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How to tell if the Covid-19 pandemic made you paranoid or just appropriately cautious

The ongoing uncertainty does calls for some caution — as well as forgiveness for the decisions you and your loved ones make with incomplete information.
Image: Restaurant, masks
A waiter wearing a mask and gloves delivers food to customers seated at an outdoor patio at a Mexican restaurant in Washington on May 29.Saul Loeb / AFP - Getty Images file

Every day in my still-virtual psychotherapy office, clients question whether or not to go back into their workplace, meet friends for a drink at an outdoor café, or send children back to school or college — and their own reactions to those dilemmas. A shy young woman who has enjoyed sheltering at home during Covid-19 said, “I’m not sure if my anxiety about going back to work is just my regular discomfort about being in groups, reasonable anxiety about being with people inside, or pandemic paranoia.” A new client told me, “I’ve never had any difficulty with separation before.” She said, “But now I’m afraid of letting my children out of my sight.”

Meanwhile, another client is thrilled to be returning to work. “The dangers of the virus are down right now,” they said. “Everyone’s being careful — even people on the subway are wearing masks. And it’s so wonderful being back with people, even if it’s not the full contingent of employees. Everyone was kind of giddy at work on the first day, so happy to be back together. We need this!”

Since the beginning of the coronavirus pandemic, questions have arisen about which normal behaviors are safe and what are dangerous; just the uncertainty itself can lead to psychological concerns. Dr. Elizabeth Weinberg, a psychiatrist and psychoanalyst at the Austen Riggs Center in Stockbridge, Massachusetts, told me, “Because we’re dealing with a virus that even the greatest experts don’t fully understand, concern seems reasonable, not necessarily paranoia or a sign of PTSD.”

Research based on past epidemics suggests that those who have had the virus or have family members who did, as well as those who have witnessed the illness and deaths at close hand are at the highest risk of post-traumatic stress disorder — but studies have shown that not everyone who experiences trauma develops PTSD. Still, difficulty trusting our own decisions is a common reaction after a trauma, as adult trauma specialist Dr. Ghislaine Boulanger wrote in her book “Wounded by Reality.”

Pressure from others can make decisions about what to do in this stage of the pandemic even more difficult. Parents are labeled overprotective “helicopter” parents by others who make different choices. Friends are criticized for decisions to eat — or not eat — at outdoor restaurants. And bosses and co-workers communicate their own opinions about what they think we should do about coming back to work.

In the United States — where some schools are opening to students while others are offering only virtual classrooms — parents are torn between legitimate concerns over safety and their worries about the impact of continued isolation on their children’s development. Ilana Steinhauer, executive director of Volunteers in Medicine Berkshires and the mother of twin 7-year-old boys told me, “As parents we are used to reading multiple opinions and deciphering what we relate to, but with Covid it’s out the door. No one really knows what’s right and the answers keep changing.”

Tori Pajeski, a licensed clinical social work psychotherapist with whom I spoke has been seeing her psychotherapy patients virtually during the pandemic. She said that she felt safe enough to send her high school age child back to school because her community has an extremely low infection rate and because she trusted the school committee’s willingness to make adjustments should the situation change. But she brought her older daughter back home from her freshman year away at college shortly after the semester began. “Her roommate and several other kids in her dorm tested positive for Covid,” she explained. “While this is an awful year for college freshmen, we did not feel that we could compromise our child’s future health.”

Another friend recently told me that she was worried about her adult son. “My community hasn’t had a death or even a hospitalization related to Covid-19 for several months,” she explained, “so I felt like it was safe to have a family gathering.” She invited her grown children to come over with their own children for an outdoor, socially distanced gathering, asking everyone to wear masks if they came closer than 6 feet. But her son and his wife refused to join them. “I don’t think we’re foolish to get together this way,” she said. “Maybe he’s gotten paranoid from the pandemic.”

Caution and risk-taking behavior are susceptible to individual circumstances and psychological makeup. For instance, Weinberg said that sometimes extra caution can help someone like my shy client, who suffers from anxiety, move back into the world.

Other people may have legitimate reasons to be extra cautious. In a recently published article, Kimberly Grocher, adjunct professor at the Columbia University School of Social Work, and several colleagues wrote that "racial disparities have contributed to disproportionately higher rates of Covid-19 infections among people of color, who are dying at two to three times the rate experienced by whites when adjusted for age." Dr. Jean Clarke-Mitchell, a professor of social work at Westfield State University, told me that since “some communities of color have been disproportionately devastated by family losses, it is reasonable that they are even more cautious about moving forward.”

Physical health issues can also influence an individual’s decision. Someone who suffers from an autoimmune disease may appear perfectly healthy but may need to take extra safety precautions to protect themselves. My friend’s son who stayed away from the family picnic wasn’t being neurotic, it turns out: He and his wife had just learned that they were expecting a baby and were being extra cautious about possible exposure to Covid-19.

So, while moving back into the world when it feels or is safe enough to do so can be good for the economy, it can be good for our psychology — as long as it’s done at the pace that feels right for each of us.

However, Weinberg added, “I’ve seen patients who have become irrationally afraid of risk (such as going outside in areas where it’s easy to keep distance).” And denial of the potential dangers can lead to unsafe risk-taking behavior: Weinberg said she would tend to see moving into the world “without any concern as involving some minimization of actual risk or even denial.”

And while we may not know what goes into someone’s reasons for making particular choices, it is important to protect ourselves and our loved ones from others’ risky actions. Pajeski says that she feels comfortable getting take-out or eating outside a restaurant, but not inside where other people could be unintentionally spreading the virus as they talk and laugh and eat without masks.

In the end, since even the authorities are unclear about the best way to move forward right now, the best any of us can do is consider our options, explore the possibilities, choose what seems right for us and our families, and give ourselves permission to make less-than-perfect decisions that we will reassess as time goes on and new information becomes available.