Mental Health and the Pandemic: New Looks

Early in the COVID-19 pandemic I wrote a column on stress in the age of COVID (Flaskerud, 2021). In that column I conveyed the information collected in three rolling surveys of stress experienced in the U.S. over the months of April, May, June, and July in 2020. These surveys were conducted by the American Psychological Association (APA), the US Census Bureau, and the Commonwealth International Health Policy Study (the Commonwealth study involved other countries as well as the US). These surveys revealed feelings of anxiety, depression, fear, anger, economic concerns, and distrust of the government. Now as the rates of infection are going down and vaccines have become available, the mental health of the nation is being assessed once again. Two news stories that provided different looks at mental health during the pandemic were intriguing and had me searching for more information. A third story had me rushing to find the reports of the original data. The first story involved a description of ‘cave syndrome’—a term used to depict people who are feeling scared or unwilling to reenter post-pandemic society, even after being vaccinated, because they have grown too accustomed to isolation. A theater critic called this anxiety about resuming social life ‘stage fright. ’ Another account was of something that psychologists call ‘languishing,’ in French ‘ennui,’ which is feeling neither joy nor sadness but just existing in a plane of indifference and stagnation. The third story reported research conducted by the APA (February 2021) about weight gain in Americans during the pandemic—an average of 29 pounds over 1 year’s time! To me this seemed unbelievable, and I wanted to look at the original findings. Added to these are the accounts of increased stress, depression, anxiety, and addiction that have been reported from relatively early in the pandemic. After a year in isolation, many people who have developed an intimate understanding of what it means to be socially isolated are afraid to return to their former lives despite being fully vaccinated. There is even a name for their experience: cave syndrome (also called reentry anxiety). Emerging into society after a year locked inside is proving to be a difficult transition for some people. When I saw the description of cave syndrome, I thought immediately of two acquaintances who were extremely reluctant to rejoin family gatherings even when all present were fully vaccinated. Both are in their late 70s and have preexisting lung conditions that made them embrace protective measures to the greatest extent possible—for example, all groceries and supplies ordered, delivered, and then quarantined in their garage for 72 hours before unpacking; no haircuts, doctor or dentist appointments; absolutely no contact with anyone. One of them over 50 years ago had experienced a severe period of agoraphobia. To them, after a few months, social isolation became favored over the life they had before—it felt comfortable and safe. A recent study by the American Psychological Association (2021) reported that 49 percent of surveyed adults anticipated being uncomfortable about returning to in-person interactions when the pandemic ends. It found that 48 percent of those who have received a COVID vaccine said they felt the same way. People are reluctant to resume their pre-COVID lives for different reasons (Newsome, 2021). Those who suffered from social anxiety before the pandemic are particularly fearful of reentry. Some still have an extreme fear of the disease while others do not want to forfeit what they found to be the positive benefits they derived from the forced isolation and solitude. Newsome (2021) interviewed Alan Teo, an associate professor of psychiatry at Oregon Health and Science University about cave syndrome. He attributes it to three factors: habit, risk perception and social connections. He notes that we had to learn the habit of wearing masks, physical distancing, or social distancing, and not inviting people over. It is very hard to break a habit once you form it. There is a disconnect between the actual amount of risk and what people perceive as their risk. For those with cave syndrome there is a focus on the risk of infection and death rather than the benefits of social connection and the risk of dying from being lonely and disconnected (Newsome, 2021). So, what can be done if someone is afraid to go out? Do people suffering from cave syndrome need professional treatment or just a bit more adjustment time? It all depends on the level of severity. If a person has symptoms of