As I’m sure many of you know, May is Mental Health Awareness Month. Mental illness does not discriminate, as it can affect anyone anywhere, regardless of their race, gender, socioeconomic status, etc. May has been Mental Health Awareness Month since 1949 to raise awareness for and reduce the stigma of mental illness.
The amount of college students facing mental health issues has been on the rise in recent years — mental health symptoms and risk have nearly doubled over the past decade, according to a study done by Dr. Daniel Eisenberg in the Journal of Adolescent Health.
Needless to say, mental health is an important topic and one that is even more important during the COVID-19 pandemic. I reached out to Dr. Miko Rose (DO), a psychiatrist and an assistant professor at MSU’s Department of Psychiatry who also teaches at MSU’s College of Human Medicine and MSU’s College of Osteopathic Medicine, to hear from her and ask her some questions about the mental health of people during this time.
Dr. Rose, thank you for being here! As you know, May is Mental Health Awareness Month. The COVID-19 pandemic has certainly shaken up the world and disrupted daily lives and what we knew as “normal living.” Certainly, this has affected millions of people across the world, not only in terms of financial impacts but mental health impacts as well. The first question I’d like to ask you is if you have personally seen a decline in mental health among your patients?
Okay, so here’s been what’s so fascinating — and this is a question that clinicians, colleagues, and medical students alike have been asking me, particularly because I’m seeing so many people in this web-based format during COVID. I work with everything from people in underserved communities of the community mental health clinics, to students who are here at MSU and who have moved to other parts of the country as well as, at times, other parts of the world. And what I’m seeing is this: regardless of their background, ethnicity, country of origin, personal practice, and/or mental health status, people are falling into one of three categories.
The first category, which has been fascinating now that I’ve been tracking people now for the entirety of the COVID, they seem to have relatively little change. Their lives have changed very little despite all of the differences and changes that we’ve had with homestay orders. For them, they are described as naturally introverts or didn’t go out very often. They found very little to no impact on their daily lives. This is the smallest group of people, but there is an important number of people that should be noted that haven’t really noticed very much other than when they do have to go to the grocery store, they’d prefer and appreciate that there aren’t a lot of lines in the stores and it’s easier for parking. Other than that, they feel sad that COVID is going on for the other people but personally feel very unaffected.
The second population are people who have either gone through a severe trauma, or have underlying psychiatric conditions, like generalized anxiety, depression, or trauma, where this idea of homestay triggered a lot of hopelessness for people. In which cases, what I’m seeing is that people are having increasing symptoms of depression and/or anxiety, and/or even post-traumatic symptoms such as flashbacks and nightmares. In addition, because of the home stay order, people are all describing senses of isolation, sense of feeling alone, feeling unsupported, feeling helpless, feeling hopeless. In these groups, maybe 40-50% have found that their mental health HAS deteriorated at least somewhat since COVID. What has been so fascinating in this population has been when I ask them about the themes that are coming up during COVID, and I ask them, was this a theme or challenge for you before, unequivocally, across the board, their answer is YES. This is whether they are medical students, athletes, whether they are homeless patients, whether they are professors in an academic setting.
Everything that’s coming up for people, whether they feel worse through COVID, has not been in fact a new feeling or challenge, it’s been an exacerbation of what, through courses of therapy, have been come to describe as avoiding the underlying feelings. So people who felt isolated and unseen prior to COVID, are now very much feeling isolated and unseen. People who are disconnected and don’t have community are now really feeling that they are disconnected are don’t have community. People who felt that they were being constricted and held back, who had too many rules and things that they had to follow and do prior to COVID, are now finding that they feel incredibly fenced in and held down by restrictions of COVID. Every single person who I work with who has said they feel much worse through COVID, when we get to the underlying layers of what’s going on, has said COVID has brought out the challenges that they had before, but they weren’t as aware of till the COVID stay home orders have come to pass.
The third group that’s been really fascinating, have been those who said “You know, Dr. Rose, I feel kind of guilty about this, but I’m kind of enjoying COVID. The idea that people are dying and sick is obviously not enlightening for me, but I found the world to be somewhat overwhelming. There was too much busyness, too much activity. I’m an introvert, I don’t like interacting with people in crowds. I found that the space and piece of COVID has actually been personally something that gave me more calm and peace.”
Those are the three groups. It’s really dependent on what the circumstances were before they came in and how that person responded, but I’ve really seen that full ray of three very different responses.
For people who felt like they didn’t really have mental health issues before or for people who are paying way more attention to how they are feeling, or for people who are kind of suffering at this time, what would you suggest or how would you suggest that people deal with their feelings?
Well, first I would say, it’s really hard for us to say “okay, this group is suffering and this group is not.” For what we’re seeing for everyone, including myself, is that things change not only for the medical knowledge that we have, but things change from day to day, if not hour to hour. So we’re now talking in the residency programs within our classes (in reference to the medical students) about patient care, this is what we know today, and for the next day, things may change. So first off, I think it’s important to be aware for people who are even reading this and thinking, “oh I’m really not doing well,” that’s just a moment. And particularly in these times of change, feelings and intensity of happiness or even sadness or anxiety are likely going to change and shift much more quickly in the context of these times.
Second, what we’re seeing is with this global pandemic what is essentially happening is a lot of the phenomena that I talked about in this happiness and wellbeing class for clinicians [part of the Joy Initiative that Dr. Rose talks about later] in that it’s almost like the entire world is being forced into some aspects of mindfulness and mindful being. What often happens when people just sit and choose mediation and mindfulness, to just sit in their own quiet thoughts, if they hadn’t had the opportunity to do that before, some of the first feelings and thoughts may be sadness, a few moments of tears, a few moments of anxiety. Similarly, COVID has put the entire world in this “going within” and this need to sit in silence. If people have been in movement and doing and pushing down their feelings and emotions and not sitting with them, then very likely those feelings are going to bubble up and come up. What people then do, and often in meditation, is that they start racing in thoughts, trying not to meditate or sit and just be present with the emotions. What I’ve seen and what we’re seeing now, if people can sit through and just embrace those feelings, 98% of the time is someone is just staying in their present moment, feelings will resolve. I’m not saying that this hasn’t been challenging for so many people, particularly for what’s going on mentally, this is also an opportunity for us to take the time for rest and this forced lifestyle of mindfulness.
What about for people who are doing that, but perhaps they’re in a tough financial situation and they don’t know what to do. How would they alleviate that? Would they have to move on and accept that things are going to be okay? What would you suggest in that situation?
That’s a good question. One of the worst things that we could do, whether we’re feeling sad or anxious or afraid, is to try to force ourselves to feel something that we don’t feel. Whatever feeling you’re having, in order to be in a better place of peace and calm, is to embrace whatever we’re feeling, whatever is present. There are many mediation instructors who talk about feelings as if they are bees. It’s almost like trying to put bees in a jar. If we try to say “I’m not unhappy. I’m not unhappy. I’m not unhappy,” guess what? Typically, we’re going to feel more unhappy trying not to be unhappy and will have physical symptoms such as pain, soreness, excess fatigue, craving snacks and sweets and carbohydrates, and even things we might not even be craving, just trying to push down those feelings. So, I think that the more that we can just be with our feelings and be present for them, the more that it will naturally start to alleviate so that we can practice deep self care and have a space of inner peace and calm.
You also started a program called the Joy Initiative, a program that focuses on emotional resilience training and mindfulness for health professionals, and you also teach an elective Happiness class for medical students at MSU’s medical schools. Based on what you emphasize in your course, what are some things that you would advise to students in general at this time?
Sure. It’s almost like I could add to the last statement of “it’s not just that you sit with your feelings and you embrace them,” the next step is that once you’ve honored and accepted your feelings is to take action. We know that in any circumstance of trauma, challenge, and any aspect for any human in a challenge, the best things to do while still honoring their feelings and emotions, is to take action, and do something that feels inspiring and uplifting. Not only for yourself, but for other people. We know that one of the things that could be very powerful is to actually take action.
This is an opportunity for many to discover all of the things that you didn’t get to do, and once life starts picking up again, you won’t get to do. While some people are struggling to stay at home and are just getting quite bored, I encourage you to write down, “what are the things that bring joy and are uplifting?” Set a timer for 5 minutes, and write down right now, taking a break from this article, “what are 25 things that make me smile?” I’m going to bet you that 20-23 of those you can do within the rules of home stay orders.
Second, think back, and do a second exercise. I want you to imagine that you’re looking back on your life, one year, two or three years from now. You’re looking back on this time of COVID, and you’re thinking about, “wow, I went through this really challenging time in the world that we didn’t see coming. Everything shut down unexpectedly, first for weeks, and then for months.” Seeing yourself, from the perspective of your future, or your future self. When you’re looking back on yourself during this time during COVID, what do you want to say you did with this time? Maybe even take that same piece of paper or journal or pen, and set a timer again, for 3 minutes, and just start writing. Whatever comes to the page. That’s going to be your key for your next steps and next pieces for action right now.
I would like to thank Dr. Rose for sharing her knowledge and allowing me to interview her. Dr. Rose currently has a Facebook group dedicated to daily meditations and exercises for those who want to take action for themselves. Dr. Rose has a daily theme and leads these meditations, teaching techniques and providing journaling prompts for introspective thinking. If you are interested, click here to join! This is available to anyone who is interested. Also, be sure to check out the Joy Initiative website for more information.
Dr. Rose also mentioned that they are now discussing a potential undergraduate elective in social psychology based on the happiness class for clinicians. If you are interested, please email Dr. Rose!
Please remember that while you may be lonely, you are not alone. If you are in crisis, please text CONNECT to 74141 (24/7 service) or call NAMI’s HelpLine at 1-800-950-NAMI (6264), available Monday through Friday 10 am – 6 pm.