June 25, 2020

The Effects of Isolation on Mental Health

Show Notes

On this episode, Chuck Gaidica is joined by Dr. Mark Eastburg, clinical psychologist, and President and CEO of Pine Rest Christian Mental Health Services. Together, they discuss physical isolation and its impact on mental health.

In this episode of A Healthier Michigan Podcast, we explore:

  • COVID-19 and self-quarantine
  • Loss of social and familial connections
  • Pandemic-induced anxiety
  • Behavioral changes in children and adults
  • The differences between an introvert and extrovert
  • The pros and cons of working from home
  • The importance of self-care

Transcript

Chuck Gaidica: This is A Healthier Michigan Podcast episode 57. Coming up, we discuss life after isolation and its impact on our mental health.

Chuck Gaidica: Welcome to A Healthier Michigan Podcast, the podcast dedicated to navigating how we can all improve our health and wellness through small, healthy habits we can start right now. I’m your host, Chuck Gaidica. And every other week, we sit down with a certified health expert from Blue Cross Blue Shield of Michigan and others to do a deep-dive into topics that cover nutrition and fitness and a whole lot more.

Chuck Gaidica: And on this episode, we’re talking about life after isolation and the impact that it may have had on my mental health, your mental health, on your family. So today we thought we get an expert. This man is President and CEO of Pine Rest Christian Mental Health Services, Dr. Mark Eastburg. And he’s also a clinical psychologist. He’s received his doctoral training from Fuller Graduate School of Psychology in Pasadena. He serves as chairperson of the board of directors for the covenant retirement communities, and also is on the board of directors for the Michigan Hospital Association. He too is married to a Susan, which is nice. That’s my wife’s name. She’s a nurse. Well, Dr. Eastburg, good to have you with us.

Dr. Eastburg: Thank you. Good to be here, Chuck.

Chuck Gaidica: So I have to ask you, before we get into this great topic, your wife Susan, is she always Susan to people in Michigan or do they tend to compress the name and call her something else like Susie or Sue? It drives my wife bananas.

Dr. Eastburg: Yeah, she is Susan to me and certainly at home, but at work it has morphed into Susie, and that’s what her friends call her at work. But that’s the only place.

Chuck Gaidica: My wife is from the South, and to her, if I called you Joe, your name is Mark. I mean, to her, anything other than Susan is not her name. It’s really funny. And it just happens by default here in Michigan. I don’t know what it is. Anyway, here we are. I hope you’re well, I hope your family is well, but we’re coming out of, for us in Michigan, which has been an onerous process for about 70 days that we’ve had this shelter-in-place order got lifted June 1st. So it may vary if somebody is listening from out of Michigan, but the same situation. And through this time we’ve been encouraged to socially distance ourselves. So now maybe you have family at home, maybe not. It’s so complicated because it’s based on your own context of what’s going on. But talk about this idea of anxiousness, maybe, because some have anxiety already before we got into COVID, but now you’ve got lots of other inputs that are causing the pot to be stirred.

Dr. Eastburg: Right. There’s really a lot going on, Chuck, with people, and as you mentioned, you’re right. Every situation is really individual. I’d just like to frame this, taking a step back, when we’re isolating in place, where we’re staying at home, we’re really disrupting the balance of our lives. We all live our life with a balance of stressors and also things that give us support and help us. But in these last 70 days, as you mentioned, or more, a lot of those things we rely on have been taken away. It’s really a sense of loss for a lot of people. We’ve gained a few things, and we can get into that in a minute. But for most people I think they would say that they have lost some things that are really important to them. And we’re certainly seeing that at Pine Rest as people are seeking services.

Chuck Gaidica: And some of those things you’re talking about that are missing could be really at the very basic level, right? You may be missing the ritual of getting up and driving for your favorite coffee and getting a muffin on your way to work. I mean, there are certain things that don’t seem like they would cause you to feel off-kilter, but they could.

Dr. Eastburg: That’s right, yeah. What we’re saying is, first of all, the face-to-face connection that people had with their friends, especially adolescents, the research shows that the peer group is so important, that connection. And after a while, Snapchat and Instagram just doesn’t cut it. And there’s really a desire, and a lot of the supports that teenagers experience… Recently a widowed man who was really looking forward to visiting his adult children is now coming to us because he’s anxious and depressed. The other takeaways really relate to jobs, and some of those can be pretty extreme. For some people it’s actually a loss of income or maybe the sense of satisfaction they get from their job that they’re not able to do. For some people, it’s a sense of safety on their job. They’re going back into work environments, particularly healthcare workers, where they’re not sure if they’re going to come home and bring a disease to their family. Unemployment has been related to really serious mental-health issues like suicide. So we’re watching all those things. That’s another takeaway.

Chuck Gaidica: And when you say that and you put all of that together, obviously again, it’s affecting everybody differently, because I have felt anxious, but I don’t tend to have anxiety. I tend to be a positive person, even by the strengths-finder test, that’s one of my top five strengths. Positivity. I just look at life that way. So yet I can still get anxious or I can get affected by watching the 24-hour news cycle. But for people who are coming to see you or others that are looking to help them, is there any common denominator of what’s happening in their life that’s causing stress that you’re seeing? Because you mentioned a few different things.

Dr. Eastburg: Yeah. So what we’re seeing are really as wide a variety as people themselves. So recently we saw somebody who tends to lean toward obsessive compulsive disorder who’s now really stressed about fear of contamination. So that was maybe just below the surface for this person, and now it’s really full-blown for people. The sense of loneliness, particularly people in a high-risk group who’ve had to be really strict about socially isolating. People who are seniors, who are over 80 years old, who, in the case of my dad, has had almost no contact other than digitally with people outside. Those are really important features that help people keep healthy and well mentally and physically, and to them away is really challenging. And we’re seeing people coming to us who now they’re seeking services and they’re saying, “I could really use some help.”

Chuck Gaidica: Yeah. And I know it’s all, again, based on individual circumstance, but in general, is it a matter of… I don’t want to make any assumptions, but is it a matter of really sitting down with you or one of your colleagues and talking to someone? Is that enough for some people that they’re able to just express, “The world seems off-kilter and I just don’t feel like I’m right within the world.” And oftentimes is that enough, is to just talk it out?

Dr. Eastburg: Yeah. That can be helpful for some people. We’re seeing people coming to us, now that they’re out there, seeking all kinds of medical services saying, “I find that I’m really anxious and this anxiety is really getting the best of me and I could use some professional help with that.” Now we were open all through the crisis as a mental health service, and we’re actually doing 6,000 tele-therapy and tele-health visits a week. So that’s been a really great resource for people, but we’re seeing the phones ringing more and more for people coming out and saying, “Okay, it’s time to get some help. I’ve been stuck at home for two, three months and I need something more than just what I’m doing.” And for some people, medication can be really helpful as a boost around depression and anxiety.

Chuck Gaidica: And I’m sure you’ve seen these articles. If I’ve seen them, I know you probably have. It’s interesting to me that we haven’t changed the name of what we’re supposed to be doing from social distancing to physical distancing. Really, the prescription is physically distance yourself, not socially distance yourself. So whether it’s a get-together on your driveway with a few buddies six feet apart, now that you can do that, or with family members or extended family, it seems to me that we assign the word social. And I read that article, and I thought, that also implies you should just keep yourself away from people even digitally. I know that’s not what’s happening, but I wish they would have changed the name early on, because now it’s stuck. I mean, now it’s just social distancing.

Dr. Eastburg: Yeah. That’s a really great observation, Chuck, is that what we’re after is physical distancing. So to keep people separate not socially, but enough space so that the virus doesn’t spread.

Chuck Gaidica: So as moms and dads, and just as members of a family unit that are together, what are signs we should be looking for in some of the kids that we have in our household, or even an adult, a spouse, what are some of the signs we should be looking for that someone is having trouble and maybe they’re not verbalizing it to us?

Dr. Eastburg: Yeah, well, so with kids and especially the younger kids, you can see acting out, new behaviors, new troublesome behaviors, socially isolating, angry outbursts. We are seeing an increase of couples that are coming to us for couples therapy. So sometimes the togetherness there, again, it’s thrown off the fragile balance that some couples have and so needing to address those. But any significant changes of mood and behavior, that’s what we look for any time we’re worried about someone with a mental health issue. And I think we can all see these changes, not only in the people that we live with, but also perhaps ourselves, too. A range of emotions that we hadn’t experienced before. COVID-19.

Chuck Gaidica: And so that also means that maybe we need to be more gracious if it isn’t us. And sometimes we don’t know, right? If I’m feeling anxious, I may be snapping at my wife Susan, and I don’t even realize I’m doing it. So let’s just say that. But if we’re trying to be mindful, and without tiptoeing around what’s happening with them, but if we’re trying to be mindful of those things, you’re giving us some warning signs and maybe some things that are overt that we’re able to see. We need to also be able to offer grace to somebody else, right? We need to understand that maybe they’re having a harder time with this than we are.

Dr. Eastburg: Well, absolutely. When I go down to the grocery store within the line and you see somebody who’s perhaps a little crankier, snappy, it’s just wise to think, well, maybe this person owns a restaurant or a small business, and they’re really not sure how they’re going to meet payroll, or if their business is going to be even around in three weeks. So to give somebody like that, who is looking at their life work fading away, as you said, lots of grace, lots of leeway. We all have our own stuff that we can react out of, but to be understanding. And we don’t know the other person’s story, especially strangers who we bump into and might rub us the wrong way.

Chuck Gaidica: And on the positive side, and even the positive side can have ancillary affection or this idea that we’ve been able to spend more time with family members. If you were typically going off to work to a location, and now the two kids are running around, and, “Mommy! Daddy!” And you’ve got that, the dogs are barking, you’re trying to do a Zoom call, you just spilled your coffee out there on your makeshift desk. I mean, there’s all kinds of stuff that even in the positive nature of your family, getting this two months of time to connect, I suspect there are issues. But what are some of the other upsides you’re hearing and seeing people maybe verbalize, they’re actually saying, “This has been positive for me”?

Dr. Eastburg: Yeah. So we make a lot about introversion and extroversion. And the folks that I’m talking to who are more on the introvert side are saying, “This is really great. There are so fewer expectations around social demands and interacting socially.” This is a great opportunity to have a lot more private time, downtime, to think and be by oneself, a lot more control over what happens to a person socially. So if you’re wired that way, this can be a moment of almost a break from some of the demands that feel draining to you. As you’ve mentioned too, I’ve heard a number of creative ways that families have connected even across the country, via internet gaming that’s going on, that they get together on Wednesday night for a game night together as a family from California to Texas to New York. Whereas before, they wouldn’t really have thought to do that because they were engaged locally. That could be a positive, if you turn it into that.

Chuck Gaidica: We did that with our kids. We have five kids and our one daughter and son-in-law are in Ann Arbor. And we were able to do game night. We set up the iPads, they had a scorecard, we had a scorecard and we’re playing Yahtzee. What’s nice about that idea was that in the midst of the game, it’s not the fastest-moving game if you don’t want it to be, but it was nice to ask, “Well, how are you doing? What’s going on? Are you both still working from home?” You’re able to interact in ways while you’re weaving that in and out of the game. And I think for us, that’s going to stick. Some of the other kids, we tried other ways of connecting, which was great, but I’ll tell you that was a huge upside for us to stay connected that way.

Dr. Eastburg: Yeah. I heard one family member say after a game night like that, “It felt like we were actually together tonight.” And so that maybe isn’t fully a hundred percent together, but that’s one of those opportunities here.

Chuck Gaidica: So a positive can also be that men and women are now working from home. We’re reading all kinds of things about what the future may be, right? That this may be something that sticks for a lot of companies. But I know from studying men, I can’t talk about women as much because I haven’t really looked at that, but I’ve seen data that shows that men, maybe even more than women, wrap their self-identity up in their job. And you’ve probably can see this and explain it in a much better way. If that’s true, then the question would be, if you’re now doing “your job from home”, even that can be a shift that affects you, right? You’re not really finding the self-worth, or you’re not the boss that you were before, or something. It seems like there could be something there.

Dr. Eastburg: That’s correct. It isn’t until you are working from home that you’ve figure out the parts of work that either gave you a lot of stress or you really miss. Maybe it’s those hallway conversations with a certain person or a group of people that you don’t have any more, that you’ve got to schedule an internet call in order to have the run-ins with them. So yeah, it can be very different. Your job takes a different turn. And I guess one of the questions that we’re asking ourselves, we’re doing a lot of the tele-therapy, is what will people want when this is all over? It’s a parallel question to what will the work environment look like?

Chuck Gaidica: Well, do you hear people also expressing the idea that they don’t have to be stuck in traffic for an hour and having the guy cut them off on the lodge? I mean, there must something there. It’s more productive, I guess, for many, that they don’t have to drive two hours a day or something, or an hour combined. Are you hearing people vocalize that?

Dr. Eastburg: Yes. If it’s an hour therapy visit or a 50-minute therapy visit and somebody lives out of town and it takes them 45 minutes to get there, it’s a lot more convenient to just go into your basement. Or what some people are saying, they’re going into their car in the garage because the household is noisy. And it saves them a lot of time. The downside sometimes is there was actually a study years ago that showed the further someone drives for therapy, the more gain they get out of it. I don’t know if they were able to process ahead of time and then afterwards. We’re in this living experiment to what post-COVID healthcare is like. And I don’t think we know the answer yet.

Chuck Gaidica: That’s interesting. You were talking about therapy, but I was asking about the idea that they actually don’t have to fight their way to their jobs every morning and every evening in traffic. I mean, it would seem to me that, and I’m just making an assumption, that that’s a lot less stress for some people that don’t have to worry about a commute both ways just to get to work.

Dr. Eastburg: Well, absolutely. You think about particularly here in Michigan, where in the winter people driving… I’m based in Grand Rapids. We have people drive from the Lake shore. Well, at the end of January during the ice storm, that’s pretty sketchy. And so for them, it’s going to be great not to have to worry about that extra piece of the commute. So yeah, all the upsides of not having to travel, whether it’s your job or therapy, or even going to visit with friends.

Chuck Gaidica: And are you seeing any data that’s indicating… The hospitals started talking about this, I think at least a month ago, that they were not seeing as many people come into the emergency rooms with God forbid, a heart attack, or something, a stroke, dramatic. Not related to COVID. But they just weren’t seeing those emergencies come into the ER. Do you see any correlation to less stress in people’s lives because maybe they’re not commuting or getting all riled up at work? Have you seen anything? Because I continue to see that reported, that hospitals are still not seeing people come in for some of these things they would expect.

Dr. Eastburg: Yeah. So we’re going to have to look at that carefully. The data, the early indications are that actually it’s deferred care rather than “I didn’t have a heart attack because I wasn’t stressed out.” We’re seeing the results of people who’ve had a heart attack, decided not to come in until things have gone back for them. So in the mental health world, what we’re seeing is the people who are coming to us tended to be more ill because they had deferred care rather than the stressors have gone down, but we’ll need to sort that out as we go.

Chuck Gaidica: And that leads me to the idea of self-care. I’ve heard this a lot, the phrase self-care, because of caring for my elderly mom and dad through last year and even back farther than that. But the idea of caring for someone. In this case self-care could be more about us, about me, because I am maybe going to be the chief of the household, but I still got kids running around and the two dogs need to be walked and I’ve got to worry about dinner and going to work and all that. But talk a little bit about us allowing the oxygen mask to drop from the ceiling in the airplane, putting it on ourselves first maybe, before we go to care for everybody else. Because if we’re not taking care of ourselves, we maybe can’t keep the household running the way it should.

Dr. Eastburg: Well that’s right, Chuck. Absolutely. I would say that how we can best cope and adapt during this time is to be paradoxically focused on two different things. One is to be intensely focused on self-care, what do we need for ourselves. But then also intensely understanding of others in our world. And those two might not always seem to go together, but you’re right. If we’re not caring for ourselves first, the tank will be empty to care for, or have tolerance for, the other people in our life.

Dr. Eastburg: So as your listeners are thinking, well, how does this apply to me? The first really important step that I would suggest for people is to take an inventory of, during this period of time, what have I really lost? What have been the big things that I have not been able to do? It could be connecting face-to-face with a certain friend, or maybe it’s going to the gym that really helped inspire me to keep going. What have I lost? And now how do I replace that with things that are healthy, things that can prop me up, energize me, fill my tank?

Dr. Eastburg: What we’re seeing is a lot of people are turning to alcohol as a way to numb. People who are in recovery are having a hard time staying in recovery. There’s some relapsing going on. We’re also seeing people, they’re stuck at home, so what’s the natural thing a lot of us do? Reach for our cell phone. Get into social media. And get pulled into… One of the therapists talked about picking digital fights, getting sucked into conflicts, overeating. So for people to take stock, how do I help? What have I missed? And what do I really need to do to take care of myself? I think that’s a great place for people to start. And it’s very individual. People know themselves. Start with yourself so you can give grace to other people.

Chuck Gaidica: Yeah. That’s great advice. And yeah, I remember my late mom, before she was really in the throes of Alzheimer’s. I made a lifetime of a career in television news, and she would say, “I get so anxious.” She really used the word. “I get so anxious when I watch the news.” And I said, “Mom, I’m on it, but it’s okay. Turn it off.” I mean, if it bothers you… And I think those inputs we’re getting, whether you’re focused on your retirement plan, and oh, don’t look two months ago. It’s okay to look now, because maybe it’s come back. So make sure you’re taking a peek when it’s appropriate. Because maybe some things actually work themselves out. Or if you’re getting anxious watching this 24/7 or getting on Twitter or whatever, it just seems like if it’s causing you grief, there is an off button, right?

Dr. Eastburg: Right. We don’t always recognize that. Or we’re bored and it’s really easy to go to social media or the news. I think in this digital era it takes a lot of intentionality to find the things that are life-giving, joy-giving, that aren’t found on your phone.

Chuck Gaidica: You mentioned Grand Rapids and the shoreline there and January in about the same sentence. And so, because I was a weather guy, I know that after November, or sometimes we would joke until June 1, the clouds come in and they don’t ever leave Michigan. Well, now that we’re able to get out, isn’t there an upside to our mental health in the sense that I’m able to let my dogs take me for a walk. The sun is out. It’s a little warmer on average. I’m producing vitamin D just because it’s happening. I mean, there’s got to be a positive effect to at least the season we’re in now, right?

Dr. Eastburg: Yeah. You know, moderate exercise is one of the best ways to care for depression. So being out and active is a mood-booster, and one of the best things that you can do now, especially that some of the restrictions are lifted, to get out and physically distance. We won’t use the term socially. Physically distance. To get out and get moving is one of the best ways you can self-care for your emotional health.

Chuck Gaidica: Yeah, that’s great. And you talked a lot about how people are struggling in different ways. If we are struggling, if part of self-care is self-awareness, right, that we’re either seeing it in us or in a teenage kid or something, a lot of us have trouble asking for help. What suggestions can you give us? Even if it’s a tele-med session, how do we get from thinking about it to starting something so we can actually go seek professional help like you would offer?

Dr. Eastburg: Yeah. I guess a couple of thoughts there. One is to recognize that we as a society have been through a somewhat of a traumatic moment here in our history together as a nation. For some people that trauma is extreme. They’ve lost loved ones. People have died. They’ve been unable to grieve. For some of us it’s just trying to be a mom or dad at home, and instead of a three-month summer vacation with the kids, we’ve got a six-months summer vacation with them. But there’s this sense of trauma. And to recognize that the experiences that you have, the feelings you have, anxiety, depression, and maybe there’s guilt, it is normal. You’ve been through a trauma and it’s just like you’d go through any other physical trauma. It’s okay to get help for that. And there are a lot of really good resources out there. There’s things to read. And the tele-therapy resources are really accessible now, really easy to use. And so you don’t have to drive for 45 minutes to get to a doctor’s office and worry about where your five kids are going to be. You can access in your home.

Chuck Gaidica: What is the number one reason that you hear from people that they say, the reason they didn’t come to see you sooner? Is there a top-of-the-hit-parade reason? It, I mean, there are all kinds of things I could think about, but what is it that keeps people from seeking professional help when they probably know they need it?

Dr. Eastburg: Yeah. A lot of it is, “I thought I could handle this myself.” It’s some of the old stigma. “I didn’t want to appear weak.” Sometimes it’s a financial reason, like “I thought it was going to cost me a lot of money.” But we still have this hold-over that seeking help, seeking therapy, counseling, is some indication of moral failure, but I think it’s actually the opposite. To recognize that you need some help, it takes some courage and some determination and an intense prioritization of your own health. And those are character qualities in my mind.

Chuck Gaidica: Yeah. That’s a really good way to look at it. That’s encouraging. I know as a son of a dad that suffered from anxiety and depression, one of the other issues for me of trying to relate to it and be encouraging when appropriate, et cetera, was that unlike breaking an arm, I couldn’t say, “Dad, get in the car, let me get you to the ER. We’ll get a cast. They’ll set the bone. It’ll all be okay in six to eight weeks.” It’s different with mental health issues because for us who are looking to care for someone else, it’s hard to really relate sometimes. And it’s hard for us to expect, well, we know what to do. We don’t sometimes.

Dr. Eastburg: Yeah. Right. There’s not a lab test. There’s not an x-ray that you can take. But as you know, if you’re living with someone suffering or you yourself are suffering, it is absolutely just as real. The pain of depression, the pain of anxiety, is just as intense as the pain of a broken ankle.

Chuck Gaidica: Yeah. Well, as we start to wrap things up and I know you’ve talked about several really good takeaways for us, but do you have other suggestions that we haven’t talked about, or go over some of these things again. What should we be watching out for, for self-care and for other people in our family, as we’re starting to make this transition and re-entering society, if you will?

Dr. Eastburg: Yeah. So just a couple of thoughts. One is to have a check-in with the people that you’re living with. Maybe it’s a family, maybe it’s a partner or somebody that you’re working with closely. Say, “Hey, how are things going here in our household? How’s the relationship going? Are there things that I’m doing that are bothering you, that I can adapt to? How do you think our life could be better together?” The old family meeting. And I’m sure people have thoughts and feelings about it. They’ll have some ideas.

Dr. Eastburg: The other way to keep it positive, you start the interview talking about the importance of keeping things positive. If you’re talking about what you need, to focus less with other people on what they’re doing wrong, and just to say what you want. So instead of saying, “You’re crowding me. I feel like I have no time by myself. Every time I turn around, there you are,” to reframe that into a way of saying, “I’m finding I need about half an hour during the day to fill my tank by being by myself on the patio or take a walk around the block just by myself. And I feel like I’ll be a better person to live with if I can do that. That’s what I need.” So to take whatever’s under your skin or bugging and frame it into, what do you want? What is it that you want? It’s a lot easier to hear that than what another person is doing wrong. So I would, again, start with yourself. What is it that you need? Turn that into words about what you want from people, and then let them know.

Chuck Gaidica: That’s great advice, because it also sets some parameters without being a tough guy, that somebody knows, well, that’s your thing. And I’m going to be respectful of what you’re saying to me, because verbalizing it is really important.

Chuck Gaidica: Well, this has been awesome. I’ve learned a whole lot and I hope you and your family stay well, and we’ll continue to practice all the things you’re talking about. I keep looking at… Kids and grandkids are afar. They’re not always with us. So you keep trying to figure out, is everybody okay, and what’s going on. So it is tough to juggle. But lots of great takeaways today. Thank you, Doctor.

Dr. Eastburg: Thank you Chuck, it’s been a pleasure.

Chuck Gaidica: Oh, same here. That was Dr. Mark Eastburg, who’s President and CEO of Pine Rest Christian Mental Health Services, giving us so many good takeaways. We want to thank you for listening to A Healthier Michigan Podcast. It’s brought to you by Blue Cross Blue Shield of Michigan. If you like our show, and you want to know more, check us out at ahealthiermichigan.org/podcast. You can leave a review or a rating on Apple Podcast or Stitcher and get new episodes, old episodes, on your smartphone or tablet. So when you’re going out for your exercise, for your chance for the dog to take you for a walk, you can take A Healthier Michigan along with you. Be sure to subscribe to us on a Spotify, Apple Podcast or your favorite podcast app. I hope you continue to be well. I’m Chuck Gaidica. Take good care.