Behavioral learning in the age of Covid-19 social distancing.

"Behaviour is contagious because we catch it from other people. Much of what we do results from unconscious mimicry of others around us."

— Rory Sutherland

What are the consequences for this in the time of remote learning, working from home, and social distancing?

Why do people stockpile toilet paper during the Covid-19 crisis?

While it only explains about 12% of the reasons that people stockpile toilet paper during the Covid-19 crisis, a recent study found that people who stockpile toilet paper tend to be more frightened of the threat of Covid-19 infection, and they tend to be more "conscientious."

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Editor's note:

In my practice, I have observed that people who engage in this toilet paper stock piling tend to be more anxious, ruminate more, and tend to show signs of paranoia. The obtaining of large amounts of toilet paper seems to lower anxiety and enhance a sense of security and safety, but obtaining large amounts of toilet paper then leads to an obsession and compulsion to hoard other commodities.

The grieving process - Stage one: Shock and disbelief

Stage one - Shock and disbelief

As we discuss the stages of grief it should be noted that the stages are just a general frame of reference and not prescriptive. People don’t have to go through the stages as described here. Further, people don’t experience the stages in a linear way but in an oscillating way going back and forth not one after the other. People often describe the grieving experience as a “roller coaster.”

The first stage is sometimes called “denial” but the word “denial” does not accurately describe the experience. People cognitively recognize death has occurred but often describe a sense of life being surreal. They describe being “numb” and disoriented. They say things like, “I just can’t believe this has happened and ____________ is gone.”

People describe themselves as being in a fog and going through the activities of daily life as if they were a robot on auto pilot. The feeling of disbelief is very powerful and there is a growing sense that the event of the death will be a milestone in their lives with the death marking the boundary of life before the death and after the death.

People often find it hard to eat, sleep, concentrate, and perform the normal tasks of their daily routines.

During this stage people need assistance with daily tasks and to be excused, if possible, from social obligations to others. They need to be left alone if the person wants to withdraw from social interactions or they need to be listened to if they want to share their thoughts, feelings, and anguish with a trusted other person. Providing a shoulder to cry on is a very important form of solace and consolation. The listener need not say anything to help the person feel better. Just allowing the grieving person to share their sadness, sorrow, anger, fears, regrets, and sense of loss is very helpful. Do not try to cheer the person up or reassure them things will be okay.

It is very common at this stage to observe an expression of anger and blame and guilt that someone is at fault for the person’s death. People even blame God for letting this death occur. A regression to a narcissistic state where people take the death personally is common. “How could this happen to me!”
People often feel a disorientation, confusion, and perplexity and say, “Oh my goodness, what will happen now?” There is an anxiety about how life can go on as it was lived before the death.

People often hear the dead person’s voice, see glimpses of them, or are reminded in a hundred ways of the person as living. It is like deja vu when the person is uplifted  momentarily believing that the person hasn’t died. Dreams of the dead person are very common.

This stage of shock and disbelief usually doesn’t last more than six weeks, if that. The grieving person needs to share their experience with an understanding other who can maintain a non anxious presence and non judgmentally listen to the person express their experience. Nothing need be said or done other than mere listening, and inquiring, when it seems helpful, about the person’s memories and experiences of their relationship with the person they have lost. Sometimes people want to talk about their memories of the relationship and sometimes they don’t. Either way is okay.

Overview of grieving: general observations continued.

Before we get to describing the stages of grief there are few more topics worth mentioning about grieving in general.

Disenfranchised grief is grief that people experience without any social recognition or acknowledgement. A lover of a married spouse who dies without there ever being any public recogition of the nature of the relationship. Deaths of ex spouses after divorce.

Deaths experienced by professionals of patients or clients who were part of confidential relationships. This happens freguently to health care providers in all kinds of settings.

There are many other examples where loss is experienced alone without any social recognition, acknowledgement, or support. Miscarriages may fall into this category. People who die in institutions like prisons or nursing homes or by stigmatized circumstances like suicide, drug overdose, alcoholism.

Liberating losses - Sometimes death is experienced as a relief or as if a burden has been lifted. This often occurs after a long illness where the death is anticipated, but also can happen in a sudden death when the deceased is a part of a conflicted relationship.

Moral injuries - These are deaths witnessed or inflicted in war, capital punishment, or other acts of revenge or intentional or unintentional "accidents." Abortion is sometimes thought of as falling into this category.

Overview of the grieving process.

What are the stages of grief?

What is about to be described here is a frame of reference. Nobody goes through the stages exactly as described in a linear way. Most people oscillate back and forth through the stages but the person can probably identify where their emotions and thoughts are predominately at a given period of time when they are going through the stages.

What is presented here is boiled down from a clinical perspective. There are other descriptions but the one presented here is what seems most helpful when talking with people about their grieving process in my practice.

Here the stages:

1. Shock and disbelief
2. Bargaining
3. Acceptance
4. Hope
5. Meaning

This is the first in a series of articles on the grieving process.

Before a description of the stages, here are some general observations about grieving in our society.

The grieving process is not something to be fixed but a normal part of life.

Grief is not depression and should not be medicated except when extreme symptoms appear which are usually a sign of an underlying psychiatric problem and not the grief itself.

Our society is very intolerant of grief and does not have appropriate expectations about the grieving process.

The two biggest ways of managing grief are simply to sit with it and be mindful about its existence and workings, and two, having a shoulder to cry on, an understanding witness who can accept the expression of grief without getting upset oneself.

There are differences in the grieving process the major difference being an anticipated death and a sudden death.

Death is nothing to be afraid of but a normal part of the life cycle.

Social reactions to death are varied and often difficult to deal with for the person who is mourning.

Grief is best exprienced with one's natural support system. Professional grief counsling services initially following the death are not recommended even though they often are. 

While the deceased person's physical body is dead, their spirit lives on in the stories that are told about them.

To be continued

PHQ - 9 overestimates prevalence of depression

More and more primary care medical practices are using the PHQ-9 depression screening tool and sometimes the abbreviated version. I've had it administered to me on my primary care medical visits along with my weight, blood pressure, and pulse.

A new study finds that these depression screenings over estimate the prevalence of depression. A symptom check list screening is not the same as a structured clinical interview for depression (SCID).

The most common misdiagnosis I find in my clinical practice is the depression for grief. Often I find that people who screened positive for depression in their doctor's office are actually experienced what is sometimes called "disenfranchised grief." Disenfranchised grief is sorrow and mourning triggered by a signficant loss that is not socially recognized, acknowledged, and therefore not supported with consolation and solace. Often I find that these patients have been started on an antidepressant medication which not treatment of choice for grief.

There is no substitute for good mental health care by a trained clinician.

For more click here.

During school closure teens getting more sleep but it needs to be on a regular schedule

During the pandemic with school closure teens are getting more sleep which is a good thing because it makes them more communicative, family friendly, less moody while at home. It is important though to stick to regular sleep schedule. Staying up all night playing video games and messaging with friends is not conducive to a regular sleep schedule which is necessary to reduce inflamation and enhance physical and mental health.

I hear in my psychotherapy sessions about teen's symptoms of anxiety, depression, and irritability. I ask about their sleep. Almost always the answer is that it is disturbed and irregular in some way. This leads to an interesting observation. Is it the anxiety and the depression interfering with the sleep or the lack of sleep contributing to the symptoms? Which comes first the chicken or the egg? However you answer the question, improving the sleep cycle goes a long way in enhancing the feeling of well being.


For more click here.