Podcast: Dealing With Post-pandemic Trauma

The Atlantic staff writer Ed Yong talks with James Hamblin and Maeve Higgins about the ways, large and small, in which we’ve all suffered.

We’ve all been suffering during the coronavirus pandemic in one way or another, and as the U.S. starts to emerge, we’ll need to reckon with that. The Atlantic’s Ed Yong discusses his piece on pandemic trauma, how to think about it, and what he’s learned through talking with psychiatrists and other experts.

What follows is a transcript of their conversation, edited and condensed for clarity:

James Hamblin: So now you’re back from working on your book and writing about the pandemic again. Your first piece back on the subject is about the trauma of the moment. And how are you defining the trauma of the pandemic?

Ed Yong: Yeah, I think this has clearly been an intensely stressful 14 months. The pandemic uprooted so much of our lives. It caused sickness and death. Like I say in the piece, there is an ongoing debate among psychologists and psychiatrists about how to define the word trauma. And one of the people I spoke to talks about “big-T” and “little-t” trauma. Big-T is like what you would officially classify as trauma. So, like, death, injury—people who have obviously been very sick from COVID-19, people who’ve lost loved ones to COVID-19. And then there are all the sorts of little-t traumas, the things that we might colloquially call traumas that are undoubtedly influential on mental health, things like losing a job, being isolated from your loved ones, being trapped in this atmosphere of fear and uncertainty for a long time. And I think I don’t really want to make that much of a distinction between those two things. Both of them were keenly felt over the past 14 months. Both of them influenced the mental health of people who’ve lived through the pandemic. And both of them are things we think we still need to be talking about now.

Maeve Higgins: It’s amazing that you list all of these things, and sometimes even when we talk to people on the show, they’re so careful to point out, “Well, yes, this did happen to me, but it wasn’t as bad as, you know, X, Y, and Z.” Like, I don’t even want to mention specifics because everyone is in this kind of, like, “Oh, I can handle this because it hasn’t been the worst thing that’s happened.”

Yong: Yeah, I think there’s a lot of that happening. When you see the sort of full scope of the pandemic, it’s sometimes easy to sort of minimize what you yourself have gone through. And I think for people who haven’t really dealt with mental-health problems before or who are sort of used to a normal baseline of stress, dealing with something very unusual, like a pandemic, can actually be very jarring. They almost don’t expect to feel as stressed out or as bad as they have. And this could be anyone from doctors and nurses, who obviously have a very stressful job. And it could be parents, who are used to just the baseline rigors of being a parent, but maybe not used to having to do that 24/7 without any child support. In the midst of this crisis where schools are shutting down … the pandemic ramps everything up to the nth degree. And it’s not surprising, I think, that even people who think of themselves as sort of hyper-competent folks who are caregivers, who are used to dealing with stress, have found these months very, very hard.

Higgins: Absolutely. Jim, I was going to say to Ed about that line in his piece: “If you’ve been swimming furiously for a year, you don’t expect to finally reach dry land and still feel like you’re drowning.” And that really hit us, I think, because it’s not just snapping back and everything’s fine. So, do you feel like this applies to—I mean, everybody, like you said, but especially—health-care workers and other folks who’ve been on the front lines?

Yong: Yeah, I think this is going to be a very common experience. I don’t think it’s going to apply to everyone, but some people—maybe who are listening to this podcast—are just going to be fine. And for them, I feel joyous and happy, and I hope that it continues in that vein. But I know that a lot of people have been running on adrenaline and running on fumes for a long time. And they’ve now hit this point, in the U.S. specifically, where things are starting to feel a bit better. People are feeling safer, vaccinations are rising, cases are dropping. And yet now, when they finally get a chance to exhale, they’re finding it unexpectedly hard. And, actually, I don’t think that we should be surprised at that. A lot of the literature from other kinds of disasters or other kinds of traumatic experiences, including soldiers who return from war, health-care workers in the aftermath of crisis—we see that people, when they get a chance to breathe, often finally get a chance to look back and think about everything that has happened to them in the times before when they were just sort of trying to get past. And it’s in those moments, when you really get to take stock of actually how tired or anxious or stressed you’ve been, that a lot of people suddenly collapse in a way. People who I spoke to who work in trauma say that this is a very common experience, but I think it can be all the more jarring because we don’t expect it. We expect that when things are better, we will feel better. But of course, how we feel right now isn’t just defined by the current moment, but by everything we have experienced in the past. And everything we've experienced in the recent past has been kind of awful.

Higgins: I hate that about our brains, they just collect it all up, right?

Yong: Yeah, yeah. They collect it all up. And in some ways, it’s unfortunate. But, you know, it’s seen in another way, like integrating across all your past experiences and using that to determine your current state of mind. You could just call that learning. But it’s also, in many ways, a totally reasonable way of acting. And I think it causes problems when we forget about how our responses to grief and loss actually work. It’s not just the case that things get better and people just snap back into their previous normal behavior. We need to collectively allow people who are struggling in this moment to have the time to not feel so good.

Hamblin: That’s something I’ve heard doctors advise people, especially older people, after a significant hospitalization for anything in normal times, pneumonia or a fracture, that you shouldn't have the expectation that life is going to go back to the exact same way that it was. You’ve been through something and it’s going to be slightly different now, but doesn’t have to be in a worse way. You just need to think that there will be a change. Did you get any insight from people you spoke to in covering this piece about how to navigate that in post-pandemic times? I mean, thinking about things as, they’re not going to be the same as they were, but you can still find ways to be okay.

Yong: On an individual level, I guess just even acknowledging that that is how things might play out is really important and it sort of goes against some of our popular conceptions of how grief and coping work. People I talked to spoke about this very popular five-stage model where you sort of cycle through clearly defined stages of denial, anger, bargaining, depression, and acceptance. And that model is wrong. That's not actually how people cope with traumatic events. So there are no discrete stages. They don’t occur in a linear cycle. They can take a long time to resolve, and that resolution might not take the form of acceptance. So I think just having a better understanding of the nuanced and meandering ways in which our reactions to these problems will play out is really important.

We can actually start thinking about numbers of people who might be experiencing prolonged effects of pandemic trauma. We know, for example, at the height of the winter surge, we had 132,000 Americans who were hospitalized. Based on what we know from past coronavirus epidemics and studies coming out of Italy with this one, we know roughly around a third of those people will probably develop PTSD, which works out to about 40,000 or so. We also know that at least 580,000 Americans have died from COVID-19. Each of those deaths, on average, leaves nine bereaved close relatives of parents, children, siblings, spouses, grandparents. In general, about 10 percent of bereaved people develop prolonged grief disorder, which means that your grief is intense, it’s incapacitating. You don’t get over it, even after a year or more. So that means that we probably have about half a million Americans who are experiencing that kind of severe, prolonged, intense grief. Which is the population of a reasonably sized city. That’s a lot of people. And here I’m only really talking about those big-T traumas. We’re not talking even about people who are grieving friends. We’re not talking about long-haulers who are still experiencing symptoms, not talking about folks who are dealing with all the little traumas like unemployment and isolation and all the rest.

Higgins: And those people who were hoping to start families who kind of lost that time.

Yong: Yeah, the value of life lost. So many people and students who were looking forward to graduating and starting college, people whose businesses were on hold for years. There’s so much loss, the rhetoric of individual resilience only gets us so far. It almost shifts the blame away from institutional failures. You know, we’ve talked in the show about the systemic failures that allowed the pandemic to just spread readily in the United States. But there are now going to be systemic failures that affect who gets access to care, who has the time and the capacity to actually heal. We’re now entering a phase where employers are forcing people to return to the office; where people will increasingly want to seek mental-health support for everything they’ve experienced but will run headlong into the dramatic dearth of mental-health-care providers in the U.S., the labyrinthine nature of the insurance requirements. It’s going to be hard. And I don’t think that we should allow the idea that people individually can often be resilient in the face of hardships to [erase] the fact that a lot of people will encounter massive structural barriers to feeling whole again.

Hamblin: Yeah, I’m trying to resist the inclination to ask for individual advice about what people can do, because that plays into the exact problem that you’re talking about.

Higgins: You’ve got to stay hydrated, everyone.

Yong: Everyone try to do yoga, go for a walk. We can all just rattle off a list of those tips, right? I don’t think that they’re unimportant, but one of the people I spoke to said that America is just not very good at talking about loss and about giving space for grieving and mourning. And she said, by and large, it’s all about consumption to help numb you out. It feels true. It feels like that’s where we're headed, that you’re expected to just deal with it. And Jim, you talked about health-care workers. I feel like this is especially true for that community of people … there’s plenty of stigma around even seeking care for mental health and a lack of institutional support for nurses and doctors and other health-care workers in doing so. And I worry for people who endured a long, long marathon of having to stare this pandemic really in the face and how they’re going to be feeling now even as things start improving nationally.

Hamblin: Yeah, well, maybe that’s some helpful personal advice we could give people, is talk to people around you about how you’re feeling or at least ask how they’re feeling, especially in trying to make sure that they have someone they can open up to.

Yong: One person I spoke to talked about how normalizing the collective trauma is going to be important in recovery. And I think what you just meant by talking about the stuff is sort of why [I wrote] this piece: to put words to this experience that I spent a lot of people are going to be going through. What we talked about, this disconnect between expecting to feel better and actually not, taking time for that to happen.

Higgins: And it’s often like I remember when we were kids, we used to kind of joke because my dad would always get sick on his days off because he worked all the time. And it was when he stopped that his body kind of gave. He was in construction, you know. And so, it feels a bit like that, too, because I know Jim and I were talking before you called, Ed, about how people are taking off their masks. That’s such a visual sign that things are better again. But maybe that’s the time, then, that it all hits you. Maybe if you haven't been physically sick yourself.

Yong: Yeah, I agree. And I think you’re right. In talking about the physical aspects of this to you, like I’ve been saying to folks, everything I’m seeing now reminds me of going to university for the first time, and like your dad on his days off: As soon as terms finished, I got sicker than I’ve ever been. You run and run and run. And the minute you stop, your body just gives out. And I think there are reasons for that. The stress affects the immune system. And ironically, for this conversation, it makes people more vulnerable to respiratory viruses, and not only do people become sicker, they often mentally crash, too. This is what we discussed earlier, that often it’s when you get to stop swimming and reach dry land, that you start to feel like you’re actually drowning.