I’m calling it Post-Pandemic Adjustment Syndrome: On getting out in front of the Mental Health crisis that is emerging, and coming

By now, so far into quarantining and physical distancing that your days are running together, you are beginning to see that this pandemic, this new and forever changed normal, is impacting you, and those around you, and neighbors from afar. You may have seen reference to the U.N. report on a looming global health crisis (Reuters, 05/14/2020), or come across Kaschak’s (2020) reference to “Post Pandemic Stress Disorder”, and wondered whether your own mental health and wellness are in question.

What we generally appear to agree upon is that a crisis is coming. It is here, in fact. Your questions of the emotional wellness of yourself and others are not isolated ones. Many of us are struggling. Many who are denying those struggles are finding profoundly interesting ways to distract and sedate themselves, and still many more are leaning in and describing their struggles. I would suggest that a benefit of this time is that we have created the room for the normalizing and processing of our unwell thoughts and feelings more readily. That is not to say it we have created a full functioning culture for engaging our mental health, but we have created some ragtag version of a thing, some communal process that we are tapping into. It has allowed our systems to know that we are reacting to our reality. This pandemic has created in us, something different. Several things, all flowing together. You are right to ask questions of yourself, and others, and your functioning.

We are seeing reports, nearly weekly at this point, of the struggles of populations the world over in managing their emotional health, and the kinds of symptoms which are being triggered by isolation, grief, a rejection of a new reality and confronting mortality. We haven’t yet drilled out to very much definitive, but we have reason to be concerned about the relationship between unemployment rates and suicidality. We have been provided reports and images of front line medical staff grappling with stress reactions. We are being flooded, and probably experience first-hand, bouts of sleeplessness, nightmares, elevated anxiety levels, anguish, depressed mood, poor concentration, excessive worry and the agitation associated with wanting to get out, connect, and change routine. These feelings, these processes, are our new normal, in some ways.

That is not to say that we will not reset post-covid, but it is to say that having to live with these many stressors changes the brain. It changes how we process information and our environment. It changes how we build emotional defenses and it shapes how we experience our environment. That is, in large part, what makes so much of what we see rather like its own brand of Posttraumatic Stress Disorder. Thinking of much of what we will see in others coming out of this pandemic being a result of their experience of these events as traumatic is sound. It feels, and is, just right. We shouldn’t stop there though.

As a Clinician, I felt prepared to accept that the moment, right here in the midst of this global pandemic, was feeding and growing a unique version of PTSD (or PPSD), but I wasn’t able to stop there. Not as I read more, and inquired more, and processed more.

What I am hearing in our society, and in so many others, and seeing in the desperation of many to “open things back up”, is a brand of immature, frantic hopefulness. One that you simply don’t come across very often with “simple” PTSD. What we are seeing is something entirely different, a new stew and gumbo, and we should see it, the better to be prepared when our children need return to schools, and adults need to return to jobs, and routines need to re-emerge at some point.

I’ve termed it Post-Pandemic Adjustment Syndrome. We Psychologists, and truly most other mental health specialists, tend to use disorder and syndrome interchangeably. This typically results from a need to transmit meaning to the public we serve, quickly and in lay terms. Briefly, a disorder is typically characterized by a significant disturbance to the functioning of the being’s systems and quality of life. A syndrome is thought of as a grouping of signs and symptoms which are associated with a disease. I am conceptualizing what we are experiencing in its development, as a syndrome, and one characterized by issues of adjustment.

Adjustment Disorder. That grand, wide, misunderstood diagnostic criteria, often made an afterthought. I intend to promote it here, and link it, as it fits. We have seeing elements of anxiety and mood disturbance. We are seeing reports of physical symptoms secondary to these psychological symptoms, and we have a vast library of timelines indicating that these symptoms have emerged following the stressors of adjusting to life at home, unemployment, responsibilities for some including homeschooling, feelings of freedoms lost, isolation/disconnection, and having to spend time with the self.

That last is a critical one, so far as wellness and adjustment go. I’ve seen in my own circle, and you’ve probably had thoughts of your own, wherein you endure emotional discomfort and anguish and pain for days on end, believing that it will all self correct once your life and environment resume proper functioning. You, me, so many others are placing hope on the notion that running free of our homes will repair our bruised and fractured emotional selves. We are spending so much time fighting our adjustment to this bit of new normal, that we are doing likely considerable harm to our well-being. We are further traumatizing ourselves. This new reality blitzed us, and we didn’t have an opportunity to ready, so many of us remain cloudy, somewhere between imagining that this can’t be real, waiting to wake from it all, and projecting resentment over having to be inconvenienced by plans and events not of our creation.

I would suggest that the danger has always been in what we made of our “normal.” Our normal often relies on distracting our gaze away from who we are, and what we are becoming, what we value and what we are feeling. Our normal provides us with a natural narcotic, one that allows us to sail away from processing the things that we find most comfortable, and blurs the questions that we most need to answer about ourselves. Our normal, is wounding us, leaving open wounds and indelible marks, and what this time of pandemic is allowing for is for us to sober up and feel. For those of us who have been distracting ourselves, the idea of becoming whole and realized is frightening.

Actually working on our relationships and partnerships can be intimidating. Feeling unable to escape the very real demand that we be productive daily, is battering us. Feeling inadequate when faced with tasks, and questions, and feeling, some for the first time, emotionally unwell, is experienced as catastrophe.

You are right to feel whatever way you are feeling. Whatever narrative has emerged, is a narrative born of this time, and it needs to be birthed and heard. We will not be prepared, in any way, for what is certainly coming next, should we not ground what is living with us now. We are, across our globe, struggling emotionally, and that is okay. There is more coming.

Humans, suffering, have been holed up and abusing substances in alcohol, failing to identify other outlets. Many have been quarantined with abusers. Some have lost vocations that they will never get back. Some are struggling to find new purpose without so many of the activities which defined their lives.

All of these will come spilling out of our selves and homes when things “open up.” We will, all of us, be confronted with aiding ourselves and our neighbors as they struggle with regaining their footing in spaces where they have atrophied emotionally. We will have to project our whole selves into spaces that have been covered with the dust of inactivity. The period of adjustment, will be a difficulty one.

We are already seeing it. We are seeing, and feeling, armies of beings scrambling to reconnect with the things that gave them purpose. They are shouting, raging and demanding.

We would be wise, those of us who see this disease growing, hardening and reaching its tipping point, to normalize these symptoms for ourselves and others. It would be wisest for us to work to prepare for what is coming, and the associated needs. Because there will be far too many souls for us to help heal. We have already fallen behind. At the very least we can craft a plan to stem some of this enormous tide.

While we remain at a distance, and are noting and observing, we must name the thing, because we are humans, and we require such things to fuel our understanding and action. So Post-Pandemic Adjustment Syndrome is the target, the very colossus looming overhead. Marked by both anxiety and depressed mood, and disturbed sleep, and excessive worry, and an excessive future focus, and agitation, poor concentration and a host of others ills triggered by issues of adjustment to this pandemic, and in preparation for adjusting post-pandemic. It is colored by grief, isolation and a sense of being overwhelmed. In our various virtual meetings, posts and pictures, I would suggest that we many have learned to put on our “Faux Wellness Masks”, so as to disguise our functioning from others. Maybe to protect them, or us, or to protect the image of us that we believe they harbor.

I’d go further. In preparation, I would suggest that we create subcategories for communities of individuals who have been uniquely impacted by this pandemic. Black and Latinx communities have been hit hardest by the spread of the virus, and make up significant numbers of those dying due to exposure. That is a unique grief, one over and above the stress they live with in a tone deaf society. Essential employees are, by necessity, developing elevated anxiety around exposure, worry about the precariousness of their jobs, and the loss of colleagues, friends, patients.

I’ve been doing my best to lead Wellness conversations weekly, and tending to the Wellness of those nearest me and within my reach. I ask you to join, as you need. We are all adjusting, and struggling with it, and sometimes it is best to know the sickness, so we can settle on a course of treatment. We have one, Post-Pandemic Adjustment Syndrome. We can all now, get to, and prepare for, the arduous tasks and work before us, because it is emerging now, but will erupt outward when all “opens back up.”

See you next Well/s Wednesday