There is a popular belief in some circles that human nature is defined almost entirely by experience. In the most basic terms, those who advocate this view believe that the human mind is largely a blank slate (or tabula rasa)
when an individual is in infancy and over time it is filled in by experience. Of a similar vein, there is a belief that humans are almost endlessly adaptable and that we are capable of thriving in an almost infinite number of social conditions so long as the physical environment into which we have been placed is not too hostile. In other words, so long as we have the most basic needs for survival (water, food, air, etc), we will be able to endure and possibly even thrive.

Endure? Yes. Thrive? Hardly.

As psychoanalyst Erich Fromm wrote over 60 years ago, “The statement that man can live under almost any condition is only half true; it must be supplemented by the other statement, that if he lives under conditions which are contrary to his nature and to the basic requirements for human growth and sanity, he cannot help reacting.”¹ As humans, we have our physical, social, and psychological limits, and they are all interconnected. We are not infinitely malleable. We can adapt and endure a great deal, but, eventually, we reach a breaking point. As a result, there are conditions to which we cannot adapt.

For hundreds of thousands of years, we have persevered and thrived in tribes and in clans. Survival was only possible if we worked together to overcome environmental dangers and to ward off attacks from other animals (and other humans). In time, this process of collaboration gave way to language and highly sophisticated cultures and further ingrained the need for social interaction into our psychological DNA. Human beings are social animals, and this requires us to interact with other humans. Consequently, when we are placed in isolation, we deteriorate psychologically and physically and these two have a reciprocal effect—meaning psychological deterioration accelerates physical deterioration and vice versa (more on that below). After all, if we were not social creatures, solitary confinement would not be considered a form of torture.

One of the core elements of human nature is the need for physical interactions with other humans—and not just over the phone or through Zoom. The sense of smell and touch is an essential part of being human. The pandemic and social distancing robbed us of being able to be physically close to others and took away these essential elements of our existence. We need to feel other people’s presence, to share space with them, and to touch and even smell them. Virtual meetings may have been an acceptable solution in the short-term and may allow us to fulfill certain professional duties, but it became apparent relatively quickly that these ersatz interactions are flat and alienating ordeals that cannot substitute authentic social interactions. They simply do not satisfy our need for social engagement, and many of us have learned during the pandemic that this
lack of real human interaction can lead to a deterioration of mental health, even if we may not develop a diagnosable mental illness.

Social interaction and social engagement provide us with two vital sources of comfort. On the one hand, it gives us a sense of belonging, that we are part of a group, and makes us feel accepted and validated. On the other, it makes us feel safe and gives us a sense of security, which is another basic requirement for human beings to thrive. This is not to say that we need to be coddled or babied or meticulously kept out of harm’s way. We absolutely do need to be challenged in order to learn and to grow. However, when these challenges are constant and one feels as though they need to remain hypervigilant and fear for their life, it takes a toll on one’s mental health. This was the reality for many essential workers during the first phase of the pandemic who had no security blanket, no protection via natural immunity or vaccination, and oftentimes limited supplies. They were forced to confront the persistent threat of infection and the possibility that they might even spread the virus to others, including their loved ones at a time when very little was known about the acute or long-term effects of the virus.

The human race did not evolve to be placed under this kind of solitary and persistent stress—be it due to social isolation or due to months-long fear of a pathogen without respite. We evolved specifically to avoid these kinds of issues by forming strong social networks and working together, thereby giving us the opportunity of repose. The pandemic led to the disintegration of our social fabric, which under normal circumstances provides us with a sense of tranquility and inner calm. As a result of quarantine, being cut off from our social supports which function as emotional and psychological sustenance, as well as a barrage of psychosocial stressors amidst a backdrop of extreme political polarization, violent rhetoric, mass protests, and a cavalcade of terrifying economic and geopolitical news, it seemed as though the social order that we had come to recognize as the bedrock of our day-to-day existence began to crack and crumble.

This environment has been noxious and conducive only to cultivating psychological distress, which is why many people without preexisting conditions or genetic predispositions or a history of mental illness have reported struggles with their mental health. Throughout the pandemic, nearly everyone has exhibited some of the symptoms of affective, anxiety, or substance abuse disorders. Having these conditions does not mean that one is mentally ill, an addict, or in any way weak. Rather, it suggests that one could not thrive in conditions that are contrary to the needs of humans. If anything, it is a proof of their humanity, a reminder to practice humility, and a reason that each one of us should wear our empathy on our sleeve.

What is reassuring is that the vast majority of those who were forced into long periods of social isolation or perpetual fear during the pandemic will ultimately recover. As I have said elsewhere, humans are exceptionally resilient.

Despite this, many people will not be so lucky, and it is therefore important to understand why we need to examine COVID-19 not merely through the lens of a disease that produces specific physical symptoms but also as a social phenomenon that produced not only direct psychosocial effects but also indirect effects that exacerbated many of the preexisting health problems that are common throughout the United States. Without a doubt, the greatest tragedy during this pandemic has been the deaths of millions of people around the globe, including hundreds of thousands of Americans. However, despite that horrendous number of deaths, one cannot minimize the everlasting physical and psychological scars among the sick who survived but had to be hospitalized and continue to struggle with the onslaught of lingering symptoms associated with long COVID. In addition to those who became sick, there are millions who will experience some degree of secondary and tertiary tragedies that could play out for years to come. An unfathomable number of people across the United States and the world were inundated by stress—struggling with their living situations, employment status, or the fact that they or their loved ones could become sick—and the fear and stress of contracting COVID-19 or lack of economic or social supports have been the root cause of depleting their psychological reserve and resilience.

Additionally, the biological and psychosocial aspects of COVID-19 have been intertwined such that the pathology of COVID-19 and numerous social aspects of the pandemic led to pernicious effects on an individual’s health and in particular mental health. As described in Chapter 3: Pathology—What We Knew and What We Know, even mild cases of COVID-19 can lead to an errant immune response and systemic inflammation. Furthermore, as explored in Chapter 4: Neuropsychiatric Symptoms and Postacute Sequelae of SARS-CoV-2—The Long Haulers, systemic inflammation can lead to neuroinflammation which may contribute to or exacerbate symptoms of anxiety and depression. Needless to say, when social stressors are added to this mix, it further amplifies these symptoms and may worsen one’s mental health.

Hard evidence is now starting to emerge about the colossal impact of the COVID-19 pandemic on individuals’ mental health, and we are finding that those who were the most vulnerable before the pandemic and were already struggling with multiple stressors—particularly those tied to socioeconomic difficulties (food insecurity, housing instability, precarity of transportation, interpersonal violence, etc)—appear to have suffered the most.² As was observed multiple times in the early stages of
the pandemic, most of these problems were not new; they were merely exacerbated by COVID-19.

Considering the abovementioned facts, a psychosocial approach to these issues should not be in any way controversial. Social stressors seem to have played a direct and significant role in the pathology of COVID-19 and have also impacted the mental health of millions of people who were never infected by the novel coronavirus. To fully understand and describe every social component that potentially contributed to COVID-related anxiety or depression would require a vast chronicle of the COVID Era, which is something that is beyond the scope of this book. However, there are crucial social components to the story of COVID-19 that need to be touched upon before moving on to discuss the larger issue of stress and some of the specific manifestations of that stress.

What follows is by no means an exhaustive list of the economic and social effects of COVID-19. These are, rather, the tips of the iceberg that either caused increased stresses or were the results of stresses on individuals who were suddenly deprived of their familiar support networks and often incapable of moving freely, working, socializing, or taking part in activities that had given their life meaning.

COVID-19 either set off or contributed to multiple domino effects that all seemed to collide in a spectacular fashion in early 2020. The result was widespread chaos, collapses in supply chains and local economies, shortages of staples, and unprecedented layoffs in virtually every sector of the economy from which we are still recovering. Within the United States, an estimated 22 million jobs disappeared in the 4 weeks after a national emergency was declared on March 13, 2020. A record 6.9 million people filed for unemployment the week ending March 28, 2020, alone.³ One cannot underestimate the colossal impact of this economic loss that halted the lives of millions and caused mayhem, confusion, anxiety about the future, and in many cases, a deep sense of fear and depression.

Stress is a ubiquitous word in modern society and a normal part of everyday life. Anyone reading this is familiar with the feeling, and we typically associate it with the feeling of being overburdened or when circumstances do not go our way. Physically, it can feel like a valve has been shut off somewhere in our bodies and that there is a pressure building up within us. This is reflected in our idioms about stress, and we complain about feeling “under pressure,” or “about to burst,” “about to snap,” or “at the breaking point.”

Somewhat more formally, stress can be defined as any type of change that causes physical, emotional, or psychological strain.

In some cases, stress can be a good thing. For example, exercise is a form of stress. It puts strain on muscles, but this strain is relatively short-lived and controlled. Similarly, fear is oftentimes a good thing. As unpleasant as it may be, it is key to our emotional lives and our very survival. In fact, one could think of our fear response as really no different than a threat response. That feeling of stress or dread or terror or aggression is precipitated by perceived threats, and they start a cascade of neurochemical signals to ready our bodies to be more capable of responding to threats.³¹ This physiological reaction is known as the acute stress response or, more famously, the fight or flight response.