We're Not OK
2020’s unseen and often unspoken impacts on our individual and collective mental health
TEDRA PERKINS LIMITED her television news intake. Gaan Akers went hiking almost every weekend. Anthony Granberry set aside time for prayer, meditation, and listening to music—gospel, rhythm and blues, and jazz.
All three are mental health professionals who used their own coping mechanisms to maintain equilibrium during a year marked by disease, death, racial tension, political dysfunction, isolation, violence, and economic instability—in other words, during 2020.
CHRISTMAS AND NEW YEAR’S DAY were over, and Americans were settling back into routines of school and work early last year when they got the first hint of things to come.
January 6, 2020 / The Centers for Disease Control and Prevention issues a travel warning for Americans visiting China.
On January 20, the first diagnosis of COVID-19 in the United States became public. On February 29, the first death was reported. By mid-March, the World Health Organization had declared an international pandemic, and on March 16, Atlanta Mayor Keisha Lance Bottoms declared a state of emergency. Hospitals soon filled to capacity, and health care professionals worked long hours, often with inadequate safety equipment.
As people sheltered in place, businesses cut back their workforces, unemployment claims ballooned, and the stock market fell, adding economic pressure to the threat of disease. Schools closed, and many parents were sent home to telecommute. Those who had to go to work sites were faced with child care dilemmas. Social distancing beyond the household meant no big family gatherings, not even visiting hospitals or nursing homes. There seemed to be no escape.
“America’s mental health is being threatened by the current public health crisis,” the journal Trauma Psychology said bluntly in June. “Uncertainty, fear, and a new level of stress may be slowly seeping into the American psyche.”
As the year dragged on, so did the malaise.
“People are feeling really anxious and unsure about what’s going on,” said Perkins, a counselor at the Samaritan Counseling Center of Atlanta, founded by FPC twenty years ago as a separate 501C3 nonprofit, housed in the Hal and Julia Smith Christian Community Center. “We’ve all had to change our lifestyle in some way.”
One upside of the year is that telecommuting counseling sessions became the norm.
“I think one of the hardest things mental health-wise is not knowing what to expect,” said Akers, a counselor at Hillside, a mental and behavioral health center for children and adolescents in Atlanta. “It’s hard to make plans . . . and the new routines and infection control protocols in day-to-day life are emotionally taxing.”
“It’s very human and expected to experience fear, anxiety, hopelessness, and helplessness,” said Granberry, a licensed professional counselor in Decatur. “Nothing is wrong with us if we experience despair and even depression. The idea is to work through it. Not getting stuck is the objective.”
Some people are able to escape the slough on their own, some can do it by commiserating with friends, and others need professional help, he said. “We have to accept that in a nonjudgmental way.”
More people seem to be seeking help, said Katie Sundermeier, executive director of the Samaritan Counseling Center, which has had its highest client counts in two decades during the pandemic. Some new patients came because of stress resulting directly from the pandemic and other current pressures, she said. Some came to work through older issues. “By and large, the new clients had been managing,” she said; “then the pandemic threw them into debilitating anxiety, obsessive-compulsive behavior, binge eating, and other unhealthy responses.”
One upside of the year is that telecommuting counseling sessions became the norm, opening up the possibility of therapy to parents with young children, who would have had to arrange child care to meet in person; people whose schedules and work locations made driving to Midtown during office hours impractical; and those who just found the idea of meeting a counselor in person intimidating.
Many of the new patients came in on discounted fees based on income, Sundermeier said. And some long-term clients asked for discounts for the first time. The very financial conditions that made them unable to afford the full fee contributed to their stress.
July 26 / New cases push hospitals to the brink. All across Georgia, health care facilities and emergency services are scrambling to keep pace.
— Atlanta Journal-Constitution
Looking around at who might be most affected during the pandemic, the professionals at the Samaritan Counseling Center immediately thought of the front-line medical personnel who had to put their own health at risk to work in an atmosphere of constant pressure.
Counselor Karen Murphy, a certified child life specialist who worked at hospitals, led a group specifically for caregivers. “There was a lot of fatigue and burnout,” she said, “and a lot of bleeding of professional care into their personal lives.”
Constantly exposed to disease in a hospital setting, the health care workers feared taking the virus home to their families. “Some had work clothes and home clothes,” Murphy said. “They would change at work.”
One eight-week-long series of group counseling sessions consisted of nurses from various hospitals. “They could come to the group (virtually) and talk about anything going on with them,” Murphy said. “For them there was a conflict between trying to do the job they feel called to do and all the barriers in place. They spoke pretty openly about access to personal protective equipment—whether they could justify taking another mask. There was a lot of processing, and the shared experience was helpful. They didn’t feel so isolated.”
Murphy provided some simple techniques to help with mindfulness and grounding, from conscious breathing to looking around the room to notice everything that is a single color—all the yellow things or green things—to mentally listing everything that comes to mind in a certain category, such as musical instruments.
The goal is a shift in focus away from whatever is anxiety inducing, she said.
A support group for parents and their “creative learners”—children with attention deficits, for instance—is run by the Samaritan Counseling Center and First Presbyterian Church. It had begun meeting before the pandemic, but the interaction of the parents became more crucial with social distancing.
“When COVID came, everything with a creative learner expanded tenfold,” said Selma Ridgway, a church member, educator, and author of the book Creative Learners: Stories of Inspiration and Success from People with Dyslexia, ADD, or Other Learning Differences. “There were a lot of stresses and challenges.”
The group continued to meet during the pandemic “without a specific agenda,” she said. “It basically serves the purpose of having parents know they are not alone, of having parents know their child is not broken. Putting things into perspective is a big part of it.”
The parents share tips and frustrations, and Ridgway and other professionals offer techniques for families faced with having to home-school their children for the first time: breaking big tasks into smaller segments; having several short breaks instead of one or two longer ones; setting a schedule and keeping a calendar so family members know what to expect; building in time for family fun and personal time.
AFRICAN AMERICANS WERE ESPECIALLY hard-hit by the virus. A Centers for Disease Control and Prevention report said Black or African Americans were 2.6 times more likely to
contract the disease than white Americans,
4.7 times more likely to need hospitalization, and twice as likely to die.
While they were trying to come to terms with the pandemic and all its implications, videos of the violent deaths of Black Americans, several at the hands of police, went as viral as the coronavirus.
March 13 / Breonna Taylor is killed by police in Louisville, Kentucky, during a botched raid on her apartment.
May 5 / Video is leaked showing the death of Ahmaud Arbery, a Black man chased and killed while he was jogging by armed white men in Brunswick, Georgia.
May 25 / In Minneapolis, police confront George Floyd, who has been accused of buying cigarettes with a counterfeit bill. He dies unable to breathe as they keep him pinned to the ground.
Incident after incident, coupled with everyday overt and even unconscious acts and attitudes of racism, takes a cumulative toll on individual African Americans and the community as a whole, according to the National Alliance on Mental Illness. “The effect of racism and racial trauma on mental health is real and cannot be ignored,” CEO Daniel H. Gillison Jr. said in a statement released in May. “Our nation’s African American community is going through an extremely painful experience. . . . And with more than 100,000 lives lost to the coronavirus pandemic—disproportionately from minority communities—these recent deaths add gasoline to the fire of injustice.”
“People are feeling really anxious and unsure about what's going on. We've all had to change our lifestyle in some way.”
TEDRA PERKINS, COUNSELOR AT THE SAMARITAN COUNSELING CENTER OF ATLANTA
Of course, the number of coronavirus deaths continued to grow, more than doubling by the end of the year.
The strain of the pandemic may have been one reason that the deaths of Breonna Taylor and George Floyd in particular ignited protests across the country, said Giscard Petion, a Samaritan Center counselor. “In the pandemic, it seemed everybody was looking in on a spectacle, like we’re all standing around seeing what’s happening right in front of our eyes,” he said. “For people of color, especially, that was an extra weight to bear.”
Racism, from images in the public sphere to “microaggressions”—subtle acts and attitudes that diminish someone’s sense of worth—can result in a form of post-traumatic stress disorder, psychologist Monica T. Williams wrote. Likewise, the American Psychiatric Association recognized “a causal link between experienced racial discrimination and adverse mental health outcomes,” including “depression, anxiety, increased substance use, feelings of hopelessness, and suicide ideation.”
SO WHAT TO DO ABOUT IT. A first step is to give African Americans room to talk about what they’re feeling, said Petion. “Keeping things inside is debilitating. It’s not healthy.” But, he said, Black people may not feel comfortable expressing their feelings. “We need to be able to say, ‘I’m not OK right now because of what’s going on in my community,’” he said. “Naming it is important.”
White people may be uncomfortable talking about race, he said, but it is the proverbial elephant in the room. “Race is a social construct, but it’s there and it’s real. I’m a Black man, and that is how I navigate the world. I’m also a human being.”
Checking on friends is important, he said. People shouldn’t keep silent because of being afraid of saying the wrong thing. “It’s OK to say the wrong thing,” he said. “Vulnerability is strength.” And even the wrong thing can open up a conversation.
“We are dealing with some complicated issues,” said Granberry. “We’re talking about principles and values. Are we part of building a better society? Or are we entrenched in old ways?” For white people, reflecting on times they have felt marginalized can help them understand how people of color feel when they are the victims of discrimination or injustice, he said. Then, when all is considered, he said, “Choose to work toward a community that engages folks in a constructive way.”
OF COURSE, PARENTS are also concerned about keeping their children safe. That involves deciding how much exposure children should have to what’s going on in the world.
Parents of Black children speak of “the talk” they must have with their offspring, especially their sons, about how to behave if they are stopped by police. In June, Kenya Young, an NPR producer, the mother of three Black sons, reflected: “I remember the kids asking to go to the park and the laundry list of what I had to tell them: ‘Don’t wear your hood. Don’t put your hands in your pocket. If you get stopped, don’t run. Put your hands up. Don’t make a lot of moves.’ . . . I mean, it just went on and on.”
Granberry, who was raised in a small town in the Florida panhandle, said his parents never had “the talk” with him, but “race was always a cloud hanging up there,” he said. “I was aware that I was a Black boy in the South, and so I needed to be aware of that.”
Before the pandemic, before the summer of death and protest, suicides and attempted suicide rates were rising among young Black people. A November 2019 study by Pediatrics magazine found that suicide attempts for Black youth escalated 73 percent from 1991 to 2017, while rates among white adolescents dropped. A study by the Journal of Community Health showed that the death rate by suicide for Black boys aged thirteen to nineteen rose 60 percent from 2001 to 2017, while the rate for Black girls exploded by 182 percent.
Parents of Black children are faced with the task of cautioning their children while not instilling debilitating fear.
“Caution means being mindful,” said Perkins. “Fear means ‘I’m afraid to leave the house.’” Children need to know that “some people in the world aren’t nice,” she said, but they also need to know that all people are not bad. “We don’t want them to think that all police officers are awful and all white people are racist,” she said.
Akers suggests letting children of whatever race guide the conversation about what she calls the “current civil rights movement” by establishing a safe space for conversation.
“The effect or racism and racial trauma on mental health is real and cannot be ignored.”
DANIEL H. GILLISON JR., CEO, NATIONAL ALLIANCE ON MENTAL ILLNESS
“Ask them what they’re thinking,” she said. “What are you hearing? What are some emotions you’re having when you see these pictures or hear your friends talk about these things?”
Different families will come to the issue from different directions, she said. “Are you Black? Are you white? Are you Asian? Everybody is going to approach this differently, depending on who they are and what their peer group looks like.”
Getting out in front of racial misunderstanding and prejudice is far preferable to coming to terms with discrimination and injustice once they have occurred. That means teaching all children about inclusion and equity.
One Atlanta school has a literal recipe for making the point that everybody is valuable. First graders are given flavored syrups of different hues and instructed to mix them to make their own skin color. When all the children have finished, teachers line the results up from dark to light. The point? All are delicious.
“It’s building the notion that race is not a biological construct,” said Allen Broyles, assistant head of school at the Children’s School, an independent school in midtown Atlanta. He makes clear that he is speaking personally and not for the school. The process needs to begin early, he said. By fifth grade, attitudes are firmly fixed, and work on equity and justice must undo attitudes that are already in place.
In dealing with their children and their own attitudes about race, white people need to be realistic, he said. Claiming not to not see skin color—racial “colorblindness”—sends the message to children that “race is something you don’t talk about,” he said. “That puts kids of color in a world where who they are is a taboo subject. . . . Fear of having conversations about identity is precisely the thing that keeps things entrenched.” At the same time, he said, children of color don’t need to be singled out in lectures about racism. “Black kids don’t need to sit through lessons about how violent the world can be against them. White kids do.”
Broyles, who is white, is the father of an adopted Black son. As Akers advises, Broyles said he and his wife are letting their son direct the depth of the conversation.
“For us it’s a continuous process.”
ONE CHARACTERISTIC of the current national state of affairs is that everybody is affected in some way. Professional counselors themselves are practicing the techniques they preach as being good for both adults and children: setting limits on time in front of television news; looking for constructive approaches to concerns about injustice; setting aside time for meaningful rituals that provide a sense of normalcy and calm.
Akers, whose job at Hillside focuses on clinical education and training, sums up much of what the others say:
Have some positive experiences. This can be taking time over a good cup of coffee, enjoying a long shower, or listening to a favorite album. “It’s almost like an ATM,” she said. “You bank positive experiences, and when you have to do something stressful, you pull out of that account.”
Work on a skill or craft. Progression gives a sense of accomplishment.
Don’t wait until the last minute to make decisions.
Pay attention to your body and the messages it is sending.
Don’t eat too much or too little, and try for balanced meals.
Avoid mood-altering substances.
Maintain a regular sleep schedule.
Exercise. Mental health and physical health are linked, and both benefit from exercise.
Invest in spiritual health through practices such as devotionals, journaling, meditation, and worship, spiritual formation, and Bible study offered online.
“Our current reality is a stark reminder that we’ve never had the control we thought we had,” said Granberry. With that in mind, he said, he recommends the first few lines of the serenity prayer of theologian Reinhold Niebuhr:
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
Amen.
