The public health crisis, combined with economic, political, and social turbulence, has prompted a rise in anxiety and other mental health disorders. Last spring, as the number of COVID-19 infections rose, so did demand for antidepressants. “Zoloft prescriptions climbed 12 percent year-over-year to 4.9 million in March, the most ever in the U.S.,” reported Bloomberg Intelligence.
“The structure of most people’s work and personal lives has really changed.” said Jodi Perelman, a California-licensed psychotherapist with an office in Dogpatch. “They are having to manage new or different work responsibilities; some have lost jobs; others are losing colleagues to layoffs. Many of my clients are also parents and must contend with home learning and childcare responsibilities in radically new ways. It can be overwhelming. Some of my younger clients are missing important school traditions and rituals. So, there is a lot of loss and grief, as well as a lot of radical acceptance. There is also a lot of anxiety given all of the uncertainty, illness and death, and added pressures. I would add that for some clients, especially healthcare workers, there are newer issues of helplessness, moral injury and fatigue.”
Seth Ambrose, a California-licensed marriage and family psychotherapist with a Potrero Hill office, has seen similarities in the symptoms being reported by his clients.
“A big change that took place with COVID was that before people were dealing with very different issues, and suddenly everyone was dealing with the same concerns. Feelings of isolation, loneliness, afraid of contracting disease, difficulties in housing situations, fear of being sick, fear of losing loved ones. A lot of the work we were doing had to be put on pause so that we could deal with these very pressing issues” said Ambrose.
“Both my long-term patients and new patients have experienced increases in both anxiety and mood issues since the COVID crisis began,” echoed John Lundin, a licensed clinical psychologist with a Hill practice. “The main difference is that the topic in sessions are mainly around the crisis and just trying to understand what is happening and get through it. I have gone from addressing long-standing underlying issues, to more of helping people cope with the crisis. The crisis has added a layer of stress, worry, and even terror into the lives of everyone I have come into contact with. Since anxiety and mood issues are often closely linked and anxiety is the basis of most psychological disorders, nearly everyone is feeling worse than they did before.”
Many psychotherapists find the shift from in-person meetings to remote therapy triggered by shelter-in-place orders challenging.
“As a body-oriented psychotherapist, I pay attention to how my clients’ relationship to their body shapes how they perceive the world.” said Robin Levick, a California licensed family and marriage psychotherapist with an office in Dogpatch. “During therapy, I pay attention to my body as well as my clients’. I track my clients’ breathing, movement, and notice certain gestures and ask them to explore those. It’s hard to have therapy mediated by a screen because there’s a latency, and it’s not the same resolution as real life, all of which makes it harder to attune to my clients. Psychotherapy is about relationships, fundamentally.”
“So much of the benefits of therapy come from the therapeutic relationship a client has with their therapist,” confirmed Ambrose, who practices Somatic psychotherapy. “This therapeutic relationship relies on being able to share a safe space where my clients’ get to feel seen and heard without judgement. I’ve asked myself, how do I work with bodies when there’s no way to share a hug or a handshake?”
San Francisco’s technology startup industry may augment negative feelings during current times, said Levick. “People were already suffering with loneliness and isolation, and this is just exacerbating that. One of the striking features of the tech culture in San Francisco is an erosion of personal and private life. People’s identities are really wrapped up in what they do at work. Many eat breakfast, lunch, and dinner at work. People co-work on their off time or work for extended hours into the evenings. While that can create wonderful bonds between co-workers while you’re at work, you’re not really your truest self when you’re at work.”
Individuals tend to project a “work-persona” when they’re laboring, said Levick, which reduces the vulnerability and authenticity upon which strong relationships are based. Home-based toil, loss of coworkers, and unemployment can exacerbate feelings of isolation and loneliness. Levick, who charges $50 to $200 an hour, said clients who are service industry workers or students have expressed shame for not being able to make rent payments or losing a job.
“When the pandemic hit and lower income people began losing their employment opportunities, they felt the shame brought on by the myth of meritocracy and the hyper individualism bred by American neo-liberal economic doctrine,” said Levick. “That’s another reason that people are really isolated. I have to tell people, if you can’t pay your rent, that’s nothing to be ashamed of. Nobody is malingering, people are just trying to get by.”
Melanie Thomas, a perinatal psychiatrist at San Francisco General Hospital
(SFGH), cares for Medi-Cal patients, who are lower income, often people of color, with higher risks of contracting COVID-19 and being adversely affected by the economic downturn.
“Black and brown people are more likely to be lower income frontline wage earners, such as working at grocery stores or being a delivery driver. These same people may as a result of unaffordable housing be living in larger groups or shelters, both increasing anxiety and the risk of contracting COVID-19.” said Thomas. “While I provide psychiatric services to new mothers, I also connect them to other services, something we call linkage to care. We recognize that people have underlying social determinants of mental health, such as food insecurity, interpersonal violence, housing instability, racism, so we provide holistic care with multi-disciplinary teams that attempt to address the underlying root causes.”
Expecting mothers are anxious about whether they’ll be able to have a companion with them in the delivery room, such as the father or another family member. While SFGH has allowed at least one person to be on hand during labor throughout shelter-in-place, stories of companionless births from the East Coast have rattled pregnant women’s nerves.
“In our society support for new mothers is really important so that they don’t feel isolated with the stress of having to care for a newborn. People are really isolated right now. New mothers or families with young children are fending for themselves during shelter-in-place, which is a great stressor for everyone, particularly for people with less economic resources to begin with,” said Thomas.
“Many gay people and queer people don’t have the same access to family support networks that others do,” Ambrose said, indicating that half of his clientele face a particular array of emotional challenges. “Some may have moved here from somewhere else to be in a more accepting place, or their family may have kicked them out and they are no longer in contact. Gay people tend to lean on families of choice, or friends that they make in their chosen home. Because of this, gay and queer people may feel more anxious or depressed if that chosen family doesn’t exist or if they are new to the City and don’t have strong social ties established. There have been moments with clients where they expressed a strength from the memory of overcoming AIDS. There is a real community strength and sense that gay and queer people have seen a scary virus come through and rampage a population before, and they use that to feel able to overcome the virus. They say, “We know we can find ways to be safe, take care of each other, and still have meaningful relationships during this difficult time.’”
Psychotherapists recommend focusing on self-care and community involvement to help get through difficult times.
“The basics of self-care is helpful: SELF is a handy acronym here: sleep, eating, laughter and food. For others, we focus on regulating or resourcing the nervous system and engaging their body’s own relaxation response. This can be through focused breathing, guided meditation or expressive art and embodiment practices like dance, writing and singing. For some people, engaging in acts of service and protest can be a powerful force against the stress of uncertainty and injustice.” said Perelman.
“Self-care is talked about a lot, but I think it’s even more important right now,” Lundin echoed. “The obvious things like sleeping and eating right are particularly difficult now. It is important to pay attention to these things, but also forgive yourself if you slip up. It is particularly difficult to behave ourselves when we are coping with such high levels of stress, so forgiveness is key. It is important to pay attention to how we speak to ourselves during these times and try to do it kindly.”
Before shelter-in-place, Ambrose saw patients in an office space above
Farley’s that he shared with two massage therapists and a chiropractor. During the public health crises his co-tenants were unable to work and eventually to pay rent. All four are being forced to move out. Still, Ambrose sees hope in the way the Hill community is persevering through difficult times.
“We are all able to see that we are going through this together, whether I’m picking up my mail at the office, or seeing the crew at Farley’s or Hazel’s, everyone is wearing masks and gloves, using Purell, and finding a way to keep a sense of community and business alive. People are being patient and recognizing this is hard.”