As a return to ‘normal’ seems achievable, adjustment disorders are the new elephant in the room - The Globe and Mail

It can be tempting to believe that we don’t need to step back and assess our mental health – that if we just knuckle down and make it through what seems like the last stretch of the pandemic, we will automatically feel better on the other side. Yet, that’s not a helpful mindset to have, health experts point out.

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For many months, Canadians have hoped for signs that the COVID-19 pandemic is slowing, both at home and abroad. While global recovery remains inconsistent, Canada has seen encouraging vaccination rates, decreasing national case numbers and the easing of social restrictions. It seems like the tentative beginning of what we have all been waiting for – the light at the end of a very long tunnel finally coming into view.

Many hope the waning pandemic will launch life into a new, more exuberant phase, one in which we’ll finally be able to go to parties, travel and shake off the various struggles and funks we’ve grappled with since this crisis began. It certainly seems like some of us just can’t wait to have fun: Travel agencies are seeing a jump in vacation bookings for the fall, music promoter Live Nation reported U.S. music festival tickets are selling out in record time and public-health experts are entreating everyone to get an STI test before having a wild, post-vax summer of hooking up.

Yet, there will be those who want to collapse in exhaustion rather than jump for joy.

“Some of the people who are anxious or depressed right now will bounce back after this is over,” says Steven Taylor, a professor and clinical psychiatrist at the University of British Columbia. However, “there will be people who develop chronic mental-health problems” caused or exacerbated by the pandemic, he says – likely many. Already, a March, 2021 report by the American Psychological Association found nearly half of respondents felt “uneasy about adjusting to in-person interaction” and uncomfortable with “going back to living life like they used to before the pandemic.”

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One postpandemic mental-health outcome Dr. Taylor anticipates is a surge of “prolonged grieving disorder,” a condition that affects about 10 per cent of bereaved people, that only becomes apparent months after the death of a loved one and that can last indefinitely. As of June, as many as 13,000 Canadians could be at risk of developing the disorder.

“If you’re one of those people, the pandemic has never ended for you,” Taylor says. “In a sense, what happened in 2020 and 2021 is going to pale in comparison to what happens to you in the rest of your life unless you get treatment,” he says. “And then you ask yourself, how many mental health practitioners out there are trained and qualified in the treatment of prolonged grief disorder? Not many.”

Dr. Alain Brunet studies the effects of traumatic stress on mental health at the McGill University-affiliated Douglas Research Centre. Last year, he and his team began researching the pandemic’s impact on mental health.

Brunet found a “significant minority” of people – such as front-line health care workers or those who witnessed death or had a near-death experience – have developed or are at high risk for developing post-traumatic stress disorder due to their experiences during the pandemic. But “tenfold more,” he says, will grapple with an “adjustment disorder,” a kind of lesser-understood mental-health issue that can feature symptoms like intrusive thoughts, avoidance behaviours and changes in mood and cognition.

“An adjustment disorder is like a little brother of PTSD,” Dr. Brunet says. “It’s essentially a series of anxious and depressive symptoms that people might develop as a result of being exposed to a stressful but non-traumatic event,” such as losing a job, struggling financially or quarantining alone. Also contributing are the more existential factors we’ve reckoned with during the pandemic, such as realizing our own physical fragility, experiencing new depths of loneliness, or losing our fundamental sense of faith in the institutions we expected to better protect us all during a crisis. Society’s acceleration towards a “Roaring Twenties” postpandemic period of jubilance may only exacerbate adjustment disorders. Feeling off-kilter during a global crisis in which the whole world is commiserating is difficult, but struggling when it seems like everyone around you is in a celebratory mood is an entirely different kind of challenge.

Adjustment disorders are sometimes referred to as “the common cold of psychiatry,” because while practitioners see them frequently, there is “no empirically validated treatment,” Brunet says.

While some people may seek and obtain help for coping with adjustment disorders, there will likely be many more who are either unable or hesitant to do so. There are, however, some modes of self-care that can be both useful and accessible, experts say.

The first step to addressing mental-health challenges is recognizing they are there. If you feel unwell, reach out to trusted people for support, Brunet says. It’s important to understand people will emerge from the pandemic at different rates – we must have empathy for each other, as well as for ourselves, says Lysa Toye, a psychotherapist based in Toronto.

“We have, all across the planet, come through something really big – and to pretend like there’s not going to be an enduring impact on us is not realistic and not fair to any of us,” says Toye, who recommends we proceed with kindness and compassion for ourselves as the pandemic slows, giving ourselves permission to discover we may not want to snap back into our pre-pandemic lifestyles immediately, or that things we thought we were excited to do again may not feel the way we anticipated.

Toye also cautions against believing that everyone is necessarily doing great – even if that’s how it looks on Instagram. “I think that we are all trained to fake that we’re feeling better than we are,” she says. “Even if everybody around you is authentically, extrovertly loving the chance to be back in the swing of things, just know that there are many, many, many people – like millions of people, even billions of people – for whom that won’t be the case. And that that’s okay.”

It can be tempting to believe that we don’t need to step back and assess our mental health – that if we just knuckle down and make it through what seems like the last stretch of the pandemic, we will automatically feel better on the other side. Yet, that’s not a helpful mindset to have, health experts point out, due both to the fact that the pandemic is unlikely to end definitively, and because what may feel like a perfectly reasonable hope or expectation could in fact be unrealistic optimism bias.

Recovery takes time, and there’s no need to rush it, Toye notes.

“Everybody has their own state and their own process – and it’s wise and skillful to seek help if we feel like that’s what we need.”

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As a return to ‘normal’ seems achievable, adjustment disorders are the new elephant in the room - The Globe and Mail
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