Languishing in the Time of Covid

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Throughout the last several months, I have noticed a consistent theme in my practice. Reports of lack of motivation, decreased energy levels, and an overall feeling of "meh" — for lack of a better word — a feeling that strongly resonated with me.

What was it? Ennui? Malaise? Apathy? I furiously flipped through my internal Diagnostic and Statistical Manual of Mental Disorders in a futile attempt to put a name to this elusive state. It was not necessarily depression. I have experienced clinical depression and, although there were some similarities, this was something different; something more insidious; more chronic rather than acute.

Then I stumbled upon Adam Grant's recent piece in the New York Times about languishing or, what he terms, "the neglected middle child of mental health." Actually, the article was first brought to my attention by a patient of mine. Putting a name to this mysterious but ubiquitous feeling was relieving to my patient. It was relieving to me. Like most states of distress, being able to label the negative emotion(s) is often healing in itself. It is normalizing; validating. Helping others understand and navigate their own internal state helped me do the same. This led me to want to understand further.

Languishing versus flourishing

The concept of languishing has not been given much attention until now, as many of us succumb to the effects of the past year. If mental health is viewed on a spectrum from positive to negative feelings, languishing would be closer to the negative end, but not far enough to be considered an illness. Its opposite, "flourishing," would be on the positive end, indicating good mental health. According to researcher Corey L.M. Keyes (2005), languishing may be conceived of as "emptiness and stagnation, constituting a life of quiet despair that parallels accounts of individuals who describe themselves and life as 'hollow,' 'empty,' 'a shell,' and 'a void.'" It is the "absence of mental health." Though not categorized as a disorder, studies indicate that languishing could be as debilitating as, and is a major risk factor for, major depression.

The World Health Organization (WHO) defined mental health as "a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. Similarly, in 2000, the Surgeon General defined mental health as "a person's ability to function and be productive in life; to adapt to changes in his/her environment; to cope with adversity, and develop positive relationships with others."

So, what happens when society and life essentially are put on pause? When we are unable to engage in many of our daily activities? When contact with friends, family, and colleagues is limited to a computer screen? When our psychosocial functioning is forcibly interrupted?

Psychiatrist Christine B. L. Adams, MD, draws the analogy of psychological functioning to how an engine operates. "During a pandemic when we are sequestered, we become low on psychic fuel. Just as an engine needs gasoline to run, people need psychological fuel to operate at fulfilling and optimum levels." Psychological fuel comes from both new experiences, such as novel or re-visited experiences, and rest, doing nothing." Throughout the pandemic, we have gotten little of either. "Our input of psychological fuel is nil when our output is high. So, we lose our spunk and feel blah." She has noticed many of her patients having less ability to concentrate and be creative and productive during the pandemic. "To escape this blahness," Adams says, "we need to create new psychic fuel and do what we can within the constraints we live under." To generate psychic nourishment, she suggests planning new and fun activities at home and doing outdoor things. These ideas will generate psychic nourishment for everyone.

Time perspective: What day is it again?

This is a question that most of us have uttered at some point or points throughout the last year. "Time perspective (TP)" refers to how we construct and relate to time — past to present to future, or "the often nonconscious process whereby the continual flows of personal and social experiences are assigned to temporal categories or time frames, that help to give order, coherence, and meaning to those events" (Zimbardo and Boyd, 1999). According to researchers, "a balanced TP, wherein one can flexibly switch among different TPs depending on the situational demands, would be of greater importance for an individual's well-being than would 'living life as a slave to any particular temporal bias'" (Boniwell & Zimbardo, 2004). Further, they state that a balanced time perspective is the "key to the good life".

Psychiatrist David M. Reiss, MD, points to this disruption of routines and time markers, or typical activities that normally divide the passage of time; for example, getting dressed in the morning, going to work or school, seeing friends, and participating in social events. "Hours in the day/night blend together; days of the week blend together." This loss of normal perceptions of the passage of time, he states, significantly contributes to the state of languishing. "Beyond the disruption of developmental tasks and basic isolation, the loss of those 'markers,' distorts the sense of time, often into a blur, which can generate a sense of confusion, boredom, or even meaninglessness or existential fear."

Going forward: From surviving to thriving

So, what are the repercussions of a year spent languishing? Will it linger and remain chronic. Or will we experience an internal renaissance? A reawakening of old hopes and aspirations; an appreciation and even zest for life-perhaps not felt since the peak of adolescence?

According to Adams, the effects of the pandemic on our mental and emotional health will be varied. "Some people will be anxious over getting back to their lives. Others will feel depressed over what they could not control but felt they should have controlled [such as] deaths of loved ones, missed family events like marriages and graduations, loss of jobs." Despite all of this, she believes that most of us will resume our accustomed lifestyles and return to our pre-pandemic functioning.

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"We have all been universally affected by the pandemic, either in a large or small way," states Anjani Amladi, MD. "My hope is that through this collective experience, we develop more compassion and empathy for each other, specifically with regard to mental health [and] that we are better able to see the value of wellness: emotionally, mentally, and physically."

This, too, is my hope.