The Main Focus: Why ‘Social Distancing’ is a Dangerous Term – Part 1

Interview (part 1 of 2) with internationally renowned researcher, Professor and Former Chair, Department of Psychology UC Berkeley and mental health stigma expert Stephen Hinshaw

We sat down with Stephen (Steve) Hinshaw, leading psychologist, renowned professor at UC Berkeley and UC San Francisco, and pioneer in stigma reduction and evidence-based treatments for mental disorders, to discuss the impact of COVID-19 on our mental health. Our lives will remain forever changed from COVID-19, and Steve’s advice on the importance of living with empathy and compassion is critical. 

In this interview, Steve generously offers insight on everything from the history of mental disorders and the Spanish Influenza to concerns about substance abuse, screen use in teens, and mental health in the workplace. Part 1 will focus on the impact of Covid-19 and the relevant history to understanding the effect of the pandemic on our wellbeing. Stay tuned for Part 2, which will specifically focus on the impact of working from home on America’s mental health. 

As someone who is so intertwined with the Mental Health community, what has been the biggest setback from COVID-19? What is the largest takeaway you’ve had so far?

We’re living in a time of utter uncertainty. Can we flatten curves? If we do, can we reopen businesses and educational institutions? And if we do that, will we have a rebound a few months down the road (as we’re already experiencing here in the Summer of 2020) , including when the cold weather comes back in next Fall/Winter? Will the economy come back? Will I get my job back? Will I be able to keep raising and teaching my kids at home when I’m also struggling with work–and not fully equipped to do that? 

Anxiety, stress, depression, uncertainty, doubt, fear: It’s hard to imagine a family that’s not experiencing some or all of this these days. In fact, if you’ve had a history of an anxiety disorder,  major depression, or post-traumatic reactions, this climate, if you will, puts you at huge risk of relapse–of sinking back into some of the symptoms you had at the clinical level before. So that’s the tough news. 

The good news is that we are learning how to be resilient. We’re learning to rely on one another, even if it’s through Zoom or FaceTime. We are actually incredibly adaptive as a species, and I think we’re going to find new ways to connect. But let’s not deny the greed, the loss, the uncertainty, the stress, and the anxiety that’s occurring for so many people right now. Those are issues we must address.

Do you anticipate a lasting uptick in mental illness diagnoses due to the pandemic? And has this occurred in the past in response to any sort of crisis that we’ve faced as a country?

Well we know that just over a century ago, the Spanish influenza epidemic may have killed 60-100 million people worldwide. There wasn’t brain imaging back then, of course,  but upon post-mortem evaluations, it was found that the virus sometimes attacked brain tissue. During this era some survivors of the influenza, who had not previously had learning or attention problems, developed them. Thus, the origin of the term minimal brain damage, or minimal brain dysfunction, which later morphed into the term ADHD. 

Today, we’re hearing more about coronary issues, heart attacks, and neurological symptoms emanating from COVID. We don’t know enough yet, but there appears to be a real increase in the morbidity, if you want to use the fancy term, related to psychiatric and neuro-developmental problems related to COVID. 

Overall, it’s hard to imagine that the world will be the same after the pandemic subsides. We’re going to have to find safer ways and less crowded ways of interacting, but will the anxiety and depression kind of lift or will it linger? Part of the risk stems from genetic vulnerability–again if you have a history of anxiety, depression, or PTSD, the pandemic and the sheltering in place may exacerbate and put you at risk for a relapse. 

Yet will the pandemic and the shelter in place induce major depression and major anxiety disorders in people who haven’t been vulnerable before? We simply don’t know. We’re a very social species and not used to living this way. We will need a significant amount of data to figure out what the long term ramifications are and how to get mental health services to people who are in need of them in the months and years ahead. 

Let’s talk about the risk of misinformation online. What are some of the misconceptions that you’re seeing about mental illness, COVID-specific or not, that you would like to see changed or clarified? 

Over the last couple months, all of us have had to engage in social distancing. Gotta keep those 6 feet apart, whether you’re waiting in line for food or jogging at a park. I’m really concerned about this term, social distancing

My career has focused, in the last two decades, on the concept of stigma – the shame and silence around mental health. I’ve devoted much of my career toward reducing that stigma. If you do research on stigma, the measure you typically use is something called a social distance scale. These were scales that were invented about 90 years ago, originally to start to try to understand and reduce racial prejudice. 

So on a social distance scale, let’s say I’m filling out a questionnaire on you– and you’re a member of an unfavored group, racially, religiously, or with a a history of mental illness. Would I live in the same state with you? That’s not a big problem. Would I commute on public transportation with you? Would I work on a class or work project with you? Would I hang out with you? Would I go out with you? Would I let my daughter marry you? You can see there’s a continuum of really distant interactions to very close ones, and the classic measure in stigma research is as follows: Would you, after an intervention or after a sort of change of heart, want to be closer to someone in that group? 

We try to reduce ‘social distance’ through contact, compassion, and empathy. But now, we have to keep social distance to prevent death and to keep ourselves safe. Words aren’t everything, but they matter. I’d rather we call it physical distance. Social distance is something that we don’t want to promote. Physical distance during the pandemic is essential for our health, but we need to be more socially related and connected than ever before coming out of this, so that’s just one of the side effects I worry about. 

“We try to reduce ‘social distance’ through contact, compassion, and empathy. But now, we have to keep social distance to prevent death and to keep ourselves safe.”

— Stephen Hinshaw

Do you think there is a flip side where people will start to appreciate each other more? Is that a possibility in your mind? 

Maybe we’ll learn to not take for granted hanging out with friends, or going to a ball game or concert, or really appreciating what it means to light up your day or month or year by being in close contact with someone you care about – whether romantically, whether it’s friendship, or whether just erasing that social distance. I maintain the hope that we may end up reducing stigma in the aftermath of COVID, because we’re going to realize how much we do need one another. We may come to appreciate the things we’ve taken for granted in our society for too long. And we may realize that nearly everyone is feeling at least some ramifications of isolation–including anxiety and depression.  I remain optimistic, but guardedly so. 

And lastly, what can the general public do to help at this time from a mental health perspective?

Be empathic. You don’t have to be an emergency room doctor or nurse to have felt the stress of underemployment, unemployment, trying to work and care for your family and raise kids at the same time, etc. Realize that we all are in this together–and that if we want to have a fighting chance, scapegoating and blaming aren’t going to help. Having compassion is the only thing that’s going to carry the day, frankly, for us as a species moving forward.  We need to prioritize disclosure, acceptance, and support.

Stay tuned for Part 2 of our interview with Steve Hinshaw on The Main Focus – coming next week.

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