As a psychiatrist, my most common patients during the pandemic have been working mothers trying to manage a full-time job at home while also being primarily responsible for children at home. Most report feeling irritable with low energy, difficulty focusing, uncontrollable emotions, guilt over perceived privilege, loss of interest in past hobbies, general lack of motivation and thoughts about death and the meaning of life.
They aren’t sure if what they have is clinical depression but are left feeling incompetent at work and at home.
Their feelings aren’t unique. The National Center for Health Statistics and Census Bureau’s Household Pulse Survey shows that in the third week of July, 30 percent of adults had symptoms of depressive disorder, compared to 6.6 percent last year; 36 percent had symptoms of an anxiety disorder, compared to 8.2 percent last year. Commonly affected groups appear to be women with children, young adults and people who are in sexual and gender minority groups.
Many are experiencing trauma from the widespread pandemic, grief over losses (be they life, job security, relationships or former ways of living), legitimate fears of getting sick and the absence of community and caregivers. In the background, all lack many of the typical outlets for coping with such stressors, including gym workouts, vacations, office talk and outings with friends — because, of course, exercise, regular sleep, healthy eating, social contact and a routine can help mitigate feeling depressed.
Beyond that, with the medical necessity of unprecedented physical distancing comes touch deprivation and social isolation — the latter of which is may rival obesity in its ability to harm one's physical health. But, increasingly, evidence suggests that video calls can help prevent depression. One study in Cyberpsychology examined levels of connectedness among pairs across four types of communication (in-person, video chat, audio chat and instant messaging). The highest levels of connectedness were in-person, but they were only slightly higher than the video chats.
While we are all experiencing ennui and collective grief, we need to understand, too, that there is a spectrum of clinical depression and that if you or a loved one find yourself on it, it's time to seek help.
We all have bad days, but when the periods of sadness persist throughout the week and months and are severe enough to impact functioning, that's when it might be time to consider seeking professional help. We need to shift our inner dialogue — and even our broader social understanding — to realize that though feeling depressed at times is a normal reaction to the extreme amount of stress most people have experienced since the start of this pandemic, a normal reaction doesn't mean you shouldn't seek assistance for it.
What should you do if you are feeling depressed and are unsure if it’s something serious that needs professional attention? Question how persistent and severe your symptoms are and recognize the difference between sadness and depression.
Persistent, extreme hopelessness and negative thoughts about self-worth — such as, “I’m horrible at this.”; “Why can’t I do this?”; “I should be able to do this and clearly something is deeply broken about me.”; “I’ll never be able to be anything.” — should be seen as a sign of depression and a reason to seek support from a mental health professional.
Now is the time to both question and prioritize our needs, not ignore them for the supposed greater good.
For instance, I have a patient who was working full-time while caring for her children at home. She was filled with guilt that she was not “good enough” in any area of her life because she was denying her children access to normal social outlets while also failing to be as productive at work, but also resentful toward her spouse and children.
Resentment is a sign that one’s emotional needs are not being met: Instead of owning our needs, we may find ourselves minimizing them or being ashamed of them. Neither eliminates the needs themselves, but rather leaves us with anger when the needs remain unfulfilled.
My patient — like anyone else — needs to feel safe, competent at work and loving as a parent. Only after respecting that she needs those things can she let go of her guilt and allow herself to seek realistic and creative solutions to having her needs met.
Her need for safety provides the rationale for not allowing her kids to have guests at her house. Her need to feel competent at work should allow her to have a discussion with her employer and problem-solve temporary changes in productivity or a change in work hours. Her need to feel loving as a parent can guide her to consider bringing in outside help — a family member, friend or other caregiver — while still respecting her need for safety.
Sometimes, depression and resentment can be a sign to ask what your needs are and embrace them unapologetically.
Meanwhile, you can watch your own loved ones for signs of helplessness, hopelessness and negative self-appraisal. Then try to listen and validate the reasons for those feelings, while holding back on trying to fix the situation. We can let loved ones know their feelings are understandable while also helping them to keep perspective: Yes, times are tough, but that doesn't mean they are failing to be tough enough.
Depression can change the lens through which people see the world with a focus on the negative — such as the limitations and freedoms lost during this time. Those of us lucky enough to be able to maintain perspective can gently shift them toward a more balanced view that includes what one can still do in these moments and the gratitude that comes with that.