Pandemic stress looks a lot like protracted war: We need a national mental health plan

The COVID pandemic has created psychological trauma for people across the country as they struggle to cope with unforeseen challenges of daily life. As a clinical psychiatrist and retired Army general, I have seen the impact of stress and trauma on the fighting force and their families as military operations persist year after year. The recent wars in Iraq and Afghanistan left hundreds of thousands of men and women with invisible injuries — from post-traumatic stress disorder to substance abuse — that indelibly affected their lives. The impact is not just  immediate as people lose their ability to function, but on generations as families suffer from the continued inability to cope. The COVID pandemic looks to me a lot like protracted war. It has imposed the stresses and hardships that we have seen with extended combat operations. This country has not endured such strain since World War II. We must all realize that the trauma created on the scale of this pandemic has devastating consequences on our communities and respond with nation-wide public health programs.

The challenges are immense. Getting over trauma and stress — or even thinking about “healing” — is much more confounding and difficult than many imagine. Moreover, the pandemic has set up a toxic state of fear, financial hardship, illness, and death. But we can look to our military experience and to leadership experts to guide us.

The military has learned that it needs to make special efforts to prepare its men and women for surviving the hardships and dangers they will encounter. The programs are by no means perfect, but DOD continues to commit necessary resources to train and support the warfighters and families to endure the stress and survive the hardship. The most effective programs and initiatives have focused on building resilience to optimize performance and quality of life. In addition to the exigencies of fighting wars, leaders and the mental health experts have identified principles for coping with stress and survival. The effective programs that build and support resilience follow simple guidelines for establishing the best habits and daily routines.

This is not “rocket science,” but a matter of organizing, funding, and implementing programs that have been recognized to work for many years. Special effort is committed to helping all the personnel on the frontlines protect themselves from the emotional damage of their stress and hardship. Such programs include teaching the principles of getting better sleep, setting up routines of diet and exercise, identifying how stress affects mood and behavior, and keeping healthy relationships. Basic stuff, common sense some would say — except that trauma and stress often prevents even the most organized folks from practicing good habits and setting routines. Therefore, the responsibility rests with leadership to set priorities for good mental health and to teach self-care, survival and practical skills.

This is the time for emotional well-being to be a public health priority of President Biden’s COVID Task Force.

President Biden convincingly communicates his appreciation for the feelings and the devastating impact of the pandemic on people across the country. He affirmed in his inaugural address that he “gets” the hardship across all sectors of the country and is committed to moving the country beyond the crisis. According to a recent poll, trust in the federal government to provide accurate information about COVID is urgently needed. Everyone needs to feel confident that leadership has listened to their concerns, is willing to build up their resilience, and that the leadership will give them tools for support and survival.

The effectiveness of a public health campaign goes beyond the biology of the virus and the vaccines to contain it. An effective campaign over the coming year should include dedicated interventions for psychological support and well-being. This is an opportunity to prevent devastating consequences and scarring where and when we can.

Stephen N. Xenakis, a psychiatrist and retired Army brigadier general, serves on the executive board of The Center for Ethics & the Rule of Law at the University of Pennsylvania and is the director of the COVID Resilience Program for Silver Hill Hospital. Follow him on Twitter @SteveXen.