By the first day of summer in Massachusetts, daily cases of COVID-19 across the state were dwindling. Restaurants ordered picnic tables and string lights in bulk. Drive-in theaters, once a novelty of yesteryear, were cool again. Coastal towns prepped for an onslaught of pasty beachgoers.
And in the warm days that followed, Massachusetts embraced the credo of one of the state’s most ardent nature lovers, Ralph Waldo Emerson: “Live in the sunshine, swim in the sea, drink in the wild air.” But any semblance of normalcy achieved through socializing and recreating outdoors will become increasingly elusive as daylight wanes and temperatures dip.
“We need to hunker down and get through this fall and winter because it’s not going to be easy,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said last week.
The change in seasons has many mental health experts worried that an already tenuous landscape will worsen. Six months of turmoil and uncertainty have left two out of five Americans with feelings of depression or anxiety, according to a recent CDC study. In Massachusetts, the worst of the pandemic may be behind us for now, but the trauma caused by the virus, social unrest, and economic recession still lingers.
Blue Cross Blue Shield of Massachusetts reported that use of mental health services was up 14 percent from January to July of this year compared to the same period of 2019. A recently published study by a group of researchers from Boston, Providence, and New York City found that symptoms of depression were more than three times as prevalent during the pandemic than before, with an outsized toll exacted on lower-income populations.
“When you’re treating depression, one of the biggest things you can do is behavioral action, and that means basically getting people to do stuff,” said Karestan Koenan, a professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health. “Telling someone to stay home is exactly the opposite of that. The weather changing will compound that. We’ll be robbed of some of the ways we’ve been able to cope.”
Even in nonpandemic times, the winter months, with their midafternoon sunsets and paralyzing frosts, can cause seasonal affective disorder (SAD), a form of clinical depression affecting at least 5 percent of American adults. But now, for many people, the cold will also mean a return to the homebound stage of the early pandemic, as flu season and the coronavirus coincide.
“On one hand, it’s like how much worse can it actually get? And on the other, I’m telling myself don’t ask that question because you’ll find out just how much worse,” said Sarah Shaw, a 38-year-old Roslindale resident.
Shaw has worked in the restaurant industry for two decades, most recently as a server at Democracy Brewing, but the Downtown Crossing brew pub closed in March when the pandemic hit. She’s been out of work ever since.
“There is a feeling of hopelessness,” Shaw said. “Anybody who says they aren’t feeling anxiety or depression right now is lying to you.”
Aside from distinct stressors such as job loss or health concerns, many also report feeling a murky but unshakable sense of uncertainty and apprehension. With the president sparring with scientists over the nature of the virus, contradictory reports about the timing of a vaccine, and the absence of another virus aid deal, the future feels precarious.
“Uncertainty has always played a role in pandemics, and the coronavirus is no different. People have a lot of difficulties tolerating uncertainty,” said Steven Taylor, a clinical psychologist and author of “The Psychology of Pandemics,” published last year. “When you take away the things that people derive a sense of pleasure or security from and combine that with the mishandling of the pandemic, it is a recipe to depress and demoralize people.”
Chris Mastrogiacomo teaches a group of adult students with disabilities at a postsecondary program on the Cape. He’s escaped the stresses of work this summer by spending time on and near the ocean, but he begins in-person instruction in a handful of days. He worries about his students transmitting and falling ill from the virus but also suffering from isolation and instability if they’re forced to stay home. All the while, he still doesn’t know where to send his fifth-grade son for remote schooling when he and his wife, also a full-time in-person teacher, are at work.
“You could say there is a sense of impending doom,” Mastrogiacomo admitted.
Taylor also suggests that the ongoing uncertainty could lead many to adopt a myopic view, living purely on a day-to-day basis rather than with a long-term focus, as a way to cope with financial or psychological stress. And as with all aspects of the pandemic, the brunt of the mental health crisis has disproportionately fallen on the shoulders of already vulnerable populations. The September study by a group of researchers from Boston, Providence, and New York City found that respondents with less than $5,000 in savings were at 50 percent greater risk of experiencing depression symptoms.
But such short-term thinking might be detrimental in the long term. Norman Rosenthal, the South African psychologist who coined the term seasonal affective disorder, said the primary way to avoid feeling down in the winter is to preemptively develop healthy ways to adapt and cope.
Health care providers are expanding access to and increasing reimbursements for virtual mental health services. All the while, mental health experts maintain that the tools — daylight walks, artificial lights, healthy eating, regular sleep, and maintaining virtual or distanced social connections — traditionally used to combat SAD should also be used to stave off feelings of confinement and isolation.
Mona Vernon has spent the summer on long nature walks with friends. But the Parisian who moved to Boston in the early 1990s had a moment of reckoning the other day when she contemplated the seclusion and suffocation of the winter. She promptly ordered a pair of snowshoes and all seven volumes of “In Search of Lost Time,” the mammoth novel by the prolific novelist and recluse Marcel Proust.
“I panicked. Plan A is Proust. I’m hoping he saves me,” said the single mother of two. “Plan B is snowshoes. I don’t even know what snowshoes are, but I think I need them to stay sane this winter.”
The Samaritans' 24-7 crisis help line can be reached by calling or texting 877-870-4673. People experiencing a crisis can also call the Disaster Distress Helpline: 1-800-985-5990, or the National Suicide Prevention Lifeline: 1-800-273-8255.