Tanzina Vega: I'm Tanzina Vega and you're listening to The Takeaway. Thanks for spending some time with us today. I recently tweeted about something I called a "pandemic wall," the burnout from working nonstop, no break from the news, childcare, and isolation. According to my social media feeds, tens of thousands of you are feeling the same. From Hawaii to Spain, many of you got in touch with me to say that you were feeling it too.

Hitting this wall as the weight of work, economic uncertainty, isolation, and everything else just keeps piling on top of us all while living through a deadly global pandemic. What we're feeling is different than a kind of pandemic fatigue where you're just tired of wearing a mask or social distancing. This is something a little deeper. It's a feeling of total exhaustion and of being so overwhelmed that it's hard to see the light ahead. For months here on the show, we've been talking about the growing mental health pandemic happening alongside the COVID-19 crisis.

According to the Kaiser Family Foundation, 53% of adults said that the pandemic was having a negative impact on their mental health. Now, as we passed the one-year mark of COVID-19 here in the United States, I want to check in on that and to understand why so many of us are hitting the pandemic wall now and, more importantly, how we can find some relief. I'm joined by Dr. Jessica Stern, a clinical psychologist and clinical assistant professor of psychiatry at NYU Langone Health. Dr. Stern, thanks for joining us.

Dr. Jessica Stern: Thank you so much for having me.

Tanzina: Dr. Suzan Song is the director of the division of child, adolescent, and family psychiatry at the George Washington University Medical Center. Dr. Song, welcome back to the show.

Dr. Suzan Song: Thank you.

Tanzina: Dr. Song, why did my tweet get so many responses?

Dr. Song: I think it's because, clearly, you resonated with so many people. Many people right now are feeling ashamed and isolated with their feelings, but everybody is depleted. We are exhausted. We can't focus. There's no motivation. People have lost their jobs. They won't work or they're working and it's too much work. All these terms are going around. Like you mentioned, the pandemic fatigue and burnout, the pandemic wall as you've described.

People are wondering if they're depressed. Burnout. I think just the final little bit. It's when we're exhausted, we're detached, we have lower productivity, we have a sense of ineffectiveness. A common metaphor for burnout is of a battery running out. If you have a toy, the battery runs out, the toy stops working. Let's say you're a parent. There's no parent that can just stop parenting.

The best thing that I've heard around burnout is from someone named Dr. Drummond. He's an expert on physician burnout. He relates burnout to a bank account for your energy. At the bank, if you overdraw your account, they don't close your account. They charge you fines and interests. You actually accelerate your downward spiral when you go below zero. I feel like that's what-- the pandemic, the politics, the social violence, that's what it's been doing. It's dipping into our emotional reserves.

Tanzina: A lot of people are feeling that way. Dr. Stern, some of the responses to this were interesting and I just tweeted this off the top of my head really. I was shocked to see so many people responding, but a lot of people were saying that the fact that you could name it was comforting. Is it important, Dr. Stern, to name what we're feeling? Does that help us feel better or at least to start to feel better?

Dr. Stern: Absolutely. I think what you did so beautifully is you took this very deep, dark, vague feeling that people were experiencing and you put a name to it and you helped people identify what it was that they were experiencing. I think it's like having this dark cloud over your head that you don't really know exactly what it is. When you're able to spot it and say, "Ah, that's what it is. That's what I'm experiencing," it makes it feel a little bit less scary because you know what's happening for you.

It's also so validating because then you can explain it to other people and share that sentiment with other people. It doesn't feel like this random, unexpected experience that people are having. Putting a face to the name can be so extremely powerful for people. I thank you for doing that in that tweet.

Tanzina: I'm wondering, Dr. Stern, is there something about-- It almost feels like people were somewhat ashamed and pivoting off of what Dr. Song was saying about lifting, pointing this out, and a lot of people feeling like they're falling behind. Is there something endemic to our culture in the United States that makes us hesitant to say-- these things to say, "Look, I'm hurting and I'm not doing well"?

Dr. Stern: Absolutely. I think there are a couple of pieces here that are particularly powerful and relevant. I think the first one is that we as a society has still have a long way to go in terms of reducing stigma related to mental health. We are, in general, a very go, go, go society, which has its blessings for sure, but I think that oftentimes for people, when they feel like they can't do the things that they want to do or they can't achieve or it feels like they can't stay on top of the various different responsibilities that they have, they feel like they're failing or they feel like there's something wrong with them or something I hear often is, "It feels like I'm broken."

I think that can be really upsetting for people. What happens with shame is when we don't talk about it, it feeds the shame, which then prevents us from talking about it and creates this very nasty cycle. Brené Brown has talked a lot about this. It can be challenging. I think what happened at the beginning of the pandemic is a lot of people were excited about how they can use their time and sourdough starters and using their time to be more productive.

While those were helpful coping mechanisms, I think there were a lot of people who are feeling overwhelmed by the fact that they actually couldn't be so productive because, of course, they were stressed and anxious and hopeless and helpless. I think seeing this sentiment around them where it seems like everyone else was keeping it together when, in fact, that wasn't really true, I think, really fostered a lot more shame in people that took a lot of time for people to be open about.

Tanzina: Dr. Song, I want to pick up on that idea because I'm wondering, how has our mental health collectively-- and, of course, all of us are individuals with unique circumstances, but have you noticed a shift in how people, at least generally, have felt about the pandemic in the spring versus how they're feeling now?

Dr. Song: Yes, I think we are experiencing a collective demoralization. I have had so many of my patients, my friends, my family just asking if we are clinically depressed because we're still-- I think many people think this pandemic has been almost one year. We know now there's a new normal. We're all used to finding out ways to get our groceries and still we're feeling really incompetent.

I think it's important to distinguish between being demoralized and being clinically depressed. They both make us want to stay in bed all day, make it hard to concentrate, motivate, but depression, true clinical depression, is an individual biological problem. Demoralization is due to the society in which we live. I think, collectively, we're feeling demoralized.

Tanzina: Dr. Song, one of the interesting things about the tweet was that I got responses from parents who could identify, but there were also people who said, "Look, I don't even have kids and I'm feeling like this," or there were people who were elderly folks who said, "Look, I feel totally isolated." One woman said she had lost her husband, that this was a very difficult year. Someone else reached out and said they were struggling with really heavy issues that are surrounding depression, et cetera. Are there certain groups of people who might be feeling this more than others right now?

Dr. Song: Yes. The studies right now are showing there are three groups that are popping up. The first are young people. UN defines youth as age 18 to 25 years old. Developmentally, it makes sense. Youth need peers to interact, to shape their identities and who they want to become, who they are. Peers are everything in that age group. I'm seeing that in my clinical practice, most of my young people, so the kids who are either in their seniors in high school or they're in their first years of college, those are my most serious cases right now.

They're suicidal, actively suicidal, and really struggling. The second group are Black and Hispanic individuals. That's also understandable. They're witnessing their communities to be disposable by law enforcement, by health care, education, by the pandemic. The third category right now are essential workers because they're experiencing this vicarious trauma witnessing the massive loss of death on top of the demoralization when people aren't really taking the pandemic seriously.

Tanzina: Dr. Stern, one of the things that really hit me was the length of this pandemic. It happened-- I gave birth weeks before the pandemic, really hit the United States, and it hit home for me now that I have-- and close to one-year-old child. How long this has been going on? Is the length of the pandemic contributing to how we're feeling collectively?

Dr. Stern: Most definitely. There's a level of chronicity now that we've hit where this has become a chronic problem. The more time goes on, the more time we feel that fatigue building and building. While we do have this opportunity to learn from it as time goes on, at the same time, it's like compounding interest. To go back to Dr. Song's analogy before is the interest keeps growing and keeps growing.

It feels like we are drastically having to change our lives in a way that no longer feels temporary. This is very, very exhausting for individuals and many people are going a long span of time without seeing loved ones. The more time that goes on, the more we're feeling the permanence of this all. Even if we do come out of this at some point in the next couple of years, it feels very fatiguing because it's built up for such a long span of time, which is very overwhelming for people.

Tanzina: Of course, we also need to acknowledge that we are in January, which is a month that I think, typically, for many people, there's something called Blue Monday, which is one of the "saddest days of the year." People talk about in January, it's the post-holiday slump. Is that also exacerbating this, Dr. Stern?

Dr. Stern: Yes, for sure. We know that winter can be a very hard time for people in general, even pre-pandemic. Oftentimes people will have the seasonal blues or, in a much more clinical capacity, will have what's called seasonal affective disorder where it's cold in a lot of parts of the world and it's darker. People definitely experienced more sadness or more loneliness or things like this. When you have that on top of the pandemic, it definitely creates a lot more of that difficulty, that struggle that people are having.

Having to navigate both of those at the same time is difficult. I think for a lot of people in parts of the world, there was this opportunity in the summer and fall to reengage with some activities by being outdoors and things like this. It felt a little bit nice for a couple of moments in some places. To have to go back to being very isolated in cold places for a lot of parts of the world is just very overwhelming and definitely creates a lot of exacerbation of the isolation, so definitely dual struggles.

Tanzina: Dr. Song, you made a distinction earlier that I'd love to dig into a little bit. You said that there's a difference between being demoralized and having clinical depression? How can people tell the difference?

Dr. Song: When we are demoralized, it's a subjective incompetence and hopelessness that we feel when we witness or have to engage in something that goes against our moral compass. It's an existential distress. When we are feeling really down because innocent people are being murdered because of their skin color or we have someone threatening our very democracy and insurgents or our kids can't feel safe going to school or there's conflation of pleasure of being irresponsible at the pandemic public health measures, these are all moral challenges that leave us in despair.

Clinical depression is when we have a lot of negative self-talk. We can't stand who we are, we feel worthless, we dislike everybody. There's really very little relief. There's no periods of laughing, no energy to get out of bed, let alone exercise. Whereas in demoralization, we can still have moments of happiness. We still love our friends, our family. We can still go out for a run, but we're just feeling an existential despair.

Tanzina: Dr. Stern, those moments of hope, I think a lot of folks were saying to me that they were hoping that the minute the clock turn to 2021 and the presidential administration changed and, potentially, a vaccine was on the horizon that things were going to change. Is that giving people some hope? Is there spark for a hope with that? Are expectations in line with reality there?

Dr. Stern: There definitely is a lot of hope. I think you're talking about a lot of people are looking for markers of change and almost anchors to look to, to know that something new is coming around the corner. Thankfully, we have a couple of those in terms of government, in terms of vaccine, obviously, the New Year. It's giving people a little bit more energy to get started and to look forward to what's yet to come.

The struggle is that, obviously, all these things are going to take some time. I think some people were hoping for almost the sense of magic that things were going to come back to normal or change rather quickly. It's going to take a little bit more time there, so there's a little bit of patience that's required. Definitely, there is something to look forward to. Absolutely.

Tanzina: Dr. Song, given that the pandemic isn't going to end tomorrow, how do we put together a toolkit to navigate this reality, especially if we're not feeling so great? Is it a day-by-day thing? Is it an hour-by-hour thing? Is there a longer-term way that we should be thinking?

Dr. Song: I think just to build off of the hope, hope is one thing that people are turning to right now. I think we have to remember that hope is a-- it's something you do, not necessarily something you feel. It's okay to build a practice of hope where we're intentionally trying to move towards not avoiding by sleeping in bed all the time or opening up that second bag of Oreos, but we're actually engaging in life. It doesn't mean we're engaging actively, physically, necessarily because that's very hard for a lot of people right now who are feeling down.

It means that we engage with ourselves with who we know ourselves to be. We build hope as a practice. We think about our own values. This pandemic has led to demoralization in part because the pandemic has tested our values as a society. Will we look out for each other? Will we sacrifice others for our own gain? Will we put the interests of the economy over the wider hole? Will our leaders rise to the challenge or will they play political games? We should think about how we want to answer all of these questions and enact our values. All of that can help to create a practice of hope.

Tanzina: Dr. Stern, for those people who are listening right now who might say, "I think I'm more than demoralized" or "I'm feeling like I'm slipping into something else that doesn't feel familiar but definitely doesn't feel good," are there resources that people should consider?

Dr. Stern: Definitely. I think now is a wonderful time to seek out therapy or counseling of some sort, potentially, psychiatry for medication, consultation, and management. Now can be really the best time to invest in those types of things and to take care of your mental health moving forward. I like to think about it as almost like we go to the dentist to either prevent cavities or to prevent new cavities and so, too, we should be taking care of our mental health in very much the same way.

You can build these toolkits for yourself that you can use for the rest of your life. Seeking out a mental health provider can be extremely helpful. In order to do that, there are a couple of ways that you can do that. One is to visit Psychology Today where you can put in information about your insurance and your location and any specifications that you have for the type of therapy you're looking for. You can also go through your insurance panel if you have insurance or also see if you have out-of-network benefits to visit a local outpatient clinic or a mental health center.

Also, word of mouth can be truly helpful and to look for a couple of different nonprofit organizations that are available for typically underrepresented individuals. There are beautiful organizations that are emerging for therapy for Black girls or individuals who are underrepresented in terms of economic status or veterans or things like this. Please feel free to use the internet as your resource and look for some of these wonderful nonprofit organizations that are popping up and have also long existed because there might be a really good fit for you out there for sure.

Tanzina: Dr. Jessica Stern is a clinical psychologist and clinical assistant professor of psychiatry at NYU Langone Health and Dr. Suzan Song is the director of the division of child, adolescent, and family psychiatry at the George Washington University Medical Center. If you or someone you know is having suicidal thoughts, please call the National Suicide Prevention Lifeline at 1800-273-TALK, 1800-273-8255, or text HOME to the Crisis Text Line at 741741

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