mental health

Self-Isolation Is a Recipe for Depression

Photo: Fiorella Macor/EyeEm/Getty Images

Since going into isolation, I’ve developed a Girl Scout’s fixation with making my bed. Every morning, as if a troop leader were waiting with a whistle between her teeth, I dutifully square the pillows and whip the duvet across the mattress until it’s lined up just so. The result is tidy and unassuming, which I like, but the real goal is symbolic: In making my bed, I prove that, although my civic duty currently demands I do nothing but shuffle around a confined space, what I do might still have an effect on how I feel — however paltry. This connection is critical for my mental health, and I know this because, when I go off the rails, so does my living space.

In its more severe forms, depression can keep people in bed for days, but my milder strain tends to manifest as an accumulation of insignificant failures. I notice a sock has fallen from the hamper, and I ignore it for days. I leave a cabinet door perennially ajar, even when it bugs me. I abandon a cup on the counter and let sticky juice coagulate in its seams. Though this sort of neglect can register as minor, it represents something fundamental: a kind of mental blindness to optimism, an unwillingness to see my actions as meaningful, and a self-defeating inner monologue that favors stasis above all else. It’s then that chores become a litmus test for my well-being: Do they feel simple or in conflict with my general sense of doom? Obvious or too diminutive to solve the problem with me, the world, and everything wrong with both?

As a global health crisis takes hold outside, in hollowed out offices and empty restaurants and hastily constructed field hospitals, a collective sense of helplessness has perhaps never felt more palpable. So: I make the bed. I fluff the stupid pillows and smooth out the stupid wrinkles, as if by keeping my house from falling apart I can stave off the implication that I am too. In this way, coping with social distancing isn’t so different from coping with depression. And as I round the corner on a month at home, I’m finding the comparison increasingly helpful — both for understanding my mental state, and for treating it too.

The Perfect Conditions for Pessimism

青青青国产在观免费2018Among the urgent needs facing people around the world—face masks and ventilators, sick leave and rent relief, cooperation on a global scale—mental health doesn’t feel quite so acute, but it’s suffering all the same. Maybe it’s just my corner of the internet, full of media addicts prone to gallows humor, or New York more generally, where social distancing subverts the entire value proposition of the city, but nearly everyone I know stuck in self-isolation is struggling with some form of depression or anxiety. And it makes sense — we cannot leave the house, we cannot conceive of the future, society as we know it is falling apart. Why wouldn’t we all feel like shit?

Lina Perl is a New York–based clinical psychologist (and — full disclosure — my therapist) coaching her clients through this situation via FaceTime, and she agrees that self-isolating in the midst of a crisis is a recipe for depression. “Many people theorize that depression, at its core, is a disease of social isolation,” she tells me on a recent phone call. “People who are depressed feel lonely and hopeless and want support,” but instead of seeking it out, they often enforce a kind of voluntary social distance, assuming they’re a burden or beyond helping. While depression may be triggered by a specific circumstance or trauma, this resulting withdrawal is what maintains and increases it. “Isolation can be viewed in a number of ways,” she says, “but it always involves depriving yourself of social reinforcement.”

In other words, as the catalysts for trauma stack up — the global panic, the mass layoffs, the existential uncertainty and unprecedented halt of everyday life — the mandate to self-isolate functions as much like a depression trigger as it does a necessary public-health measure. “At the moment when we most need other people to share our sadness and anxiety and fear, we’re being told to socially isolate.” Mix in our society’s general reluctance to emphasize mental health with the moral imperative that we prioritize physical青青青国产在观免费2018 health, and we’re left with the perfect conditions for feeling helpless and sad, privately wondering why this feels so much harder than simply “staying home.”

My first days in isolation, before I understood the serious psychological effects of withdrawing from everyday life, I felt guilty for feeling like a shell of my former self. I may have been facing some employment instability, but I knew I was one of the lucky ones, my rent paid and pantry stocked, at least for a little while. So why was l overcome with anxiety and paralysis? Why couldn’t I somehow capitalize on this moment of crisis by responding “productively,” or even creatively, as the optimists online seemed so intent on suggesting?

Dr. Perl says this is likely because my needs contracted in response to intense stress. “When we experience trauma,” she says, “we regress to a more childlike place where we feel like things are out of our control.” That’s when we need to shift our focus away from tending to more sophisticated needs, like the satisfaction we get from adhering to a hyperproductive ideal, to something more basic. “You need to care for yourself like you’d care for a child, making them feel safe, cared for, and loved.”

This is the notion underpinning Maslow’s hierarchy of needs, whereby sophisticated pursuits like esteem and self-actualization are irrelevant when we’re deprived of a sense of belonging, safety, or the satisfaction of basic physiological needs. In other words, depression pulls us down the ladder. This may explain why, per Dr. Perl, the most basic treatment for it consists of simple acts of self-care: feed yourself, move your body, sleep at the right times, and seek out connection with others. In this, rather than in listicles suggesting we learn to knit or finally start that novel, we may find an essential road map for coping with this current moment. “A major treatment for depression is what’s called ‘behavioral activation,’” she says. “You have to get up and go through the actions of a person who cares, and just doing that ultimately becomes reinforcing.”

Making the Stupid Bed

青青青国产在观免费2018As the economy crumbles, the global death toll continues to climb, and public-health experts warn that we could need social-distancing measures for up to a year or longer, remaining optimistic can feel impossible, if not downright delusional. But by tending to my emotional response to this crisis like I might a bout of depression — and in fact accepting that they may be one and the same — I’ve finally accessed a softer outlook. By establishing a daily routine so simple and rooted in personal care it’d be fit for a 90-year-old (a tidy home, a short walk, a shower, three meals, a phone call), I now feel equipped to extend myself to others, and to tend to the more nuanced, higher-up-on-the-pyramid aspects of my well-being, including those stubborn enough to believe things could get better. I’m not actualized or anything, but isolation is starting to feel less like a free fall. And in the moments it still does, I know exactly why.

It’s always been easy to discount mental-health concerns when more material crises loom large; that temptation might be even stronger now. But whether we’ve just lost a paycheck, a daily routine, or a more diffuse sense of stability, there is no version of this situation that doesn’t demand we radically adjust our mental frameworks. This is not a retreat or a rainy day; it’s a pandemic. It’s not reasonable to maintain our previous pace. “So much of my work is about getting people to do less,” says Dr. Perl. “Maybe this is a forced opportunity to slow down.”

As we’re confined to our homes for the next few weeks, months, year, or beyond, we’re presented with a common challenge: to change how we define a good day. We cannot party, distract, or overwork ourselves out of the discomfort. We have been reduced to our most basic human needs: to feed ourselves, to move around, to reach out and say hello. In these mundane pursuits, we may discover a source of meaningful action. It may not feel like much, but when the future is otherwise unclear, it can be an essential form of optimism.

Self-Isolation Is a Recipe for Depression