Milwaukee psychiatrist Dr. Himanshu Agrawal is having a tough time in the era of COVID-19, and he wants his patients to know it, so they feel less alone.
“I’m having to work very, very hard every day to make sure I keep my head above water,” he tells patients, and he means it almost literally. Agrawal uses a metaphor that, once upon a time, we were all riding on a great boat. As the pandemic took hold, we fell overboard and started bobbing in a “sea of despair.” Out here, we have to connect to other people largely through screens, as he does with a group of medical school friends once a week and every morning as he pores over a group text from their entire graduating class, a form of daily medicine.
Over the past 12 months, our collective mental health has buckled under the stress of COVID-19 and social distancing . In local psychiatric offices, such as at the Tosa Health Center where Agrawal sees patients, the phones have rung incessantly. “I have never worked this hard in my life,” he says. “except for when I was an intern in medical school or in residency.”
Social isolation wears upon one’s mental and physical health and has been tied to everything from bone fractures to higher rates of psychosis. A 2018 study by an insurance company equated the effects of loneliness on mortality to smoking some 15 cigarettes a day. And isolation may be to blame for a recent increase in opioid deaths, Agrawal says, as users have no one to call for help.
In Milwaukee County, trends suggest that a large number of people who are not regular users of mental health care are seeking help. In 2020, the number of 911 calls for mental health reasons skyrocketed, and in some months, the number of calls for attempted suicide was more than double the figure from 2019. (Suicide deaths rose only about 7% to 123 last year, well short of the record of 153 in 2017.) Meanwhile, usage of low-cost county services, including its mobile crisis teams and crisis line, was relatively stable.
Michael Lappen, administrator of the county Behavioral Health Division, believes that disparity comes from the bulk of new cases coming from people who are unfamiliar with the mental health system and seeking help for the first time. “A lot of people were just getting by,” he says, “and this thing came and blew up their lives.”
He noticed a related pattern in the suicide data from 2020, which included many names foreign to the Behavioral Health Division’s records. During all of August, only one person who died by suicide had had any previous contact with the division, which he took as highly unusual.
Wide surveys of mental health conducted in 2020 by authorities in the both the U.S. and U.K. found that the youngest adults, 18-24 years in the CDC study, had suffered the greatest increases in depression, anxiety, suicidal thoughts and substance abuse. In the U.S., anxiety symptoms increased dramatically over 2019, and some 40% of the over 5,000 adults who responded to the survey reported struggling with a mental illness or substance abuse.
Adding to the mental health crisis is the coronavirus itself, which is “neurotropic” and more than happy to invade and damage brain cells in some patients.
In November, a well-publicized study found that 18% of American COVID-19 survivors went on to receive a psychiatric diagnosis, and there have also been cases of “COVID-related delirium” recorded in hospitals, where patients lose track of time and reality. They may also experience hallucinations and become severely agitated.
While it’s tempting to think of the mind as a temple, Agrawal says it’s “not that uncommon” for a pathogen, especially SARS viruses like the current coronavirus, to attack it.
He talks to patients from his makeshift basement office, where he also teaches classes at the Medical College of Wisconsin virtually, and generally – like so many of us – tries to keep up.
“I am a week behind in my notes, my pile of readings is getting taller,” he confessed in a May 2020 blog post, “and I perpetually feel inadequate in each of my personal and professional duties.”
ONE GLOBAL MENTAL HEALTH EFFECT of the pandemic is “mass regression,” or the reversion to younger or less mature patterns of behavior. Local psychiatrist Dr. Himanshu Agrawal sees it in patients, including one who has taken refuge in foods like frozen pizza that remind him of his youth. Agrawal also ascribes the January riots at the U.S. Capitol, at least in part, to regression.
Personally, he has found comfort in the world of cricket, which reminds him of growing up in India. He spends time playing a cricket video game or listening to cricket commentary as he relaxes. “That’s my meditation tape,” he says.