The psychiatrist’s couch isn’t even a couch anymore.
These days, Dr. Marra Ackerman sees her patients through a computer monitor on a desk in her Manhattan apartment, reminding her caregiver patients to ready themselves for fresh waves of virus ahead.
They are doctors, nurses, med techs and other frontline health-care workers, many of them. They link to her from break rooms at the hospital, from quiet corners of the cafeteria (when they can find one) or after they finally collapse at home from another emotionally draining shift in the long-running battle against COVID-19.
“It’s like what they tell you on the airplane,” she was saying, turning briefly away from her urgent mental-health mission. “Put your oxygen mask on first. If we don’t practice self-care, we risk burning out, and we risk not being able to provide the ideal care at the bedside.” She delivers the same message over and over again: “Yes, it’s for you. But it’s also for your colleagues, for your patients and for the larger community.”
As director of the house-staff mental-health program at NYU Langone Health, Ackerman has organized 25 support groups for the hospital system’s employees while also maintaining a busy one-on-one therapy practice. Now that the coronavirus patient counts are receding for the moment and the ERs and ICUs are a bit less slammed, New York’s hands-on healers are finally catching their breath and preparing for the next wave and the one after that in what could be a very long-running war.
“That’s the right word for it, war,” she said. “This is a health-care war, and PTSD is part of the equation. Even with all the massive stresses, a majority of frontline healthcare workers will not go on to experience major mental-health issues. But most of them will have some degree of distress, anxiety, difficulty sleeping, irritability or just feeling down.” Three months into the worst of the crisis, “lots of people are experiencing those feelings already.”
Getting on top of them now will determine how severe a price they are likely to extract later on.
“It can feel really futile when we lose a patient,” Ackerman said. “But we also see people recover. We know we’ve been able to provide a huge group effort, just showing up, taking care of people, preventing further infection, providing comfort and care, at this time when so many of the patients are isolated from their families.”
It’s crucial to keep those lifesaving achievements in mind, as well. They are empowering.
“9/11 was very traumatic,” the hospital psychiatrist said. “But this pandemic is an ongoing fight for the day-to-day. People are scared that their own lives could be at risk if they get sick. Certainly, we have some idea about risk factors and who’s more vulnerable. But the consequences haven’t followed the exact patterns we expected. So much is still unknown.”
Who wouldn’t be rattled by that?
The mental-health team Ackerman supervises is there for a prompt consultation when a hospital staffer feels a need for one. Team members are constantly on the lookout for signs of spiking distress. They keep searching for new procedures that might ease the tensions more broadly.
“A lot of what we can provide,” she said, “is validation. Basic support. What we call psychological first aid. How do you create a sense of calm? How do you manage anxiety? How do you reground yourself in the moment? It is really hard.”
There are tools to help with all of that, ways of guiding the caregivers to peace amid the grief. “We use what we call radical acceptance,” Ackerman said, “trying to accept the things that we can’t change and acknowledging the feelings that come with that. The sadness, sometimes.”
No one expects this wave of COVID-19 will be the last one. Ackerman and her mental-health team members are already preparing for the next one or ones. What might be surprising is how many of these mental pressures now apply to all of us, in and out of the health-care world.
“We have some lessons learned,” the doctor said. “We have procedures for managing the spread of infection. But as a psychiatrist, I am also concerned about the mental-health risks of ongoing social isolation. That piece of the puzzle is really difficult. We have to continue to try to protect against the public-health risk of spreading this infection or having a resurgence. Social distancing and isolation will continue to be important until we have a vaccine. But we also have to find a way to be with other people safely. It’s really important for our mental health and for our children’s social and emotional development. We need to socialize.
“I do worry that depression, anxiety disorders, fear of being in social settings — all that could get worse the longer we continue to be afraid to spend time with other people. We have to deal with that. How do we find that middle ground?”
Ellis Henican is an author based in New York City and a former newspaper columnist.