on a mental ward tend to do. Grooming and dressing every day is a multi-sensory reminder that you're healthy, sane, and have a purpose—on the inside and out in the world.

4. Separate work from play. Remember how before this whole COVID-19 thing happened, many people were so concerned about maintaining a proper "work-life balance"? So what the hell happened?

Look: If you've been fortunate enough to keep your job during this pandemic, and especially if you are now working from home, don't make the mistake of blending work with the rest of your life into one big, gelatinous stew. Set aside certain hours of the day for work, and other hours of the day for "absolutely not-work." During the not-work hours you can do anything else—but your work phone, work e-mail, work computer, work meetings, etc. should be absolutely off-limits.

5. Schedule time for play. This is the flip side of tip number four. Those of us old enough to remember The Shining know that "All work and no play makes Jack a dull boy" - and doesn't lead to a happy ending! Preserve your sanity—make sure there is specific time set aside in your schedule every day to take a break and have fun—and then do it.

6. Exercise daily, outside if possible. This is related but not identical to tip number five. In addition to having fun—which might include reading a book for pleasure, doing a crossword puzzle, playing board games or charades with the family—it is separately important to physically exert yourself each day. Daily exercise keeps both your body and brain healthy. If allowable in your area and safe for you medically, you should get out of your home while you exercise—preferably in the fresh air and sunshine—just maintain appropriate social distancing while you do so (see tip number seven).

7. Stay social. Yes, we all have to practice social distancing. But that doesn't mean you should be antisocial. Find ways to stay connected with important people in your life. If you're sheltering-in-place with family, remember to give each other space (appropriate social distance from a family member may at times be far more than 6 feet)—balance family time with time alone and time with friends—by video or phone if necessary. As my youngest child wisely observed, "The good thing about this is I'm spending a lot of time with my family. The bad thing is it's only my family."

8. Limit all forms of screen time. One of the unanticipated consequences of this situation is that we're not only working more on screens - we're doing everything more on screens. That includes learning, teaching, working out, socializing, reading, and getting entertainment. Make sure you turn every screen dark and do something else for at least a few solid hours each day. Spend more time away from screens on weekends, or any other days you're not tied to one by your job.

9. Turn off the news and social media. Twenty-four-hour commercial and social media coverage of this pandemic is not helping anybody. Turn it off. If you don't want to miss important developments, schedule a well-defined time each day, or perhaps just once or twice a week, to check a trusted news source for what you really need to know. Avoid trying to stay abreast of all the latest COVID-19 chatter. Rest assured, even with every news channel muted, you'll still hear what you need to hear when you need to hear it.

10. Do your part not to contribute to the chatter (see tip number nine). Information, like oil, is not at a premium right now. Of course, you should share this blog widely—but don't re-post everything you hear, read, or see about the pandemic. The echo chamber is already shuddering; there's no need to add your voice to it!

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