Since the COVID-19 virus hit the United States, the mainstream media have regularly covered its psychological impact on the American public. According to these reports and commentaries, the potentially deadly disease is stirring not just fears of illness but also sadness, anger, and loneliness created by the strain of mandatory self-isolation. This anxiety and depression, they say, is to be expected in most people. But for those who already struggle with such feelings, their responses to the pandemic can be seen as a flare-up of their “mental illness symptoms.” So, while the “normal” part of our population is being comforted, those with “disorders” are being told to watch out! And at the same time, media are telling of a new epidemic that may be on the way: an outbreak of mental illness.
Acknowledging Stress & Anxiety
For example, we’ve seen stories such as “7 Reasons It’s Hard to Control Your Coronavirus Anxiety” (STAT News); “Don’t Go Down A Coronavirus Anxiety Spiral: Here’s What You Can Do to Relieve Your Worries, While Still Keeping You and Your Family Safe”(Wired); “How to Stay Resilient and Mentally Healthy During the Coronavirus Outbreak” (“On Point,” WBUR, Boston’s NPR station), and “Psychology Experts Share Their Tips for Safeguarding Your Mental Health During Quarantine,” (CNBC), among others.
Such pieces provided useful tools for understanding our emotions and behaviors, and reassured us that changes in mood, energy, and personal habits are normal reactions to a dangerous situation with many uncertainties.
As reporter Nicole Ellis explained in “5 Ways to Respond to Coronavirus Induced Anxiety” (Washington Post, March 20), the upending of routines and scary news unfolding on our TV screens and newsfeeds create “the perfect storm for feeling powerless and anxious.” Says her guest, “mental health expert” Dr. Jennifer Yip, “When we’re feeling anxious, our fight-or-flight response is being triggered—which is there to protect us. The problem is that some of us focus too much on the things that we can’t control rather than what we actually can control.”
“Healthy” Vs. “Unhealthy” Reactions
At the same time, as a Mad in America study of press coverage between March 8 and March 25 found, we are seeing warnings that for certain people, those hard-wired stress responses to the virus may not be normal, and that we should be alert for signs of “unhealthy” anxiety. Consider this video, promoted in a press release from the University of Florida’s Center for OCD, Anxiety, and Related Disorders:
Here we learn that, according to psychiatrists, you might have “unhealthy” anxiety levels if you “go too far” about preventive measures or avoid your normal passions. For example, constantly washing your hands for longer than the recommended 20 seconds may be a problem. So might not wanting to play baseball after school anymore, what with multiple people touching the same sports equipment. Not mentioned: Both behaviors make sense in the current context.
Like all press releases, this one was designed to steer news coverage during the crisis. In doing so, it was promoting the type of coverage that pathologizes the emotional distress experienced by those with “mental illness.” This was the type of coverage we regularly found in our review of reporting on COVID-19 and mental health. For example, this piece from The Hill, titled “The Mental Health Costs of Containing the Coronavirus Outbreak: A Pandemic Takes a Unique Toll on People with Mental Illnesses,” states that it is normal for the general population to feel anxious: “Everyone is going to feel some level of discomfort and anxiety right now.”
However, the article also warns that “For some, the anxiety can rise to a clinical level during an outbreak,” which requires professional help. In other words, what is normal for some is abnormal for others. According to Krystal Lewis, a clinical psychologist at the National Institute of Mental Health, symptoms that might be “clinical” include “difficulty sleeping, changes in eating patterns, rapid changes in mood, inability to carry out required or necessary tasks, [and] self-medication using alcohol.” The article urges people experiencing such symptoms to review the recommendations and resources provided by the National Alliance on Mental Illness, a primary source for the piece.
NAMI has long been known for promoting the idea that mental illnesses are underdiagnosed and undertreated, and this piece is, in essence, telling many readers that their reactions to the pandemic are “abnormal” and they may need help.
ABC News published a report that displayed the same confusion. Headlined “Anxiety and Depression Likely to Spike Among Americans as Coronavirus Pandemic Spreads,” its subtitle told readers that “Stress, Anxiety and Depression Are Normal and Expected Now.” But then the article quotes Yalda Safai, a psychiatry resident, who cautions that “[T]he unique and unprecedented threat of COVID-19 has exacerbated anxiety, depression and potential for hysteria in our most vulnerable – the mentally ill.” Put bluntly, reactions by the “mentally ill” are being depicted as a form of “hysteria.”
Meanwhile, a CBS affiliate segment titled “Health Officials Warn of Increasing Mental Illness Symptoms During COVID-19 Crisis,” went a step further, suggesting that the virus could make previously OK people mentally ill. The piece compared the pandemic to 9/11 and implied that overly strong reactions to such disturbing events could be a sign of a mental disorder. Although a voiceover tells people not to self-diagnose, that message is contradicted by the crawler at the bottom of our screens: “Guarding against mental illness during pandemic.”
Even behaviors appropriate under the circumstances might be pathological, as one therapist told The Washington Post (March 14): “Now all Americans are being told to view their surroundings in a way that seems to mimic OCD.”
All told, the public is left with a confusing message: Becoming more anxious in response to COVID 19 would be normal if you are mentally healthy and a sign of illness if you’re not, although apparently some normal people might experience so much anxiety that they, too, could now be seen as mentally ill. And finally, everyone is now to practice behaviors that in the past would be a sign that they had OCD, but now are considered reasonable…unless one goes “too far.” Perhaps those labeled with OCD had it right along when it came to handwashing?
Destabilizing the “Disordered”
Facing exceptional circumstances, everyone can be expected to feel levels of fear, sadness, and irritability well above their usual baseline. This is especially true for people who, even in more ordinary times, struggle with anxiety and depression. But because of the conventional view of mental illness as an intrinsic, biological defect of individuals, the press is treating these individuals as a separate case.
Headlines blared, “Some with OCD, Other Anxiety Disorders Are Struggling Amid the Coronavirus Epidemic: ‘It’s Tripping the Wire for Many Different People’” (Chicago Tribune), “OCD and Anxiety Disorder Treatment Can Be Complicated by Coronavirus Fears” (Washington Post, March 13), and “Coronavirus Is a ‘Personal Nightmare’ for People with OCD and Anxiety Disorders” (NBC News), to name just a few.
In this schema, if “normals” panic, it’s because of the pandemic; if “mentally ill” people do, it’s because their Generalized Anxiety Disorder, Bipolar Mania, or OCD is flaring up or relapsing. This is shown in how mental health professionals in these pieces talk about the heightened worries they’re seeing in their clients—by definition “patients” in treatment for a disorder/disease.
For example, in NBC News’ piece on OCD, an illustration of people frantically washing their hands is captioned “The wave of anxiety sweeping mental health patients is unlike anything counselors have seen before.” Here, the network reports that “one of [psychologist Reid] Wilson’s OCD clients nearly canceled an appointment because they were concerned they had touched their nose too much and could give the coronavirus to Wilson . . . Another, with generalized anxiety disorder, couldn’t stop worrying about whether their daughter traveling from another country was at risk.”
Yet, given the pandemic, both of these worries seem well-founded. Who wouldn’t be concerned about giving the coronavirus to another, or agonize about a daughter traveling in another country?
In an article titled “Coronavirus Responses Trigger Anxiety, Distress for Vulnerable Oklahomans” Oklahoma Watch describes the anxieties experienced by a Norman Oklahoma woman named Sarah, who “has depression that is brought on by stress”:
Her speech quickens and her heart races as Sarah talks about the spread of COVID-19 and how it could affect her brother, whose medical history makes him more vulnerable to infection . . . According to her journal, she has been anxious and fighting insomnia for weeks—signs that her depression has returned.
The idea that a “disordered” individual’s response to the pandemic can be understood as evidence of pathology can also be seen in comments by leaders in American psychiatry. For example, NIMH Director Joshua Gordon told the Washington Post (March 17), “We’re all a little suspicious of others on the subway, on the street, if they’re coughing or they look sick. Imagine if you had schizophrenia—that concern or suspicion could turn into frank paranoia.”
A piece in Psychiatric Times (“Psychiatrists Beware! The Impact of COVID-19 and Pandemics on Mental Health”) similarly warns that worries about the virus may “further destabilize patients and increase functional impairment” in those with OCD-related “contamination obsessions” and inflame medical “conspiracy theories” among those with “psychotic disorders.”
This is the “pathology” framework that people diagnosed with mental disorders live within: Reactions that are seen as normal in others are seen as pathological in those who live with a diagnosis. In a March 16 piece headlined “This Is Going to Compound Your Problems: Coronavirus Poses New Challenges for Many with Mental Illness,” CBS News tells of Katherine Ponte, who “had been obsessively watching the horrors of the Iraq War on cable news in 2006 when she took a hammer to her TV. She suffers from severe bipolar I disorder with psychosis as well as major depressive disorder, and the images of a war-torn Middle East triggered a manic episode that caused her to be hospitalized. If Ponte isn’t careful, the current coronavirus pandemic could have a similar effect on her.”
Similarly, a story in USA Today (“‘Isolation Is a Big Trigger’: Feelings of Suicide Are Amplified Amid a Pandemic”) quotes “Danielle Sinay, 28 . . . a writer in Brooklyn who has a history of suicidal thoughts. She’s been diagnosed with a panic disorder, post-traumatic stress disorder and depression. While she isn’t entirely isolated—she lives with her husband and four pets—[she says] disruptions to her routine and the proliferation of unknowns have left her vulnerable.”
A Looming Epidemic?
With the pandemic said to be causing a surge in anxiety and an increasing number of people seeking therapy, there has been a wave of stories on therapists scrambling to meet the demand. This spike in emotional distress now described as a “symptom” of a growing “epidemic” in which “normal” people will show signs of “mental illness” and “mentally ill” people will relapse or get worse. This is a problem, it was often stated, because anxiety disorders already affect tens of millions of people.
Some such pieces were straightforward. The New York Times, in “As Coronavirus Takes Emotional Toll, Mental Health Professionals Brace for Spike in Demand,” focuses on mental health professionals struggling to fulfill appointments safely via telehealth sessions for the many clients now fixated on disease. In “Mental Health Professionals Are Preparing for an Epidemic of Anxiety Around the Coronavirus,” Mother Jones shares one therapist’s anecdotal take on the barrage of “extreme symptoms” she’s seeing among patients. The magazine then recounts a rise in ordinary people taking Mental Health America’s online anxiety screening test, which the magazine considers “newly available data.”
These stories were framed around the idea that much more conventional mental health treatment is what’s needed now, as exemplified in Mashable’s “Coronavirus Reveals Everything That’s Wrong with Our Mental Health Care System.”
Other pieces were more sensationalistic, epitomized by a March 24 op-ed in The Guardian, “We Face a Pandemic of Mental Health Disorders. Those Who Do It Hardest Need Our Support” Here, Guardian Australia columnist Paul Daley declares:
Yes, this is a frightening, deadly viral pandemic. But another plague, one we are not hearing nearly enough about from our leaders, will arrive in a wave just behind it.
That is the pandemic of severe depression and anxiety that will sweep over the world as the unemployment rate pushes into previously unseen digits, families who’d prefer to be socially distant are thrust together and young people are denied the certainty and structure of school. . .
As mass desperation, anxiety and depression elevate in line with the lengthening of the . . . queues, civil society will come to depend almost as much on the maintenance of individual mental health as on the availability of testing kits and masks.
The media confusion could be seen in full display: Although becoming anxious could be seen as a normal reaction by normal people to COVID-19, the pandemic nevertheless was stirring an epidemic of “mental illness.”
Separate, Not Equal
While news media warned of an overwhelmed mental health system, they also attempted to provide advice on how to cope on one’s own. Here the tips given to “normal” folks and those to “the mentally ill” were much the same: Maintaining social connections, getting exercise, meditating, maintaining a routine, and practicing cognitive-behavioral therapy techniques such as reframing negative thoughts. But there was one key difference. While the general public was urged to cultivate their inner resources and reach out to colleagues and loved ones, the mentally ill (and people noticing signs of “clinical” level anxiety) were urged to reach out to a professional.
One of the most popular anxiety-busting tips for “healthy” and “unhealthy” folks alike was going on a media diet—avoiding those scary, 24/7 news updates the news media themselves were producing. According to mental health pros interviewed in Wired (above), people should “limit how much information you consume about the coronavirus outbreak. Try to find a balance between being informed enough to make decisions about your life, but not so overloaded with information that it becomes stressful.” This isn’t far from advice offered to those with mental disorders. In “COVID-19 Pandemic Can Take Toll on Mental Health,” the CBS affiliate reports, “Jessica Ryan with Mental Health America . . . says it might be time to take a break [from obsessing over online news]. She says all of the changes happening and constant news coming through, it could be triggering for someone that has been diagnosed with a mental illness.” Same concept, different framing.
Sometimes the same outlet created two separate segments on the same topic. For example, “CBS This Morning” broadcast a video segment, “Minding the Crisis: How to Curb Anxiety During the Pandemic,” featuring psychiatrist Gail Saltz, who offered everyday tips for alleviating stress reactions to the pandemic. She reassured viewers, “Pathologizing, or making yourself feel worse about ‘why am I so freaked out,’ is not helpful and it’s not true. It is normal to be feeling anxious now as there are some dangerous things going on and we have an evolutionary system evolved to alert us to things we should be aware of.” This piece was embedded in the online CBS News piece noted above, in glaring contrast to its coverage of the special risks and needs of the “mentally ill” during the coronavirus crisis.
By drawing exaggerated distinctions between the heightened emotion and counterproductive behaviors that “normal” people experience and those expressed by people with pre-existing mental illness labels, the news media here are carrying water for the psychiatric enterprise. Indeed, we tend to hear such warnings every time there is a crisis, which ultimately serves to push more people into treatment and, most likely, onto psychiatric drugs. This is the goal of not just NAMI (whose contact info is included in several stories we examined) but also two other major sources for these pieces: Mental Health America and the Anxiety and Depression Association of America. These groups have a vested interest in promoting this narrative, and the pandemic provides an opportunity to do so.
Psychologist Lucy Johnstone makes this point in an op-ed, “Why It’s Healthy to Be Afraid in a Crisis” (The Guardian, March 25):
We’re not facing “a pandemic of severe mental health disorders.” We’re all facing entirely normal fear, anxiety, despair and confusion about a truly terrifying situation that challenges our whole way of life. Never has it been clearer that so-called “mental disorders” make sense in context. . .
The more we label our understandable human reactions as disorders, the greater the temptation to disconnect them from their source and focus on new individual “treatments” instead. The drug companies must be rubbing their hands at the prospect of all these new customers.
While well-meaning, this type of coverage is unhelpful, serving to increase existing anxiety by raising the possibility that a person’s reactions to an international pandemic might mean there is something “wrong” with them. It is also dangerous to suggest that the public-health guidelines we need to follow now, such as self-isolating, might break us—it only serves to make people reconsider the wisdom of social distancing.
Stereotypes of those with mental illness labels, and their perceived neediness or dangerousness, have already had real-world consequences. In the U.K., a mental health law was temporarily changed to lower the bar for involuntarily detaining people deemed mentally ill requiring the approval of one doctor rather than two. The rule also will extend or remove time limits on involuntary commitment.
As a March 19 article from Disability News Service reported, the “National Survivor User Network (NSUN) fears this could lead to both more coercion and more neglect, as well as fewer safeguards.” The story quotes Akiko Hart, NSUN’s chief executive: “Whilst we understand that these are unprecedented times . . . keeping individuals unnecessarily detained beyond their section because of workforce pressures is a violation of their human rights.” She added, “Equally, releasing individuals because of pressures on the workforce or the mental health estate is deeply irresponsible.”
The Fragility Myth
Finally, the coverage emphasizes the fragility and vulnerabilities of people with “mental illness,” rather than the strengths they also possess. Bob Nikkel, Former State Mental Health and Addictions Commissioner for the state of Oregon* observes, “Journalists have the same stereotypes as everyone else.” Recently contacted by a reporter about the impact of coronavirus on services for “the mentally ill,” he tried to convey that “People with mental illness diagnoses have more resources than people realize.”
He told Mad in America, “We don’t need to feel pity, we need to see them as leaders. We need to recognize that they’ve been doing some version of peer support, which reduces isolation, for decades.” Nikkel cited the work of Intentional Peer Support and the National Empowerment Center, reporting that “Dual Diagnosis Anonymous started online ‘12-step plus five’ programs [recently] and saved someone’s life who was suicidal. Even in the coronavirus era, these efforts are especially valuable.”
Indeed, people with psychosocial disabilities might be better able to cope with “healthy” or even “unhealthy” anxiety. They have learned many lessons and tactics from dealing with those challenges for years. Ken Goodman, a therapist on the board of ADAA, told The Washington Post (March 11) that “of the roughly 60 patients he treats each month, just one has expressed a fear of the virus so far.”
Toward the end of a typically ominous article on the mental health risks of coronavirus in the Detroit Free Press, Toni Lupro, a medical student with “Obsessive-Compulsive Disorder,” noticed that “ the coronavirus pandemic has revealed how far she’s come in therapy.” The story goes on, “Fears of contamination have dominated her life in the past, but the arrival of COVID-19 in Michigan hasn’t caused her to regress.”
Lupro herself is quoted, saying: “It’s kind of good to realize that everybody’s in the same boat. Even people who’ve been physicians for 30 years, we all don’t know necessarily what is going to happen . . . I think that helps me to know [fearing germs is] not necessarily an irrational thing.”
To be sure, many people are currently undergoing immense suffering, and psychiatric patients and people with substance-use issues are more vulnerable to contracting the virus because they tend to be marginalized. Also, research shows that the echoes of this traumatic time will likely linger long after the virus and quarantines have passed. What this means is that all of us will need varying, increased levels of support.
But these stressful events may also prove a great equalizer. As Lucy Johnstone wrote, there is an alternative to an epidemic of phobia and PTSD diagnoses: “We can come out of this crisis in a better state than before by staying connected with our feelings and the urgent threats that have led to them, and taking collective action to deal with the root causes.”
The Press’s Role
That broader perspective is something social scientists who study trauma say journalists should emphasize if they want to be both accurate and helpful during this crisis. Among them is Dr. Roxane Cohen Silver, whose research focuses on the psychosocial effects of widescale disasters and the role of news media in their aftermath. During a recent SciLine-sponsored webinar on she talked about “how we can best ensure population resilience”:
We’ve all been through community traumas before. We’ve weathered mass violence, we’ve weathered natural disasters, and indeed my colleagues and I have studied many such events, including the September 11th terrorist attacks, . . . [and] hurricanes Irma and Harvey. And our research tells us that most will get through these situations.
While the press should acknowledge that the situation is dire and that anxiety is “appropriate” now, Cohen Silver said there is an opportunity for journalists to convey a more constructive message: “If we work together, we can save lives . . . We can encourage positive community outcomes such as altruistic behavior, social cohesion, volunteerism, reaching out to those who are living alone or who are seniors.”
While our collective state of emergency continues, it would be helpful to see the news media cover more such community- and resilience-based approaches to public health instead of providing a platform for psychiatry’s pathologizing narrative.
*Nikkel is also Executive Director of MIA Continuing Education.
MIA Reports are supported, in part, by a grant from the Open Society Foundations