York County Medicine Winter 2020 - 18

YO R K C O M E D S O C . O R G

FEATURE:

Mental Health in the Pandemic

It's a marathon,
not a sprint
By: Kenneth M. Certa, MD

A

s the weeks drag on into months, with only a glimmer of
hope mid-winter, the pandemic is becoming more and
more difficult to endure. We are winning the numbers
war, at least in Pennsylvania, but the need to keep socially
distant is taking a toll that is beginning to show. As a psychiatrist
working in inner city Philadelphia, I am seeing a rising tide of
addiction-related emergency room visits and hospitalizations. The
same is true all over the country.

who roamed Africa in troops were reassured when they saw
others of their kind, getting a greater sense that this must be safe
if these fellow primates are here.

A big part of what keeps all of us sane is our interactions with
other people. Human beings have evolved to exist in cooperative
societies, as all primates do. Our brains are not suited for solitary
confinement; we can literally go crazy without being able to make
a connection with another person.

But I am also too much of a student of human behavior to ignore
the cost to the psyche. Many of the pleasures which keep us
going are not available right now. Older folks who struggle with
chronic illness get the motivation to stick around by thinking of
the next time they can have their grandchildren over. It is hard to
keep this thought in mind when you know we may not be able to
meet until New Year's. (And no Mummers Parade!)

Addiction is a disease with complex roots, but a big part of
healing depends on the ability to somehow get outside of our
own thoughts and rely on something else. The higher power
of the 12 Steps can be conceived in a lot of ways, but there is
a common thread of recognizing that by myself I will get into
trouble.
The pandemic requirement of social distancing, of not meeting
up with friends, of not going to the movies or out to dinner or
just hanging out, takes away the natural way that our society
helps us get back to center. There is a lot that can be done by
phone, text, Zoom and Teams, but our brain is not so easily
fooled. We have a visceral need to be in the presence of others,
even those we don't really know. It is comforting. Our ancestors
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York County Medicine | W I N T E R 2020/2021

I am too much of a scientist - and have seen too much of how
ill COVID-19 can make someone - to argue strongly that we
should go back to business as usual. For the sake of all of us, we
need to maintain our work to limit viral transmission, wearing
masks and staying apart.

There is a hierarchy of defense mechanisms which our minds use
to fend off anxiety; things like repression, reaction-formation,
stuff you might remember from Psych 101. People quibble over
what sorts of thoughts and actions are related to which particular
defense mechanism, but what is very clear is that the defense
mechanisms which involve other people are the most effective.
So what to do? It can be helpful just to recognize what is
happening - to cut yourself some slack and not get worried about
that glum feeling. It is a natural response to enforced isolation;
no need to feel bad about feeling bad.
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York County Medicine Winter 2020

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