The United States is experiencing a mental health crisis. The prevalence of mental illness and emotional symptoms of distress generally have been on the rise for many years, but the COVID-19 pandemic has caused a surge. Emotional problems are particularly increasing among adolescents and young adults, especially among females and especially among individuals who identify under the LGBTQ umbrella.
For example, in the recently published Healthy Minds Study of over 350,000 college students representing 373 American colleges and universities, over 60% met criteria for one or more mental health problem. Since 2013, symptoms of depression have increased 135%, anxiety 110%, eating disorders 96%, and thoughts of suicide 64%. Overall flourishing also decreased in this timeframe by 33%.
Mental illness isn’t just about personal suffering, although it clearly includes this. Mental illness also impacts many kinds of relationships, the ability to work effectively, and the success of students. For instance, depression doubles the risk of a college student dropping out without graduating. To the extent that individuals are unable to fulfill their roles in these areas, our country and world will suffer as well.
Part of this mental health crisis stems from the lack of access to evidence-based help. Waiting lists have lengthened, hospital beds are short, and the ability to see a mental health professional regularly has been diminished. Expert help is hard to come by and practitioners are burned out. Organizations that could supply mental health support – such as business, colleges, and religious organizations – do not have the staffing or training to do so.
The lack of access to good mental health care also demonstrates a societal inequity. In the Healthy Minds Study mentioned above, students of color were the least likely to use mental health services. Although Arab American students had experienced a 22% increase in the prevalence of mental health problems, they were 18% less likely to access treatment, compared with 2013. This gap in mental health access across the races parallels the gap in achievement often demonstrated in work and school across the races, and may play a causal role.
Although the availability of evidence-based psychotherapy and medicine needs to be improved, especially for individuals with serious illness, other options also may be increasingly needed. The Association for Behavioral and Cognitive Therapies provides a list of recommended self-help books based on evidence-based cognitive-behavioral principles at their website. Digital psychoeducation programs based on cognitive-behavioral principles (such as Learn to Live) are increasingly offered through partnerships with health plans, businesses, and colleges. Phone apps based on mindfulness techniques (such as the Healthy Minds Innovations app) are offered for free to anyone. In general, research on these options suggest they reduce symptoms as much as traditional psychotherapy and medication, perhaps especially for those who are mildly or moderately distressed.Continue reading
According to the most recent data available, approximately 30% of American high school students take a course in Psychology. In addition, approximately 1.2-1.6 million American students take an Introductory Psychology course in college every year.
To the extent we have control over our curriculum, we who teach Psychology courses have a unique opportunity and responsibility during the fall of 2020: we can help educate a significant slice of American youth about some of the behavioral and psychological aspects of the great challenges defining this time. We can encourage greater insight and inspire prosocial change.
Below are three topics we can integrate into our fall courses that are particularly timely and important, with some suggestions for how to do so.
1. The psychology of group behavior.
COVID-19 spreads through droplets, yes, but those droplets spread from person to person through specific behaviors. Racial inequality is systemic, yes, but systems stem from, and are maintained, by specific behaviors. Climate change is a widely considered a “threat multiplier,” a meta-problem that increases the likelihood of pandemics and many other social problems; it also is caused by specific behaviors.
We teachers of Psychology can focus on individual differences in behavior and why individuals do what they do, and each of the above problems can be fruitfully explored from this level of analysis. However, if there ever was a time to explore the psychology of group behavior, this is it, as each of the above current problems also demonstrates how behavior is powerfully determined by the norms of individuals’ groups.
Even as public health experts and government authorities continue to advocate for physical distancing to minimize the spread of COVID-19, compliance appears to be diminishing. For example, mobile phone data across the United States reveals trends, beginning toward the end of April, of individuals spending more time away from their homes.
Of the many reasons why individuals may not comply with physical distancing guidelines, concerns about mental health may be most prominent. A Gallup poll conducted in April, for instance, indicated how emotional and mental health seemed to be the strongest consideration for individuals maintaining distancing, as compared with concerns about physical health and financial hardship.
The pandemic clearly is not just a crisis for physical health and the medical system; it also is an enormous challenge for mental health and the mental health system. New data released over this past weekend by Jean Twenge hints at the magnitude of these problems. In her survey conducted on April 27th, Twenge asked U. S. adults how sad or nervous they felt and compared those responses with demographically similar adults who answered the same questions in 2018. She found that roughly 70% of Americans demonstrate “moderate to severe” mental distress now, during the pandemic, a rate three times that reported in 2018. Young people show the greatest distress, a group other research has also found to be most socially isolated.
And yet, even as these problems become more evident, no major mental health organization – such as the American Psychological Association (APA) – publicly opposes physical distancing guidelines. Instead, mental health and behavioral experts point to ways to maintain distancing while at the same time attending to individuals’ mental health.
I feel like I’m finally settling into a bit of a rhythm during this time of “shelter-in-place,” and most days, I start with some kind of spiritual meditation. One that has particularly struck me came from a podcast by Krista Tippett, host of one of my favorite programs, “On Being.” (I’d encourage you to listen. The podcast is about 10 minutes long.)
What initially made me pause was how Krista referred to how individuals typically gain a sense of self-worth, and how this time of pandemic is sometimes proving to be a mental health challenge because of that. In fact, research in Social Psychology by Jennifer Crocker shows how people use many strategies to find worth, some of which are more steady and healthy than others. Krista points out that in our individualistic, modern world, many of us have been taught to believe our worth comes from achievement and activity, and how this source of worth is now being threatened because we are not as able to achieve and be active as we might prefer. Others, in contrast, may find worth through their relationships with others, and that, too, may be challenged now during this time of physical distancing.
As an alternative to these sources of self-worth more likely to fluctuate – particularly in this time – Krista discusses how, at her best, she finds worth in simply “being human.” This idea is heavily referenced in Humanistic Psychology and particularly the writings of one of my Psychology heroes, Carl Rogers, who basically argued that all humans have dignity by birthright. In the Judeo-Christian tradition, this kind of inherent worth is thought to stem from the fact that we are “children of God,” “made in God’s image,” or possessors of a “Divine spark.” That means we don’t need to strive for worth; we already have it, if we’d just accept it as ours now.
In a passage that has become one of my spiritual touchstones, theologian Paul Tillich put it this way:
“Grace strikes us when we are in great pain and restlessness… Sometimes at that moment a wave of light breaks into our darkness and it is as though a voice were saying: ‘You are accepted. You are accepted, accepted by that which is greater than you, and the name of which you do not know. Do not ask for the name now; perhaps you will find it later. Do not try to do anything now; perhaps later you will do much. Do not seek for anything; do not perform anything; do not intend anything. Simply accept the fact that you are accepted.'”
Concerns about the novel coronavirus (COVID-19) appear to be rising in tandem with the numbers of reported cases and fatalities.
Many of us are consciously or unconsciously asking ourselves: what are we going to do?
Until we can answer that question – at least to some extent – I believe our response will be wanting.
From the decades of research conducted on stress, one consistent finding is we need – and therefore seek – some semblance of control. When something such as COVID-19 comes along that is both threatening and uncertain, many of us experience great distress. Part of this is because our sense of control is lacking.
As I wrote previously in my blog entry called “What To Do When Stressed:”
A few weeks ago, while watching old episodes of Grey’s Anatomy on Netflix before going to sleep, I noticed my right eye felt drier than usual. I tried different tactics to adjust to this and fix my dry eye problem, but none really worked. Then, one morning, I woke up to find this same eye felt kind of sticky. It would improve after a few minutes of heavy blinking but, about a week later, I noticed it felt grittier when I blinked. A few days later, my left eye was starting to show some of the same symptoms, and also was bloodshot. How aggravating. I then discovered some kind of yellow-headed growth on the underside of my upper eyelid of my right eye. What was that? I found that thoughts and worries about my eyes started to interfere with my ability to be fully present in my daily life. I was distracted and less effective than usual.
My eyes are on the mend now. I went to my trusty eye doctor who prescribed a few eyedrops everyday, and the inflammation she discovered is going away. The yellow-headed growth? A benign calcification. So, everything is good, really, and my problem only illustrates a minor inconvenience. Nonetheless, this story illustrates how even one small stressor can negatively influence someone’s life.
Anything requiring a new response can be stressful. Stressors can involve loss, challenge, the anticipation of loss or challenge, or even something positive. In the classic social readjustment rating scale, stressors range in severity from minor (such as a speeding ticket or major holiday) to major (such as divorce or the death of a spouse). Traumatic life events can be even worse.
When we experience stress, our sympathetic nervous systems are activated. Our bodies direct stress hormones such as adrenaline to respond. Salivation decreases, perspiration increases, breathing quickens, heart rate accelerates, digestion slows, blood pressure increases, and immune system functioning lessens. Although this fight-or-flight response often protects us when we face an immediate, tangible danger, it causes problems when chronically activated, as typically is the case with modern stressors. This helps explain why many distressed individuals regularly experience symptoms such as dry mouth, sweaty palms, labored breathing, irregular heartbeat, nausea, high blood pressure, and vulnerability to sickness. Problems such as headaches, depression, and heart disease all become more likely as a result of chronic sympathetic nervous system activation.