Farhad Manjoo: The hidden ‘fourth wave’ of the pandemic

Now comes the winter and the holidays, a time of special dread

Nine long, deadly months into the pandemic, Americans report severe psychic distress. It’s dark, we’re stuck inside, and we’re isolated from friends and family. Politics is fevered, the economy continues to struggle, and the coronavirus rages on. Many of us may be at a breaking point. According to a new Gallup survey, Americans’ assessment of our mental health is “worse than it has been at any point in the last two decades.”

But now comes winter and the holidays, a time of special dread. Even in ordinary years, this season turns up the needle on stress. The pandemic winter promises a new layer to our mental anguish. In addition to so much death, the next three months could bring a level of collective grief, anxiety, depression and overall stress that may eclipse all that we’ve experienced so far this terrible year.

“This year is very unlikely to be a good year for you if have had a history” of mental health issues, Ken Duckworth, the chief medical officer of the National Alliance on Mental Illness, told me. “You’re going to have fewer connections, more isolation and more uncertainty.”

Yet we might be as ill prepared for the mental toll of the pandemic as we were for its physical toll. I spent the past few days talking to experts about Americans’ mental health needs during the next few months. The picture is bleak. Even before the pandemic, the United States had too few mental health professionals to meet the nation’s needs. The shortage is most dire in rural areas and in urban communities that are home to marginalized groups. Demand for treatment has skyrocketed, but supply has not.

“It takes eight months to explode demand,” Duckworth told me, but several years to make a social worker.

Worse, at the national level, there has not been a real focus on the pandemic’s toll on our mental health — not from the Trump administration and not, so far, from the incoming Biden administration. Last month the president-elect announced a COVID-19 task force that was widely praised for its deep expertise. None of its members, though, is an expert on mental health.

That’s a big mistake, according to Luana Marques, a clinical psychologist who directs Community Psychiatry PRIDE, a program at the Massachusetts General Hospital that offers care to underserved populations. She predicted that mental health issues could create a kind of “fourth wave” of the pandemic.

“Once we get the pandemic under control, people are going to come up for air, and they will not be OK,” Marques told me. “I think we need a national force to help us guide this and have a coordinated effort toward mental health.”

The coronavirus winter will bring special challenges for our already battered psyches. Many of the ways that people have been counseled to keep up their spirits during the pandemic — maintaining connections, getting lots of exercise, going outdoors — are more challenging in the winter. There is also winter’s singular misery, darkness. Millions of Americans suffer from seasonal affective disorder, a kind of depression thought to be exacerbated, in part, by reduced exposure to sunlight.

Then there are the holidays themselves, which create their own well-known difficulties.

“There’s often a disconnect between the idealized portraits of what we might expect from the holiday season and what actually happens,” said Joshua Gordon, the director of the National Institute of Mental Health.

In American pop culture, this season is often depicted as a time of effortless cheer, a wonderland of snowmen and cozy fireplaces and skating in the park. Many people often feel terrible about the holidays because they rarely go as well as they do on TV, and this year, more than ever, the disconnect will be unavoidable — and triggering.

The mental health system is already struggling to keep up. In June, the Centers for Disease Control and Prevention found that 40% of U.S. adults reported at least one adverse mental or behavioral health condition, including experiencing symptoms of mental illness or substance abuse related to the pandemic. The CDC also reported that like COVID-19, mental health conditions were disproportionately affecting marginalized communities.

There is a bit of encouraging news: When the pandemic hit, many therapists and their patients managed to move their sessions to the internet, allowing people to get help even as the virus kept them at home. Experts were also encouraged by the public discussion about mental health in the past few months — mental health organizations and the news media have highlighted the importance of maintaining social connectedness despite the need for physical distancing.

Because the mental health system will not be able to take care of many people who are in need, the experts I spoke to offered a variety of well-meaning strategies for people to maintain their mental well-being this season. None of it will be new to people who have dealt with serious mental health problems: Eat well, sleep well, maintain social connections, spend time outside in the sun and get a lot of exercise, which has been shown to provide significant improvements for a range of mental health problems.

Advice like this may be helpful to some, but it is also woefully insufficient. Like telling people to car pool and turn down the thermostat to defeat climate change, it shifts responsibility for addressing a crisis from the systemic level to the individual and will almost certainly not be adequate for the people most in need.

The mental health effects of the pandemic will be dire. For people who’ve lost loved ones, become sick, lost jobs, endured long periods of isolation or have witnessed untold suffering while serving on the front lines, trauma will endure long after the vaccine has rid us of the virus. Winter is coming: We need a real plan to address Americans’ unraveling mental health, and we need it fast.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

Farhad Manjoo

Farhad Manjoo is an Op-Ed columnist for The New York Times.