Isolation and Depression: Intertwined, Mutually Reinforcing

Of all the risks we are worrying about regarding COVID-19, I haven't yet read about the risks of isolation. We are being advised to carry out social distancing. And many are taking that to mean we should stay inside our houses alone. And I think of the many people who live alone or live with another person unhappily. I wonder how they will fare during this time.

For many years, I was an addiction counselor, and a concept we often discussed was how isolation can lead to relapse. It is through connection and community that people support each other in a lifelong journey of recovery. And the same is true for depression. The risk that depression will escalate increases as people are alone.

It is the importance of community to our well-being that is striking to me today. I am home because my teaching jobs for this week have been canceled. And I am thinking how relieved I am that I went to the library yesterday because I wanted to get outside and feel part of my community. How I am glad I did not wait because I received an email last night that the library had officially closed for the next few weeks. And I am saddened by all the things I cannot do socially because venues are being closed.

Being part of a community is a human need. Some of us need more connection than others to feel alive and to feel safe or, even more, to know ourselves. I am aware that aloneness is not loneliness, but feeling alone, which can happen even a group of people, creates a risk.

For a recovering addict, the risk is relapse to the relationship with the alcohol, drug, or food that fills the space where healthy relationships should be. For those who have depression, feeling alone rapidly exacerbates any sense of depression. In both cases, isolation from others is the place where the craving to escape the emotions begins. And the place where motivation goes to die. The motivation to do what keeps us emotionally healthy withers in isolation.

And now, we are asked to isolate from the communities where we get support. We are canceled out of meetings for social and volunteer activities. We cannot go to events that are fun and stimulating: theaters and sports. We are canceled out of religious experiences at a time of year when many of us connect more as we approach Passover and Easter.

Many of us are told not to report for work. (I am not going into the realistic terror of running out of money at this writing.) So we are isolated from the places where we can connect to friends and colleagues. We are even isolated from family in many cases as we lose the options to have birthday celebrations and weddings and funerals where many people would gather. It is depressing to lose out on things we wanted so badly—the opportunity to celebrate or mourn in community.

I have been considering what it will take to avoid sinking into depression in these conditions. Depression robs us of energy. It becomes too likely that we will sit and do nothing. We lose the oomph to make a call or tidy a kitchen or get outside, and as we stop doing those things, our energy fails even more. I want to make some simple suggestions for avoiding that energy suck that aloneness can create.

If you are already depressed:

• Stay in contact with your therapist if you are receiving treatment. Talk about what you can do to mitigate the depression.
• Continue any meds and make sure you have appropriately refilled prescriptions. There is no evidence that failures in the supply chain will prevent you from getting your prescription, but it is best not to wait until the last minute to refill your prescription, because pharmacies may get busy.
• Continue to exercise—especially outside where the fresh air and sunshine can feel energizing.

For all of us:

1. Checking on the news continuously reinforces fear, not knowledge because the news is so repetitive. This is not like being in California or Australia during fire season and needing news of wildfire evacuation notices that may change in a moment. This is a slower moving situation.

a. Check-in with news on a reliable source once or twice a day. In fact, try to check in by reading. It is easier to get alarmed when listening to or watching people whose job it is to keep you watching with their excited reports that are often repetitive rather than new or newsworthy.

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b. Avoid conspiracy-theory websites, bloggers, or other fear-mongering sources.

c. Stop the news feed notifications on your smartphone for the time being. The constant dinging (because these days too many things are considered "breaking news") triggers your stress response, and that creates an emotional and physical toll you do not need.

2. Stay connected to family and friends. Make a list of people you could/should/want to be in touch with. Try to reach someone every day in person or by voice. Texting is great, but to feel more connected, voice is better.

a. Start by asking how that person is doing.

b. Try discussing something other than how upsetting the world is.

c. Ask that person what they are doing to entertain themselves or stay upbeat.

3. Keep a schedule. If you are at home with kids or working from home or at home because your work has been canceled, create a daily schedule that you follow. It will make you feel less detached from life.

a. Go to bed and get up at the times you normally would.

b. Eat at regular mealtimes and try to maintain nutrition. (It might be tempting to eat more junk food or snack all day.)

c. Especially if you are home with children who are out of school, plan times for games, times to be outside, and check-in online with the many sites and bloggers who are offering ideas for activities. This could be time to increase your repertoire of non-electronic entertainment.

d. Connecting with others via electronic gaming can be great fun and a tool to feel connected with friends, but be aware that unlimited time every day can make you feel distanced from those you live with and decrease physical energy.

4. Get outside! Social distancing does not require complete withdrawal into an apartment or house. Walk, run, shoot baskets, ride a bike, garden—anything that uses your physical energy and gives you a chance to experience the world outside your four walls will enliven you.

5. If you have a spiritual discipline, this is the time to continue practicing it. Whether you pray or meditate or read religious literature or listen to music that raises your spirit, connecting to these sources can help you come away inspired and reassured.

6. If you live with other people, make sure that you have some time to yourself if constant contact is likely to increase your inner tension. You might not be accustomed to having a spouse or children or roommate with you all day. Plan activities to do with family or friends, but also make sure you take some time to replenish yourself.

Finally, be aware that social distancing is a means to be part of your community effort to keep all of us safe. We are not going to escape the impact of the virus, but we are voluntarily participating in helping make sure that our hospitals, available equipment, and medical professionals are not overwhelmed by a surge of illness. By being sensible about interacting with others, we are all trying to keep the rate of escalation minimized. And in that way, we could feel part of the community, distanced from some physically, but not isolated and alone in our goals.