The State of our Emotional Health: Election Year 2020

EDITOR’S NOTE: H. Steven Moffic, MD is a nationally renowned psychiatrist and award-winning author whose fifth book, “The Ethical Way: Challenges & Solutions for Managed Behavioral Health,“ is considered a seminal study in healthcare ethics. Also a popular guest on the Talk-Ten-Tuesdays Internet radio broadcast, Dr. Moffic recently received the Administrative Psychiatry Award from the American Psychiatric Association (APA) and the American Association of Psychiatrist Administrators (AAPA). What follows is a rough transcript of an interview with Dr. Moffic, conducted by ICD10monitor Publisher and Talk Ten Tuesdays host Chuck Buck, focusing on the nation’s mental health amid the COVID-19 pandemic and a national presidential election predicted to create widespread turmoil.

The CDC reported that the prevalence of anxiety symptoms among the public was three times higher than the corresponding period in 2019.

Buck: Steve, the general news media, as well as the healthcare publications, have been reporting on an overall anxiety level among Americans during the COVID-19 pandemic: a catastrophic event never before experienced in modern times. Add to that racial unrest and protests, wildfires burning in the West, the recent death of Supreme Court Justice Ruth Bader Ginsburg, and a contentious political environment, prompted by the presidential election, and it’s an explosive combination. What do you suppose is the anxiety level of Americans at this point in time?

Moffic: Chuck, you are right on, as usual, with your concern about the rising level of anxiety in Americans, due to all the public stressors you mention, and more. Indeed, at the end of June, our CDC (Centers for Disease Control and Prevention), the same federal organization that monitors the viral pandemic, reported that the prevalence of anxiety symptoms among the public was three times higher than the corresponding period in 2019. Uncomfortable anxiety was reported by over 50 percent of the public, with, perhaps unsurprisingly, young adults, as well as Blacks and Hispanics of all ages, leading the way. About two-thirds of Biden supporters report being scared about the country’s future, versus about one-third of Trump supporters. This level would suggest an anxiety epidemic, would it not?

Actually, the societal rise in anxiety in the USA has been going on for years, albeit more slowly. One interesting clue for that is that in 2018, Barnes & Noble reported a 25-percent increase in the sale of books on anxiety, compared to 2017. Some reports take the increasing anxiety back to President Obama’s time. Another potential culprit is the overuse and misuse of social media.

However, we must go deeper to appreciate what this means and what can be done about it. Anxiety is a natural emotion that is vital for survival. It refers to a long and prolonged state of apprehension brought on by uncertainty about future threats. Past personal threats and trauma in our memory and unconscious may also resonate with these public threats and trauma, adding on a personal vulnerability for some.

One key, then, is whether the felt anxiety is appropriate for the presumed risk. For instance, having the right amount of anxiety is essential in doing one’s best in a test, in a project, in a sports competition, and in this interview, for example. Too little anxiety can lead to ignoring or underplaying risks – and, say, not voting in the upcoming election. Too much anxiety impairs concentration and can lead to harmful behavior.

So, how to know if one’s anxiety is appropriate? There actually are various questionnaires and surveys that can be taken periodically. Getting and accepting feedback from loved ones can help. Sleep is a good monitor, and less sleep will tend to increase anxiety, in a worsening feedback loop. Consulting a professional to be sure that one has not developed a full-blown anxiety disorder that is impairing functioning and needing treatment should be considered. Prepare for an increase in the commonly delayed anxiety-related PTSD disorder, and even an increase in suicide, given the correlation of suicide with economic distress.

Recognize that the right amount of anxiety can be a moving target as external concerns change.

Given the importance of uncertainty in driving anxiety, what can reduce uncertainty? Here, too, there are good and bad strategies. As Freud, all psychiatrists, and all religions know all too well, humanity has the potential to do bad and/or good.

What’s bad is to reduce uncertainty by narrowing one’s source of information to the extreme. Without more Internet control, hate groups and their erroneous conspiracy claims can cause cult-like beliefs and behavior, which in turn will increase anxiety in the groups that are hated. Blaming and scapegoating others can even extend to intimate relationships, including family members. Others can turn to street drugs to self-medicate.

Good responses include using this anxiety to act in ways that might help to reduce public stressors and improve one’s own personal circumstances. Each of us may have personal ways to reduce anxiety that are not at the expense of others. That can include meditation, music, exercise, and hobbies.

Buck: A large study, reported on by Medical News Today, says there’s been a dramatic increase in the number of adults in the U.S. who are reporting symptoms of depression during the pandemic. Can you corroborate this? Also, what do you suggest these folks do to manage depression?

https://www.medicalnewstoday.com/articles/us-cases-of-depression-have-tripled-during-the-covid-19-pandemic#About-the-study

Moffic: The new study just reported on by Medical News Today actually reflects factors quite similar to anxiety in their meaning and implications, Chuck. Again, we are talking about a feeling, a depressed feeling, which may be a normal reaction, or a sign of clinical depression needing treatment. Instead of apprehension about the future, expressed by anxiety, depression is sadness about what has been lost in the past, whether that is a job, health, people who have died from COVID-19, or even the routine of one’s life. Therefore, both anxiety and depression can also coexist, which is conveyed by the organization devoted to alleviating that combination, the Anxiety and Depression Association of America.

This new research study indicates that feelings of depression and depressive symptoms, using the Patient Health Questionnaire-9, have tripled since the pandemic started, now affecting at least 25 percent of adults, and across all demographic groups. Usually, after other large-scale traumatic events, say 9/11, the increase is double, at most. Concern about personal finances seemed to be the major driver, especially for those with less than $5,000 in savings.

What can help alleviate this feeling of depression, especially if it is impairing functioning? First of all, like with anxiety, monitor and recognize its existence. Recognize its presence, then mourn whatever seems to be lost. Denying the loss doesn’t help one get over it. Being grateful for what one has can help offset what is lost. Imagine what it may have been like during the flu pandemic a hundred years ago, without the technology of the Internet. Involvement in a religious community also seems to be a bit of an antidote for anxiety and depression, though we don’t know if that is still present when the community is virtual, rather than live and in person. Societally, work on improving the various safety nets for people.

Buck: The coronavirus no doubt is impacting the mental health of special needs and at-risk children. I assume seniors with developmental and behavioral disorders are being impacted as well. Is this an issue with a scarcity of resources? What is causing it?

Moffic: You are also right on in regards to mentioning children and adults with special cognitive and behavioral problems. One difference here is that such children and adults may not be able to say that they are anxious or depressed. Instead, that may appear in changed behavior: being more irritable, crying, or becoming uncooperative, for instance.

The cause seems to be a disruption in everyday routines that has been structuring lives. Adding to that is that they may have lost the crucial live involvement of trained caregivers because of the coronavirus and social distancing guidelines. That on-site presence cannot be replaced online with telemedicine, as it might be for others.

These disorders may affect up to one in six Americans. Educators and caregivers are trying to come up with creative alternatives.

How a society treats those most in need has been said to be the best evaluative tool of its success.

Buck: Are these concerns suggesting that we may be experiencing an emotional pandemic beside the viral pandemic? What can be done, since there is no clear end in sight right now?

Moffic: We probably need to think of this time as the Chinese written character for crisis, which is often thought to mean both danger and opportunity. Perhaps serendipitously, this interview is also taking place during what is sometimes called “the days of awe:” the 10 days when Jews are supposed to be devoted to introspection, forgiveness, and turning to our better selves in the coming year – in other words, opportunities that might be relevant for all people right now. These days started with Rosh Hashanah, which celebrates the birthday of the entire world. Today, when our interview was completed, we are not only right in the middle of those 10 days, but it is the day of the ceremony for the late and iconic Ruth Bader Ginsburg of the Supreme Court. Whether you agreed with her perspectives or not, she conclusively proved that it is the size of one’s heart, not of one’s body, that matters.

Surely, the weight of history is upon us.

Another opportunity is to use this ongoing crisis to bring out personal strengths we did not know we had. A crisis often creates personal responses that are not seen in other times. To bring out your best, try to find the right and appropriate amount of anxiety and depression, and use that appropriate emotional fuel to help address your personal problems and societal problems. In other, paradoxical words, at a certain level, this increase in anxiety and depression can be viewed not as worrisome psychopathology, but as an emotional smoke alarm going off, signaling the human potential to successfully address risk to the benefit of our well-being.

In addition, these social problems reflect widening cracks in our social network and resources. Seeing that, we can work on filling those cracks by stabilizing climate instability, increasing healthcare coverage, stopping the pandemic so the economy can recover, depending more on science and the truth, bridging the political divide, and dissenting against the injustice of racism, sexism, ageism, Islamophobia, and anti-Semitism – as well as anything else that would make America great.

Buck: Is there something for anybody to do now?

Moffic: Chuck, have you heard of the unique Japanese artistic process to repair broken pottery? It is called kintsugi. Cracks are filled with lacquer mixed with precious metals like gold. As a philosophy, this conveys an embrace of the flawed or imperfect. The results are often viewed as more beautiful than the original. Just as the awesomely beautiful fall foliage is occurring in some parts of the USA, we have opportunities to beautifully fill our personal and societal cracks in anticipation of a rebirth and recovery next year.’

Programming Note: Listen to Dr. H. Steven Moffit today on Talk Ten Tuesdays, 10-10:30 am EST.