The mental health problems waiting at the end of Covid-19

With millions of people worldwide now vaccinated, and the summer approaching, it seems like there’s light at the end of the long, dark tunnel that is the Covid-19 pandemic and associated lockdowns.

However, while any cause for hope and optimism is to be embraced and celebrated, the end of lockdown doesn't mean the end of problems. Far from it. As well as the economic fallout and various social upheavals we've all gone through, many are grimly certain that we're going to be seeing a significant increase in mental health problems over the coming years. Some are even calling it an imminent "second pandemic".

Not exactly good news admittedly, but it makes sense. A whole year (or more) of lockdown! Of being denied nearly all the pastimes and experiences we enjoy. Of being unable meet friends or family. Of having so little control over our own lives. Of any journey out of the house being inherently risky.

Even if you haven’t experienced the pain of losing someone to the virus, how could all that not cause your mental health to suffer?

By the time I get to court, my maternity tights have fallen down

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What’s the oldest woman you’ve delivered a baby to, I ask the doctor. Fifty-two, he says

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But while many, perhaps most people, have little trouble accepting the premise, far fewer people ever stop to consider why. Why do periods of stress, strife and trauma do such harm to our mental health? What’s going on in our heads to make this outcome so common?

A big part of this is down to how our brains (and bodies) work at the fundamental levels. And a key factor in all this is the effect of stress.

We all know stress. We've all experienced it. It's just a part of life, right? Technically, yes. For instance, our complex modern world is full of all manner of things for our brains to perceive, experience and process, and the many different parts of our brains react in different ways. One fundamental and very influential part is the threat detection system, which essentially monitors everything that's going on in our brain and flags up anything, anything, that might lead to a negative outcome, and tags it as a threat to be wary of.

‘Threats’

Unfortunately, our powerful brains can recognise a lot of things as “threats”. Whereas simpler creatures usually only perceive a threat if it’s something right in front of them, often something with sharp teeth or talons, we humans have the dubious honour of being able to recognise all manner of hazards, even totally abstract ones.

What if the economy declines and I lose my job?
What if I end up in a relationship with someone who's allergic to dogs?
What if they make me sing karaoke at the party?
What if I'm not married before I'm 35?
What if I'm late for my flight?

And so on. All these things, and countless other common causes for concern, present no physical danger to us at all. And they may never happen. Doesn’t matter, our brain worries about them anyway.

And worry leads to stress.

Stress is basically what happens whenever we're presented with something to worry about. It's a precursor to the full-blown fight-or-flight response (or fight, flight, or freeze response, to make it more scientifically accurate). If you think of the fight-or-flight response as the big boss in a video game, stress is the hordes of minions you must get through before you encounter it.

Stress is actually a physiological process, as well as a mental one. You get all usual cognitive effects; the negative emotional aspects, the irritability, the bias towards focussing on bad things over good, and so on. But you also get muscle tension, suppressed immune system, appetite increase, and more.

Cortisol

But all elements of the experience of stress can be pinned on the release of stress chemicals, like cortisol, into the bloodstream, where they interact with important parts of your body and brain, to induce all the stress responses we know and very-much-do-not love.

Here’s the problem, though. The human brain has evolved the ability to experience long-term chronic stress. When you can be stressed about intangible things that may never happen, those things don’t really “go away” ever. Therefore, there’s no obvious point where we should stop stressing about them.

Unfortunately, our brains haven’t evolved to deal with long-term stress very well. It has finite resources for doing so. And the harder our brain has to work to alleviate the impact of stress, the less time and resources it has to dedicate to maintaining itself and its crucial system, things which are integral for good functioning and our wellbeing.

This is why stress can be, and often is, a key factor in the development of mental health problems. Stress can exhaust the mood-regulating brain cells, leading to the onset of depression. Stress can overstimulate key parts of the brain's aforementioned threat detection system, leading to an excess of illogical, unnecessary fear, what we recognise as anxiety. Attempts to alleviate or prevent the experience of stress can compel us to "self-medicate", in ways which readily lead to addiction. And so on.

Mentally unwell

And just how much a brain has to offer when it comes to dealing with stress depends on what it's gone through already. This is why clinicians often refer to the Stress-Vulnerability model of mental health, which shows that how much stress you're able to deal with determines how much stress it takes to push you over the line into mentally unwell.

Usually, your average person experiences stress, but has many options for reducing it too. Recreational activities and entertainments, social interactions, alone time, travel, sports and exercise, getting help from family and friends, and so on. All these are tried and tested means of reducing stress.

All these things are also unavailable during a lockdown. A lockdown that’s due to the literal deadly pathogen raging through our communities.

Basically, the lockdown means that pretty much everyone is experiencing more stress than ever, while having little to no means of reducing it. And stress is a key factor in the development of mental health problems.

That’s why we’re expecting a surge in mental health problems worldwide, even after the lockdown and pandemic are over.

Because unfortunately, that’s just how our brains work.

- Dr Dean Burnett’s new book is Psycho-Logical: Why Mental Health Goes Wrong, and How To Make Sense Of It.