While public health experts agree that this scenario is best for our physical health, no one could argue it's doing any favors for our mental health. You may have seen a meme or two comparing what you're being asked to do—"stay home and watch Netflix"—compared to, say, being asked to go to war in Vietnam, with the implication being that you should stop whining because you have it relatively good. In some ways, this is absolutely true; however, downplaying the difficulty of the situation we're in is problematic. The risks we face are very real, and uncertainty remains as to how we can expect them to unfold over time.
Why and how lockdown impacts our mental health
According to researchers who study things like survival psychology and medical anthropology, sheltering in place can be as traumatic in some ways as being held hostage, getting lost in the Antarctic, or living through any similarly uncertain period of sudden social isolation or confinement under duress. Below, experts explain why something as seemingly innocuous as staying at home can have ill effects on our mental well-being while also outlining the variables which affect just how traumatic these circumstances might be on a case-by-case basis.
a dangerous duo: Isolation and confinement
The current circumstances are forcing quite a bit of isolation, which has proven negative impacts on our well-being. "Absence of face-to-face contact and physical contact is likely to produce symptoms of depression and anxiety," says Lawrence A. Palinkas, PhD, a professor of social policy and health as well as medical anthropology at the University of Southern California. You don't have to be totally alone to feel isolated, he says. "The more you perceive yourself to be lonely or isolated, the greater the risk for emotional problems, and that perception doesn't necessarily have to involve physical separation."
This link between social contact and mental well-being evolved in humans because relationships have historically been beneficial from a survival standpoint. "We are social animals, after all, and have managed to survive throughout history by virtue of our reliance on others for information and advice," says Dr. Palinkas. So, like anything we need to survive, like food and water, social contact is critically important—or at least, that's what our brains think.
Another reason the effects of social isolation are detrimental to our mental health is that interaction with other humans provides a crucial source of psychological stimulation. "It creates a diverse social environment that helps us to maintain optimal cognitive functions," says Dr. Palinkas, who notes that people who are isolated for extended periods of time may face short-term memory loss and difficulty exercising executive function.
Absent the constant stimuli with which we are faced in ordinary life, our dopamine levels could begin to drop, says survival psychologist John Leach, PhD. Dopamine is known as the feel-good neurotransmitter, a naturally-occurring chemical in the brain which rises with pleasurable or rewarding activities. In "lockdown," it might be in short supply from any source that isn't digital—you get dopamine boosts from successful social interactions on social media, for example, which is why you can't stop refreshing your feed—and this can lead to lassitude, apathy, and a lack of motivation.
Dr. Leach points to "the looking glass effect" as relevant to the current set of circumstances. Our sense of self is determined to some extent by interaction with others, he says, so when we lose that interaction, "psychological disintegration" can result. With prisoners placed in solitary confinement, he says, this can happen rather quickly.
Beyond social isolation, shelter-in-place orders have another problematic component as well: confinement, which offers almost an opposite set of problems from isolation. "If you're sheltering in place with others, you risk increased social tension," says Dr. Palinkas. "Things that you would not normally pay much attention to or let slide take on added significance when you're in a confined setting and have no opportunity to separate yourself from others. This can lead to interpersonal problems and increased conflict, which is why NASA, for example, takes particular care to select astronauts based on temperament, training them to work as a team and to incorporate meditation into their daily lives, as isolation and confinement are considered hazardous, he says. In other words, they're prepared for it.
Extroverts are more at risk than introverts for ill interpersonal effects streaming from confinement. "A socially-adept introvert can understand the need for personal space without being compelled to violate that need on the part of others," says Dr. Palinkas, noting that an extroverted person might have more difficulty respecting such boundaries.
Uncertainty exacerbates everything
The fact that most of us don't know when our shelter-in-place orders will end is not doing our mental health any favors. "The amount of time doesn't matter as long as you know what the endpoint is," says Dr. Palinkas. "We still don't know exactly when [our endpoint] will occur, or whether reemergence of the pandemic can put us through the entire experience over again. This does make it more challenging than, say, if we knew we had to go through this for a three-month period and at the end of three months we would be able to resume our normal lives or at least a life that is substantially improved from what we're going through now." Even when the orders are lifted, he says, uncertainty about the safety of returning to a normal routine will cause additional stress.
leadership matters—good leaders make it emotionally easier to shelter in place
Leadership matters a great deal in similar—if more extreme—scenarios to that which we face now with shelter-in-place orders, says Dr. Leach. To illustrate this point, he compares two groups of historic explorers stranded in the Antarctic, both isolated from society in dangerous circumstances and facing an uncertain future. One group, led in the early 1900s by Antarctic explorer Ernest Shackleton, survived in its entirety. Another group of Belgian explorers, granted better circumstances than Shackleton's, did not. The only difference between the two groups, he says, was their leadership. (Shackleton has since been held up by historians as an exemplary leader.) The implication here is that if you have a confident and competent leader in whom you trust, you are likely to fare better than those who do not.
Those with pre-existing mental health conditions will suffer the most
The most at-risk demographic for mental health fallout from lockdowns overall is those with pre-existing mental health issues, says Dr. Palinkas. Both he and Dr. Leach say that it's less likely that individuals without psychological conditions prior to the coronavirus pandemic will develop them than it is that those with conditions will find their conditions worsening.
"The risk depends on the person," says Dr. Leach. "What they're going to get out of it when it's all over and how they're going to respond to when they're in it depends very much on what they take into it." In other words, if you are prone to depression, anxiety, substance abuse, OCD, agoraphobia, or other psychological conditions, you are at risk for worsening symptoms. If you weren't struggling with those conditions prior to the shelter in place order, you're at a much lower risk of developing them even in these extreme circumstances.
When to expect your mental health to improve
If you went into the first few weeks of this crisis charged up only to find yourself crashing out a few weeks later, Dr. Leach explains that this is an expected trajectory. In his research working with survivors—including hostages but also those lost at sea or in the jungle after a downed plane, for example—there seems to be a bottoming out around week three of the emergency situation. "People can suddenly get ambushed with a feeling of depression and apathy," he says. While he's not exactly sure why this is, he posits that at around this time, people start to see their circumstances as not temporary but rather their new life, which can lead to despair. "They're in a world they don't want to be in, and there is no escape from it," he says.
Dr. Palinkas shares similar findings. "Most people enter into a period of isolation with a great deal of energy and enthusiasm and emotional resources that equip us to cope with the stresses involved with being separated from others or being confined by ourselves or with other people," he says. "However, you typically will see at the midpoint of that period of isolation and confinement, a drop in positive moods—people will get more depressed, more anxious, more irritable, simply because they've come to realize that they still have more time to go."
If there's an end in sight, this midpoint tends to be the bottom of a u-curve trajectory; however, this is not the case in our present circumstances. "Without that anticipated end date, we could be continuing to devote a great deal of energy and coping skills, to the point where they become exhausted and then we experience a letdown," says Dr. Palinkas. "The only resolution to that is either a sense of hope for an anticipated resolution or demonstrable evidence of exactly when that is likely to occur."
In this unique situation, that sense of hope is difficult for many—but not impossible for all—to locate. Some may, according to Dr. Leach, simply adjust to the new normal and start to feel better as a result. "You don't want it, but you accept it as being real [and move on]," he says. Others may have to wait for a set date on which shelter-in-place orders will end, or when social distancing is no longer recommended, or when a vaccine has been identified and its implementation is on the horizon in order to experience that mood boost. "That's when the light at the end of the tunnel begins to appear, when energy and enthusiasm will pick up again as people experience anticipation about a different lifestyle, a different set of challenges to face and so forth," says Dr. Palinkas.
Still, he cautions that given the chaos of the moment, the worst part of this may be ongoing. "At the present time, even as states begin to open up, the uncertainty and anxiety over the lack of significant reductions in the number of infections and deaths and the possibility of a second wave later in the year, not to mention the financial stress, makes the prospect of an improvement in mood less likely," says Dr. Palinkas.
How to mitigate the damage
Whether you're an at-risk individual or not, both experts highly recommend one specific strategy for holding on to your mental health as guidelines that suggest you're safer at home remain in place: routine.
According to Dr. Leach, you need to maintain some routines, even if that means getting up in the morning and getting dressed for work at the same time you did before the pandemic, while replacing other old routines, which aren't applicable in this new situation (e.g., a commute), with new ones. "Before you can adapt to this new life, you've got to disengage from the old life as far as necessary," he says. "Then you need to start reengaging with your new type of life, you have to establish new routines, new structures."
If you don't, he says, you're in danger of drifting. "We need structure because we have goals, and in order to achieve those goals, we need a routine. If we lose that, we start getting apathetic—standards and morales drop. Then, you drift into cases where you don't do anything but sit around and watch daytime television," says Dr. Leach.
Routine is also important, adds Dr. Palinkas, because it helps keep your circadian rhythms regulated. "The disruption of social cues can also influence exposure to light and dark cycles," he says. "Being bored and sleeping during the day can influence normal patterns of sleep-wake cycles, for example." This can lead to less and lower quality sleep, which in turn has negative mental health implications—it can cause depression and anxiety, for example.
Into these "new normal" routines you should unquestionably add physical exercise. It's been proven to improve mood, and Dr. Leach says it can specifically have protective effects against those aforementioned dopamine drops.
And while structure is good, you'll want to avoid setting lofty goals for this period of time. "You may have very ambitious dreams, but because of the physical and psychological stress you're going through, you're also experiencing limitations to accomplishing all of those noble goals," says Dr. Palinkas. "Many times, people begin to feel guilty about that, and the guilt can be worse than the positive outcomes associated." He advises keeping your goals reasonable, even if that means just getting through the day with the bare minimum done.
Finally, Dr. Leach notes that it's important to realize that while you've lost control over some aspects of your life, you do still need some freedoms and this, he says, is critical for your well-being. Identify small ways to exercise your autonomy. "Provided you can maintain control within the limits or constraints that have been imposed, providing you can maintain personal standards, a routine, and a structure, then this way of working and this way of living will become normal," he says. "Then, you've adapted to it." Once adaption occurs, negative mental health conditions such as depression and anxiety lessen.
While we may be on lockdown sporadically for the foreseeable future, Dr. Leach says we'll adapt to this, too. Our new normal will be as a population under attack. Pointing to research done on astronauts and polar explorers, Dr. Palinkas says we'll adjust, and there aren't likely to be long-term effects for most of us.
"Once the period of isolation and confinement comes to an end, symptoms will begin to diminish rapidly," he says. "So if you can manage to hang on through this period, you can expect to feel better for the most part when it's over." Plus, his research has shown that there are actually psychological benefits to extreme challenges such as this. "As frustrating as it may seem right now, many if not most of us will emerge from this experience with a heightened sense of self-confidence and accomplishment, gratitude for the support received from others in similar circumstances, and a feeling of 'if I can handle this, I can handle anything.'"
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