COVID-19, Physical Illness, and Depression

It’s no wonder the Disaster Distress Hotline in the U.S. has seen a 338% increase in crisis calls from February 2020 to March 2020.

Yet as a Nurse and a Therapist, I never imagined that deep into April, I’d be sitting at my desk in my Seattle artloft, gazing out the windows that look out over Elliot Bay and the stadiums, and see roads empty of people. An occasional pigeon flies by, the Olympic mountains shout their glorious presence, and all the humans of this city are under a Stay Home Order by Governor Jay Inslee.

More than 17 million Americans have filed for unemployment benefits in the past four weeks. Over 23,000 Americans have died from complications of COVID-19. Children and young adults have had their educations interrupted, their graduations to higher education still promised, yet the immediate future seems difficult to predict as we anticipate a recession. Healthcare workers in some areas are scrambling for appropriate PPE (Personal Protective Equipment) so they can do their jobs with less risk of becoming ill themselves. And the correlations between disasters, financial strain, and a rise in domestic violence calls to authorities are proving to be true as well.

Could it be worse?

Chronic Illness and COVID-19: A Disaster Within a Disaster

Yes, it can be worse. And for many of us, the dangers have been lurking everywhere for longer than the coronavirus pandemic has been in existence in the U.S.

Those who have compromised lung function (i.e. asthma, COPD), are immunocompromised (cancer, HIV/AIDs, malnutrition, some rare genetic disorders), or are otherwise more susceptible to infection (i.e. you get colds, flus, pneumonia easily), are people who have been warned to stay away from public spaces and take extra precautions during the COVID-19 pandemic.

These people have been asked to take more extreme measures than the rest of the public. For example, in the early phase of the arrival of Patient Zero (the first known case of COVID-19 in the U.S.), one of my health team members got my attention by emphatically stating, “You absolutely cannot afford to get sick, do you understand? Do whatever it takes to keep yourself away from the public, starting now.”

Although I already have theoretical and practical training in dealing with infectious diseases, I admit that I left the doctor’s office shaken. I was supposed to schedule another follow-up appointment, but we cancelled it, understanding that there would likely be no point of putting it on the calendar unless it was absolutely necessary.

I began to think along the lines of what this novel coronavirus does to the bodies of those who don’t have the recovery path of the 80% who experience moderate to severe flu-like symptoms but recover over the course of two weeks:

  • You experience shortness of breath and respiratory distress that is absolutely frightening
  • You are separated from your loved ones, taken to hospital surrounded by people who look like astronauts or Peeps with plastic shields
  • You may be intubated and aware of that intubation (before being put under to tolerate being placed on a ventilator), which is uncomfortable and also frightening
  • You may be placed into a temporary coma
  • You may or may not have recollection of procedures, surgeries, medications, or other heroic acts done to you to keep you alive

So on the one hand, it’s very likely that those who experience more complex and complicated illness and recovery from COVID-19 could also become depressed in the short term. And it’s possible that that depressed feeling from what you’ve just been through can lift as your body returns to more and more normal functioning, such as being able to breathe on your own, get out of bed, and leave the hospital.

And, it is also possible that depressed feelings around being ill can linger long after the body has recovered from a primary illness.

As we learn more about this coronavirus, recovery from long-term effects of COVID-19 suggest that many people who survive their battle with this disease will still be feeling the effects of it for one to two years, in the form of secondary organ failures, scarred lung tissues, disability, and chronic depression.

From this point forward, your life has changed due to the trauma of care, the disruption to your life, and the road to recovery afterwards. It’s the kind of recovery path that can wipe out your finances, even with good healthcare insurance, because the cost of recovery goes beyond the billable event.

Speaking as one who lives with an incurable autoimmune disease and a genetic kidney disorder, I can say I experientially understand what a fast and tremendous change, foisted upon someone who was otherwise healthy, can do to your life.

Some of the trouble begins, however, when you realize you’ve survived something like this, but you still feel terrible. You get told you’re one of the “lucky ones,” and behind a grimaced smile, you’re wondering”

…what if I can’t find work again? What if my body never feels normal again? What if I feel depressed and anxious for a long time?

It’s a crisis, a disaster within a disaster. Even if the body heals, the mind might take much longer to pick up the pieces and try to move on. Depending on how you as an individual responds to the trauma you just underwent, you might be feeling grief, sadness, a lack of energy or motivation to return to more pleasurable things, anger, denial, or even, a feeling of nothingness. Meh. Blah.

Post-COVID-19 Depression: A Need for Support

There is a strange relief when you find out you’re feelings are not abnormal, and you’re not alone.

While most of us would never wish another human being to have to face the terror and pain involved with physical illness, we gravitate towards those who have shared experiences with our own. Support groups are a good example of this. So are Social Media groups that gather people with a similar interest or experience. To be a fly on the wall with a group where every member has been struck by lightning, yet lived. Cancer support groups, alcoholics in recovery, victims of domestic violence — all kinds of groups for all kinds of experiences.

I do think that post-COVID19, there will be support groups formed that gather individuals together to help process what happened to them, beyond the facts and figures, beyond the statistics and politics.

We will create safe spaces for people to process their fear, anger, sadness, and uncertainties about what comes next.

We will encourage people to talk about feelings of depression and anxiety as they come to grips with what may be a longer, more drawn out “normal” regarding the way they respond to everyday events.

We will be trying to meet real, human needs, even though others make light of their milder cases of COVID-19. We will meet those with complex recovery issues with compassion and understanding.

Update: as of 08.01.2020 I’ll be assisting with closed debriefing groups among healthcare and healthcare related workers processing trauma, exhaustion, and racism experienced during the pandemic response. I believe that while those interactions will be confidential, what I will learn from the process of helping will be transferable to my work as a therapist in the greater community.


Seattle Direct Counseling and COVID-19

By now, you have probably received multiple emails, notices, and alerts from Governor Jay Inslee of Washington State, and from your health care provider’s office regarding the development of the spread of COVID-19.

As each of the clients of Seattle Direct Counseling meet with me, I have been asking about their concerns. We have parents with children who will now be figuring out how to work from home and make sure their children complete their online courses for the next six weeks. We have employees who don’t have jobs that can be conducted from home. We have people who are caregivers to their aging parents, and are concerned about what they can do to keep their loved ones healthy and virus-free.

The current guidelines for what you should do if you or a loved one should become sick with respiratory symptoms, such as a cough, fever, and fatigue (with more rare instances of GI distress in the form of nausea, vomiting, or diarrhea) can be found on the King County Public Health website.

The current guidelines as of 03/20/2020 include:

  1. Frequent handwashing and use of hand sanitizer
  2. Cancel and reschedule andy non-urgent medical visits
  3. Social distancing, by putting six feet between you and others in public
  4. All public gatherings of 50 or more are cancelled until further notice. Update: as of 03/20/2020, the new CDC guidelines has changed this number to 10 people or more.
  5. All smaller gatherings of 10 or more will need to carefully meet sanitation requirements 
  6. Travel bans in place: China, South Korea, Italy. UK and Europe have also recently been added. 
  7. Isolate from the public for 14 days if you have been exposed to a person who has tested positive for COVID19, or you suspect that you have. Call your doctor if you have symptoms and await instructions on having a test administered. 
  8. Work from home and keep children who have been sent home from gathering with other kids like it’s a “snow day.” 

These  guidelines will likely be changed as this is a dynamic situation, and restrictions on movement will also happen. As of 03/29/2020, social distancing will continue at least through April 30, 2020. 

It is considered safe for you to go outside and take a walk; just keep your distance from others (six feet), and stay away from sick people. 


All-Hands On Deck

Earlier in March 2020, the WA Department of Health issued a request for all available healthcare professionals with valid licenses to turn in an application to volunteer for work related to the care of those with COVID-19.

As a person holding two healthcare licenses, I turned in my application. What this means for my community is that it may become necessary to reschedule some appointments if I am asked to step into the hospital, clinic, care center, or other locations.

While I will do everything possible to not interrupt the flow of care that comes from my virtual office, I am anticipating some changes that while temporary, may inconvenience some of you.

There is a true joy in doing what is right, what is good, and what is needed. I hope you’ll join me in supporting our healthcare providers who work tirelessly to care for others.

Special Priority for Healthcare Providers

If you are a healthcare provider in need of brief therapy to help you process the many emotions, changes, and increase in stress you are facing, I am offering special priority for all healthcare providers and first responders in the U.S.

The focus of sessions will be crisis oriented as well as encompassing grief and vicarious tramatization.

Thank you for your service. If you have need for crisis-oriented brief therapy sessions (present centered and goal oriented), please call and leave a message; I’ll get back to you shortly.

Change Counseling Love and Romance Psychology Social Media

On Love v. Admiration

In the movie, My Life As a House, George Monroe is an architect who is let go from his job and discovers he has terminal cancer, of which he withholds his diagnosis from others. After deciding he wants to tear down an old house on a piece of property he has been dreaming about for a rebuild, he tells his ex-wife that he wants to take his son Sam for the summer and build the house with him.

In a powerful scene between father and son, Sam’s repulsed expression of disbelief flies out at his father, “You trying to get me to like you?” George’s response is equally telling, “I was trying to get you to love me.”

The things we do for love. Or, is it love that we’re truly pursuing?

With the rare exception of individuals with personality disorders that manifest in social aloofness, we crave love and connection. Children can create imaginary friends to fill in loneliness, boredom, or fearful emotions. And in the age of the Internet, many of us flock to Social Media to not only see what others are doing, but to curate a world where others might connect with us.

All of this sounds pretty innocuous, maybe even adaptive. Until it isn’t.

I’ve been intrigued by conversation around a fast-growing group of people who are being called out as repeat marathon cheaters. These are people, usually everyday non-elite runners, who engaged in ways to cheat the system in order to gain awards, access to other races, and followers because of their astonishing fast-paced finishes. The numbers of cheaters caught at marathons, half marathons, and triathlons are enough that there are forums and a website dedicated to investigating marathon cheaters and turning them in to the race directors and organizations to determine what, if any, consequences should be rendered. The cheating is so common place enough that Wired magazine recently published a story about the founder of Marathon Investigations and the most perplexing responses and consequences of cheating exposures. 

Ever wonder why they would do it?

I suspect the numbers of marathon cheaters is actually not growing as much as you’d think. Rather, the technology used to catch marathon cheaters has improved in such a way as to punish the cheater in a public way by way of disclosure and the removal of awards, a ban from races, and potentially retroactive removal of finish times if there is a proven history of cheating across multiple races.

In other words, marathon cheaters risk being shamed and despised for their behaviour, if they are caught. And if they aren’t caught, they receive the love and admiration of fans.

Actually, I think these people stumble on another truth. They don’t receive love from their fans. They receive admiration based on achievement. Another way of putting it is that they cull conditional love based on a transaction: I perform, and you compliment me. 

Is It Worth It?

As you might have guessed, this post isn’t about running and marathon cheaters as much as it is about answering a question: is it worth it? And what “it” did you receive?

What “it” are we talking about? 

The subject is Love. Most of us learn about the importance of love when we are children. We see it in the sacrifices our parents and caregivers made in order to provide for our needs, listen to us, take us ball games and movies, and make sure we have opportunities to learn and grow. Love is can be hidden within a voice wishing us goodnight, folded into a homemade cake for a birthday party, and embedded in a hug and a kiss. 

Admiration is a similar feeling as Love, yet with a subtle difference. Admiration involves respect and approval, usually because of something we did to earn that feeling from another. An example of being admired is when a stranger put his/her personal safety in jeopardy in order to save the life of another.  We admire that person for bravery; we don’t love that person (the person is a stranger), as much as we hold in high esteem that person’s choice of action at the risk of personal injury. 

So back to the question, is it worth it. It is my belief that one of the reasons why marathon cheaters continue a pattern of cheating is because they trade Love for Admiration.  Finding and experiencing unconditional, non-transactional Love is rare. What they want is to be loved, but what they seek through cheating is the next best thing: Respect and Admiration for being a high performer. 

If Respect and Admiration means that much to a person, I believe they can  – sometimes do — pursue Admiration at all costs; therefore, it is worth it to them. The ‘likes’ on their Social Media posts, the adoring comments filled with heart emojis and ‘way to go’s, gives the person a lot of validation. It becomes its own kind of pellet food bar, of which a hungry mouse will keep pushing despite the fear of being shocked as long as the memory of getting a pellet of food remains. Rewards light up our brains, even if the reward as an emotional one.

And it works on the negative side of the equation too. Some people will do act outrageously to get attention, even orchestrating daring examples of socially unjust or violent actions. Earning a nickname that inspires fear has become its own kind of admiration in the half light of glowing screens across the globe. 

Can’t Buy Me Love

If Love can’t be bought, can its next best feeling, Admiration, be had by lesser means? In the Age of the Internet and the viral nature of Social Media, the answer could very well be Yes

Let me propose an example. You are a woman, a mom, a wife, and you’ve worked all your life to help your family. You do good things in community, volunteer for charities, do your share of duties in your local PTSA, and help the kids with school. At the end of a long day, you take a glance at your Social Media feeds. What do you see?  The accounts with thousands and millions of followers for women are often in the world of beauty, celebrities in film and music, wellness, politics, and sports figures. Oh, and cat ownership.

While you have changed diapers,  helped the kids get launched to college, supported a spouse through think and thin, perhaps you have not been celebrated and noticed. One of the ways we feel Loved is when we have been seen. And one of the ways many of us have sought to be seen by more people is through Social Media. 

One of the ways we feel Loved is when we have been Seen.

The strange thing is this: even accomplished people, celebrities, and sports figures can fall prey to the this online search for recognition. In those cases, there may be money involved in the form of exclusive sponsorships, and a poor performance could translate into loss of income. There would be incredible pressure to cheat, lie, or embellish a story. I’m not excusing cheating, just providing a possible explanation of why someone who was already accomplished might feel pressured to cheat or lie in his or her industry.

What about the Age Group athlete (a non-elite, non-professional athlete), in running or triathlon? Why would they cheat if there was no other financial reward for an Age Group win?

I suspect that the search for Admiration and Respect are in play. It can feel so good to be called a, “Badass” because you are fast and strong. People are curious about seemingly unreachable feats that require commitment, sacrifice, dedication, and focus. We elevate athletic pursuit to be characteristics of the gods.

Still, you can be the head of a tribe of people – a leader! — if you promote a certain kind of lifestyle that others find challenging — such as being a Vegan* or being Sober**, but in the world of Social Media, being Vegan and being Sober aren’t necessarily enough to win the attention of others. If you’re aware that you hunger to be Admired, you’d better match that Vegan lifestyle with something else, something Hard, something Ideal, something Extraordinary.

Of course, I am pointing out the flaws in this formula for living. Why can’t each person be celebrated for these decisions, just as they are? Why don’t we see them?

On Reading

My point is, that rabbit hole has no end. If you search for a sense of worth by Doing instead of Being, you will be tired. You might get some followers, and you will be exhausted.

Valentine’s Day has come and gone. I personally don’t subscribe to the romantic overtures of expensive dinners and romance packages. You’re more likely to find me continuing to do the little things behind closed doors that lets my loved ones know how much I care. I still make the bed every morning, as much for myself as for my husband, so that the pillows are plumped and inviting, and a fresh pot of brown rice is ready for dinner at the end of the day. It’s mundane, yet it has it’s own Truth.

The love I feel is about having read people. It is not, “love at all costs” based on the accumulation of achievements. It is love based on our ability to see a person and choose to bestow warmth and affection for who they are.

Love is given because we can choose to love someone based on who they “be” in your life, not what they do. If you knew you were loved that way, you would never feel the need to cheat your way to being admired or respected. You would not worry so much what strangers thought about what clothes you wear when you’re on vacation, or what foods you do or don’t eat.

Yet, as I mentioned before, this kind of non-transactional Love is rare. It takes time to cultivated, because not everyone learns it early in life, and there are social forces around us that whisper other truths about what our essential worth is based on: appearance, agility, youth, genius, gender, economics, work performance, possessions.

The false form of love that people seek or fear on the Internet is costly. Yet, if you choose to See, it’s possible to learn how to cultivate Love versus Admiration based on accomplishment.

Note * and **: In case you were wondering, I have nothing personal against either lifestyle choices of Veganism nor Sobriety, and I have seen how some have healed aspects of their physical and mental health with both. I have simply chosen these two examples because of the abundance of writers on the subjects.