Reluctant on ‘reentry’? You’re not alone
Feelings of uneasiness accompany return to normal as restrictions ease
There has been plenty to worry about over the last year, plenty of things and moments to stir up feelings of stress and anxiety and depression.
A global pandemic is, after all, a traumatic experience.
Local experts say that those mental health issues are persisting, even as the world inches closer to “back to normal.” In fact, the idea of returning to normal life is spurring even more struggles.
“I have seen this both in my own practice and anecdotally we are seeing more patients in the ED with psychiatric issues. I am not sure that the cause is ‘reentry’ but just that the isolation overall has probably contributed to it,” Dr. Angie Nicholas, a family physician and Chief Medical Officer for Einstein Medical Center Montgomery in East Norriton Township, said.
“Many people are calling the next pandemic the mental health pandemic,” Dr. Tim Ring, a Wyomissing psychiatrist, said.
Sure, restaurants are welcoming back diners, office buildings once again have the buzz of workers, schools are returning to inperson classes, families are gathering together.
“Many people are calling the next pandemic, the mental health pandemic.” — Dr. Angie Nicholas, Family Physician and Chief Medical Officer for Einstein Medical Center Montgomery, East Norriton.
But the mental health crisis isn’t magically disappearing.
“Regular life is not a panacea of joy and exhilaration,” Ring said. “It’s regular life and we get to go out and do stuff and hang out with people, but it’s not nirvana.”
An unprecedented year
No one was prepared for what COVID would do to
the world, for what the pandemic would so quickly and harshly change.
To use a word that has become commonplace over the past 13 months or so, it has been unprecedented.
“There has never been, in my lifetime, anything like this,” said Dr. Alison Hill, a psychologist with Berks Counseling Associates. “Not at all.”
Hill said the suddenness of the pandemic, the speed at which it impacted society, left most people ill-prepared for how it altered their lives. And, boy did it alter lives.
The pandemic has made people fear for their health and safety, fear for their lives. They’ve isolated, they’ve postponed, they’ve given up things like hugs and eating at restaurants and visiting with loved ones.
“Our lives have changed considerably in the last year, obviously,” she said. “And, quite frankly, without much warning. I would say that no one has been untouched by this virus and this situation.”
A year ago, most people’s heads were spinning as they suddenly found themselves huddled in their homes. At that time, Hill said, a fear of the virus was the chief concern, with people worried about what would happen to them or their loved ones if they caught it.
As the pandemic progressed, so did its impact on mental health.
Dr. Nora Maidansky, a psychologist with The Human Aspect in Wyomissing, said many people struggled to deal with the “abnormal life” that the pandemic spurred. People weren’t going to work, kids weren’t going to school. Restaurants and businesses were closed, concerts were canceled and travel was restricted.
“For some people it all really hit hard,” she said. “It’s hard to imagine something that had such a wide-ranging effect. It’s health, it’s jobs, it’s financial, it’s family. There’s not a sphere of life that this didn’t effect.”
And all the while, Maidansky said, COVID-19’s death toll continued to rise.
“As deaths started to pile up, some people were really affected by that,” she said. “A lot of people were afraid to get COVID. Or they thought that they’d be fine but were really uncomfortable with the idea of passing it onto someone else and that person dying.”
Ring said that many people found themselves in crisis during the pandemic and without an ability to properly deal with it.
“When you’re in crisis you’re experiencing anxiety but you’re not really processing it, you’re not dealing with it,” he said. “This was scary for a lot of people. And since they were isolated and social distancing they didn’t have time to recognize it as real anxiety.
“It became just a normal state of being.”
Isolation, Nicholas said, compounded the fundamental issues of the pandemic.
“Teens can’t really see their friends, can’t have usual events – proms, dances, parties are all different this year. Schools that are hybrid are struggling - teens that chose to go to school have 4 or 5 in their class, they can’t eat lunch at school, go home for lunch and have one more class on Zoom or other platforms,” Nicholas said.
“For adults I think the lack of control, everyone at home in each other’s space, unsure when or if they will travel or can travel. For those that live alone, I have had some tell me it was weeks that they went between seeing their friends or family.”
Dealing with trauma, old and new
One piece of the mental health puzzle is taking time to finally process everything that has happened during the pandemic, Ring said.
And, he said, it’s important to realize that pretty much everybody else is doing the same thing.
“Nothing is wrong with you, you’re just processing anxiety that is normal given the circumstances,” he said. “It’s a normal reaction to an abnormal situation.”
For some that may be easy, Ring said, something they can handle on their own. For others it may be helpful to reach out to a professional for guidance.
“Why not have an objective person who knows how to deal with confusing situations provide some advice and help clear up the fog?” he said.
But dealing with the past, working through the trauma and grief of isolation and loss, isn’t the only mental health struggle people are facing.
Many people are also facing anxiety over reentering “normal” life.
“As things open up there’s this expectation that we are supposed to be happy,” Ring said. “But we’re still sort of faced with the old stressors we used to have.”
Ring said that rejoining society brings with it anxiety-causing things like dealing with co-workers or classmates again. And then there’s the COVID-related issues, like feeling uncomfortable in crowds or figuring out things like whether or not you should be shaking people’s hands or hugging loved ones.
“There is anxiety for people reentering back into what is now the new normal,” Ring said. “And we’re not getting specific information on what the rules are. Am I supposed to wear a mask outside? When can I take off my mask inside? I got a vaccine, why do I need a mask?”
Maidansky said she’s found that some people are perfectly comfortable returning to normal life. They’re excited to return to work, to get back to eating out and going to events.
Others aren’t ready for all of that.
“Some people are worried to the point of having panic attacks,” she said.
Hill said she has some patients who, during the pandemic, were eager to get back to school sports or their job or in-person classes or eating at restaurants. But now that all of that is becoming possible, they’re uncomfortable.
“Now that the opportuni
ties are starting to present themselves, they are apprehensive about it,” she said.
Figuring it all out
Nicholas advises her patients to talk and share what they’re feeling. And, she added, to add a bit of pre-pandemic activities to their list of things to do.
“I tell them to talk with their friends or family about their feelings. Do things that may help them feel a bit more normal. For example, an outdoor hobby like bike riding or hiking is something that you might be able to do comfortably with friends or family.”
Maidansky said her best advice to patients dealing with reentry anxiety is the same she gave throughout the pandemic.
“I try to get people to look at the risk realistically,” she said. “Are you safe in that crowd? What is your chance of contracting COVID? Of getting sick? Of dying?
“It’s very similar now. If you’re vaccinated, what are your chances of getting sick or dying?”
Ring said he has been preaching patience.
“People need to go at their own pace,” he said. “It’s OK to say to somebody, ‘I’m not really comfortable hugging you yet, but let me take a rain check on that hug.’ Some people will adjust to going back to old routines better than others.
“People have to have realistic expectations.”
Hill agreed, saying it’s important to remember that just because they’re comfortable with something doesn’t mean others are.
“Everybody has a different level of comfort in regard to these situations,” she said. “There are no rules as to how we should or have to reenter society.”
Hill said she is encouraging patients to do things gradually, increasing what they do as they get more and more comfortable.
“People shouldn’t push themselves, there’s plenty of time here,” she said. “It’s also important for people to remind themselves that they have been through a very difficulty and stressful year.”
One tip that Hill thinks can help people struggling with anxiety is to use visual imagery.
For example, she said, if you’re worried about going to a family gathering try to picture what it was like the last time you did so before the pandemic.
“Think about how you felt when you went, walk yourself through it,” she said. “I did it then, I had a good time. I did these things before in the past, before the pandemic, I can do them again.”
And if someone is still struggling, Hill said, it’s important that they know that’s alright. Feelings of anxiety aren’t going to simply vanish, but must slowly be worked through.
“It’s important to remember that change doesn’t come overnight,” she said. “Although this pandemic was very rapid, most things aren’t like that. Change is a process.”
Nicholas echoed that caution. She said if the thought of returning to “normal” is overwhelming, don’t ignore those feelings.
“If you are really struggling, having thoughts of hurting yourself or others, please talk with a health professional. Many are spending a lot of time alone, and for some they realize it’s time to start dealing with issues that would have been ignored before, therapy is something that is really easy to do over phone or web platform like Zoom.”