May 22, 2020

Reframing the new normal with U-M's Dr. John Greden

In this Current article, John Greden, M.D., has suggestions on how to keep our heads above water as we look to the future. 

This article was first posted to Current magazine's website
by Erin Holden

It’s been over a month since most of us began socially isolating and taking other protective measures to ease the spread of COVID-19, but it seems much longer than that, partly because time appears to be moving much more slowly now. Working from home and limiting our interactions with others makes our world feel much smaller, even as watching the news from all over the world makes us all feel connected in a way that we haven’t before. Generally, it’s hard not to let apathy, anxiety, depression, and a general malaise about the future get the better of us.

John Greden, M.D.

How do we protect our mental health as we are thrown out of our routines and into increasing uncertainty? Dr. John Greden, founder and director of the University of Michigan Comprehensive Depression Center, has some suggestions on how to keep our heads above water as we look to the future.

Let’s talk about our feelings 

Clearly, as Dr. Greden points out, the most common mental health issues during this time stem from fear and anxiety, feeling like you have little control over what is happening with the spread of the virus. Then there is the inevitable loneliness during social isolation that can often lead to depression. 

“And then you start getting into the consequences of some of those,” says Greden. “Namely, the sleep disturbances that follow and substance use.” 

A (questionably) essential business

The danger of turning to substances rather than processing your emotions in a productive way can create a snowball effect in its mental health ramifications. One of the main ways this manifests itself is when the substances, particularly alcohol, interfere with your sleep patterns.

Greden says that “alcohol is a pretty good anesthetic in that it makes you sleepy. So you think, ‘I’m going to have a glass of wine, maybe two, and then I’m going to go to bed.’ But it’s a lousy sedative-hypnotic sleeping pill with a half-life of a few hours, and you wake up at about three o’clock in the morning. Now the worries that were feeling manageable at 11pm at night… they aren’t anymore. Now you could sit there and lie awake while the really bad thoughts start to come.”

In other words, drinking alcohol in excess (or even moderately every single day), is not the answer to your anxieties about the future. It is likely to negatively affect your immune system, disrupt your sleep quality, and lead to further anxiety.

So, if you’re going to stock up on Tito’s vodka at the liquor store for your extended isolation, make sure to partake moderately. Greden suggests that people have the occasional drink early in the evening with food rather than multiple drinks late at night.

Know your limits

Speaking of moderation, substance abuse isn’t the only habit that can get out of hand during your extended time at home— media consumption can also be problematic for your mental health. With streaming rates of apocalyptic pandemic films soaring right now, the question becomes, is watching them cathartic or harmful?

“The problem turns out to be that we’re getting a lot of that on news as well,” Greden points out. “It’s what we hear every night— death rates, how many new cases and so  on. We’re living it, and then we’ve got the fictional ones.”

He says people’s reactions to movies about the traumas that many are experiencing in real life worldwide, along with constant updates from the news, will vary greatly; therefore you need to monitor your own stress response to these things. If you feel heightened anxiety, it’s time to turn off the screen for a while. 

Mental health for our most vulnerable

One of Dr. Greden’s biggest concerns for mental health is for two groups— the elderly and people who live alone. In the case of older folks, it’s likely that they don’t have the established familiarity with video chats, texting and social media that younger generations have. 

For people living alone of any age, the inability to go about their daily routine at work or school could leave them vulnerable to unhealthy coping mechanisms. Both groups should make a concentrated effort to reach out, whether that means learning new skills with technology, or making a good old fashioned phone call. In turn, family and friends of vulnerable individuals should help maintain these connections as well, maybe even giving tech lessons.

A lot of it has to do with getting back to the basics and maintaining some kind of structure.

“I think it’s the same strategy, whether it’s for couples or helping out the elderly neighbor next door,” Greden says. “It takes planning, going for walks, talking with a neighbor, even if it’s 10 feet apart.”

Don’t get stuck in the denial phase

Last month the Harvard Business Review released a story titled “That Discomfort You’re Feeling is Grief,” which pinpoints how individuals across the world are processing what’s happening with COVID-19. Echoing this idea that we are going through the oft-cited five stages of loss, Dr. Greden says that it’s important to not get stuck in the denial phase, but to process them as they come. 

We’ve all experienced loss in this. It ranges from high school seniors not getting to graduate with their class to people facing financial scarcity, illness and death. We hear about people dying every day from a threat we can’t see. If you haven’t lost someone to this virus, you are likely thinking of someone close to you who is vulnerable. We’re afraid and, yes, we’re grieving.

“These phases that we all go through— first we deny, then we get angry, and we bargain. And then we get sad,” says Greden.  “And then, at some point, we have to accept. A real solution would be how can we speed these things up? And how can we get through the denial really early? And we have to know that it’s okay to be angry. I think getting to that acceptance point is the goal for everybody.”