It is indescribably strange to hear the mantra that usually spirals through your head during a panic attack become the title of a new government order.
But that's exactly what happened when Los Angeles Mayor Eric Garcetti initiated "safer-at-home" on March 24, the quarantine guidelines telling Angelenos to combat the coronavirus outbreak by remaining indoors, avoiding all unnecessary social interaction, and only going outdoors for essentials.
As an agoraphobe (which for me manifests as a fear of crowds and public spaces) with social anxiety and panic disorder, "safer-at-home" is what I was built for. What I wasn't prepared for though was just how debilitating it would feel to watch my internal, irrational fears of imagined threats become everyone's external reality in facing one of the realest threats ever. While the rest of the world is struggling to believe in this terrifying post-pandemic world, those of us with anxiety disorders are struggling to maintain our disbelief in the seemingly impossible apocalyptic scenarios we've been dreading.
"Even when we're not in the middle of a pandemic, most people with anxiety disorders grapple with trying to distinguish between excessive fears to threats that aren't real, or what's called false alarms," said Tom Armstrong, a psychologist and professor at Whitman College in Washington who specializes in anxiety-related disorders and phobias. "Now we're being told those fears that once seemed irrational are rational. The alarm isn't false."
"Those fears that once seemed irrational are rational. The alarm isn't false."
I'm not the only one with an anxiety disorder having the mind-melting experience of watching their tendencies not only become the norm, but a weapon to combat a fierce threat to humanity.
On the other side of agoraphobia, those with separation anxiety are likely feeling nightmarishly alone because of social distancing. People with contamination-related anxiety disorders like germaphobia and certain types of OCD are obviously getting hit particularly hard. Disordered eating may be triggered by the stressors of quarantining at home. Those with generalized anxiety and panic disorders aren't being spared, either, especially since shortness of breath is a symptom of both COVID-19 (the disease caused by coronavirus) and panic attacks. All that compounds with hypochondria (aka illness anxiety disorder), which is likely amplified by the CDC's recent report that one in four COVID-19 cases can be asymptomatic.
"People who struggle with anxiety disorders have what we call an intolerance to uncertainty," said Dean McKay, a psychology professor at Fordham University in New York specializing in anxiety disorders.
It becomes impossible to distinguish between what's a trigger, what's life-saving information, and what's your anxiety disorder. Honestly, is there even a discernible difference at this point?
"The level of uncertainty is suddenly heightened for everyone," said McKay. "So now here you are, the anxiety sufferer, dealing with the uncertainty in a way that's measurably worse while everyone else around you is also suddenly struggling with it too."
Hello anxiety disorder, my old friend
While just about everyone's anxiety is skyrocketing right now, the danger for people with phobias and anxiety disorders are manifold and multi-layered.
On a practical level, treatment for said disorders often relies heavily on therapy and medication. While telemedicine is certainly a viable alternative to in-person sessions interrupted by social distancing guidelines, there are roadblocks in the U.S. State restrictions and health insurance limitations leave many without coverage for telemental services. While Medicare and Medicaid have temporarily lifted telehealth restrictions, phone-based therapy sessions are still not covered. That's not to mention the many people losing any healthcare benefits due to wide-sweeping layoffs.
It's an unending cycle of an anxious snake compulsively eating its own tail.
Then there's the more existential Catch 22 of having an anxiety disorder in the age of COVID-19. It's not just that public health and safety guidelines are reinforcing and exacerbating common symptoms of these anxiety disorders, like obsessive-compulsive hand-washing or avoiding people and outdoor spaces. For people with an already low tolerance for uncertainty, these unhealthy behaviors are also how we regain a sense of control during times of crisis. So now, it's an unending cycle of an anxious snake compulsively eating its own tail.
The temptation to regress feels impossible to stave off when your reality appears indistinguishable from the apocalyptic "what if" scenarios you worked so hard to convince yourself would never happen. And it's only made worse by a sick, twisted sense of vindication.
Even before all this, one of the biggest hurdles to managing my anxiety disorder was that no matter how much my rational brain understood it to be an issue hindering my life, nothing could stop a small part of me from continuing to believe that staying home really was the only guarantee of safety. Despite the morning dose of anti-anxiety medication doing wonders by turning excruciating experiences like going to work or the grocery store into something commonplace, for some reason I couldn't bring myself to take the nightly pill my doctor also recommended. I still can't.
The painful truth is that I'm attached to my anxiety disorder. It was always my first line of defense. It feels like I need it now more than ever.
While much of Freud's approach and theories on disorders are considered outdated, one of his most famous quotes still strikes a chord for me: "Neurotics complain of their illness, but they make the most of it, and when it comes to taking it away from them they will defend it like a lioness her young."
Before the pandemic my anxiety disorders made basic existence hell, rendered dating and maintaining friendships impossible, reduced my life to the walls in my apartment, turned the everyday into the catastrophic on a dime.
But I was safe.
Social distancing isn't all that different from my regular life, honestly. I worry less about how long it will take for this to be over and more about being incapable of reacclimating to the normal world when it comes back. Already, I feel the social muscles I forced myself to exercise starting to atrophy as I stutter and stumble through mundane interactions with the pharmacist. I can't empathize with friends who need our Zoom hangouts, my heart racing whenever the calendar invite reminds me of a virtual social engagement I agreed to for some ungodly reason.
What will I do when perpetual isolation is no longer guilt-free, when my fear of people goes back to being irrational, when my disorder becomes a disorder again and not the right thing to do?
What helps
Then the rational side of my brain pipes up again, thankfully. Of course, the reason my anxiety disorder kept me safe before I started treating it with therapy and medication was because it also deprived me of life as a whole, with all its simultaneous risks and wonders.
"We need to remember that it's not forever. This is temporary," said Armstrong. "Now is different than before the pandemic. So, later [after the pandemic] won't be like it is now either."
In many cases, if you take this as an opportunity to gain deeper understanding into where your anxiety or phobia really comes from, you might even realize the pandemic doesn't make the threat you imagined more rational at all.
Take my agoraphobia and social anxiety, for example. My fear of people and leaving the house mostly stems from an excessive fear of negative evaluation or judgment from others. That has nothing to do with the reason why being around people is a threat right now because of coronavirus.
Admittedly, that framework is a little harder for people with contamination-based anxieties and phobias. But consider the advice of lifelong germaphobe A.J. Jacobs in Esquire: "I read some very convincing defenses of germs. Turns out they suffer from bad PR. Our bodies are hosts to billions of germs, and many perform crucial life-saving functions. Only a small percentage are bad."
Others suggest cognitive-behavioral exercises like writing down your most feared scenario (like catching coronavirus), and re-reading it repeatedly throughout the day until it holds less power over you.
In Slate, New York City psychotherapist Liz Heckel speculated that we might even think of coronavirus as a kind of radical exposure therapy, "in which you are exposed to the very thing you fear the most— think poop, cockroaches, and the like—until it feels non-threatening... It’s abrupt, intense, downright uncomfortable and sometimes even gross, much like COVID-19 itself."
Nothing beats getting professional one-on-one help in whatever way you can, whether its requesting remote services from your regular provider or starting new treatment with apps like BetterHelp or Talkspace. (However, Talkspace's and BetterHelp's privacy policies have some concerning language that requires a leap of faith.)
Meditation is a widely applicable salve (here are some free services). However, mindfulness may not work for you if you've experienced past trauma. The CDC also has some general tips and resources for dealing with mental health issues right now.
"The people who are already anxious have been preparing for this moment their whole lives."
As Armstrong explained, "The lifeblood of anxiety disorders and what keeps them going is avoidance."
So find safe, small ways to push yourself out of your comfort zone. If you're agoraphobic, McKay suggested, going outside for a walk regularly, even if it's not very far. (You can still do this in much of the U.S., but in India and elsewhere, the lockdown rules are more severe.) If you have social anxiety, stay in touch with friends and family through video chat hangouts and phone calls. Speaking from personal experience, it's helpful to ask loved ones to hold you accountable for those catch ups. You might have every excuse to not interact IRL right now, but there's no reasonable excuse for avoiding a FaceTime.
Another great piece of practical advice is to realize, as McKay put it, that, "When you see health experts and government leaders urging people to follow precautions to minimize the threat, you are not their target audience. That's for people with an overdeveloped sense of optimism who aren't taking it seriously," he said. "The people who are already anxious have been preparing for this moment their whole lives, particularly those with contamination fears. You're good."
You are likely already washing your hands more than enough times, and to avoid triggering completion anxiety, be sure to limit your time spent washing to no more than the recommended 20 seconds.
Don't join us
Despite what this asinine Wall Street Journal headline suggests, we absolutely do not need everyone to develop OCD right now. Actually, it's the exact opposite.
At the risk of adding to our laundry list of concerns, both Armstrong and McKay strongly believe and worry that COVID-19 will spread a different kind of contaminant.
"Right now folks are kind of walking in the shoes of those with OCD, illness anxiety disorder, social anxiety. And when this is all over, what happens to these fears that are now becoming so widely held by the general population?" asked Armstrong, pointing to the hyperawareness of contamination and fear of people or public spaces. "For some, I imagine this will be the beginning of a diagnoisable anxiety disorder."
Before COVID-19, anxiety disorders were already one of the most commonly diagnosed mental health issues in the U.S., affecting 18 percent of the population according to the Anxiety and Depression Association of America.
At the very least, there will undoubtedly be a period of post-pandemic adjustment, McKay and Armstrong said. Many might find themselves feeling unsure of what's safe or what the appropriate level of fear should be while returning to regular activities. Uncertainty will still be thick in the air. There will be a great need to address that mental health crisis (not only for increases in anxiety disorders but also depression, alcoholism, etc.) currently brewing on top of the physical public health crisis.
If you find yourself slipping into the symptoms and thought patterns of these disorders, it's important to try to push past your fears and discomfort while of course staying within the limitations of public safety precautions.
"The good news is that those irrational or excessive fears are really receptive to corrective information through experiences," said Armstrong. "If you face your fear a few times, you can usually overcome it because it shows that things aren't as bad as you think they are."
One day, this will be over. We will have watched the apocalyptic "what if" scenarios we feared most come to pass. We will see that the world survives. We will continue. Maybe then we can look back on COVID-19 as a way to shake hands with the countless uncertainties from unseen threats — at least metaphorically.
If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others, the CDC suggests that you can: Call 911, visit the Disaster Distress Helpline's website or call the helpline at 1-800-985-5990 (TTY 1-800-846-8517). You may also text "TalkWithUs" to 66746. If you want to talk to someone or are experiencing suicidal thoughts, you can also text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. For international resources, this list of suicide hotlines is a good place to start.
Topics Health Mental Health Social Good COVID-19
