Beyond the Perfect Storm

Due to the convergence of three major forces: systemic racism, COVID-19, and economic calamity, a tsunami of mental health conditions has swamped millions more Americans during 2020. The recent statistics on suffering are staggering: “Overall, 40.9 percent of 5,470 respondents who completed surveys during June 2020 reported an adverse mental or behavioral health condition,” the Centers for Disease Control and Prevention says in its Morbidity and Mortality Weekly Report.

Anyone who is experiencing severe worry or hopeless thinking in response to these major forces should contact a licensed clinician for therapy services.  This article will focus on resilience strategies for coping with current forces that are challenging us as individuals and as a community.

The groundbreaking work of British based family physician Mohan Kumar identified eight characteristics of resilience that are the keys to positively adapting to stress or adversity.  Given the forces of the pandemic, systemic racism, and economic adversity, we are called to channel the resilience within ourselves to finish 2020 with our physical, emotional, social and financial well-being intact.

Connectedness:  One of the key attributes of resilience is staying connected with a support network of friends, family and peers. Resilient individuals seek connections and accept help from those who care about them. They reciprocate this support and try to help others in times of need. Belonging to social groups that are mutually supportive helps build resilience.  LGBTQ persons often identify a family of choice, beyond our family of origin, to have allies and confidantes who support us for who we are and what we stand for as open, out individuals.

Curiosity:  Resilient people stay curious. They maintain a sense of wonder and awe. They are curious about what has happened and what will happen. They are curious about how they feel and how they could feel. They are reflective and mindful of themselves and others’ thoughts and emotions.  Being diligent about seeking reliable sources of information about remaining safe from COVID-19 or recovering from the impact of COVID-19 with skilled physicians and other care providers is essential.

Communication skills: Resilient individuals develop their communication skills. They can articulate (internally and externally) their challenges and their coping strategies. They can communicate their viewpoints while actively listening to others.  Resilience requires channeling our anger about matters like systemic racism effectively by expressing any additional feelings of sadness, worry and shame in a manner that produces good trouble as Rep. John Lewis would refer to including constructive conversation with those whose opinions differ from ours and subsequently engaging in peaceful protest to seek change.

Control & Crises Management:  Resilience comes from a sense of control. Resilient individuals get beyond the temporary feeling of loss of control and make decisive actions. They do not shut themselves away and hope the trouble goes away. Staying decisive in times of adversity is hard but helpful. Resilient persons do not view crisis as a tragedy of immense proportions. They maintain a long-term view. They view crisis as a milestone, a chance to improve, to change strategies and regroup. They get past the initial emotional response and think beyond towards solutions.

Change Acceptance:  Resilient individuals accept change. They view change as a path to growth rather than a hurdle. They perceive things that can be altered while accepting certain things that cannot be changed. This helps to focus on things we have control over rather than get distressed over those we cannot.  For those who have experienced recovery from substance abuse, change acceptance is the overall theme of the Serenity Prayer.

Clarity of Focus:  Resilient persons make bite sized objectives and stay focused on achieving them. They break odds into surmountable chunks. They are realistic yet ambitious. They are content with making incremental progress towards their goals and seek positive feelings from small successes.  The athletes who have engaged in Black Lives Matters protests and subsequently increasing opportunities for persons to vote demonstrate this clarity of focus.

Confidence:  Maintaining a positive view of oneself helps build resilience. Moving away from negative emotion and catastrophizing while nurturing a positive self-image is quite helpful in times of crisis.  Ask your spouse, partner, or confidante to identify your greatest interpersonal qualities if you need to boost your self-esteem.  If you lost a job due to the pandemic, do not personalize the loss and keep focused on the skills and strength you will bring to a new employer while seeking a new job or career opportunity.

Creativity: Learning a new skill helps to bolster resilience. An artistic expression such as music, dance, cooking, meditation or creating art also builds resilience. The positive buzz from artistic endeavors has a healing effect particularly when we feel outrage, grief, or sadness about the challenges of 2020 and channel those energies into creative outlets.   Thinking outside the box can yield wonderful results in building new friendships, finding a new career, affirming artistic talents, and standing up for your beliefs.  Take note of how Smart Ride is adjusting its usual schedule of events to minimize COVID risk exposure yet still raise a million dollars for HIV/AIDS organizations throughout the State of Florida.

Our Southeast Florida LGBTQ community has been challenged to move forward with the circumstances of 2020 that has us being physically distanced due to COVID-19.  Theatre and musical groups are adjusting ways to deliver their artistic performances through a combination of live audience and camera feeds.  Sports teams have been off the field and gathering in small groups outdoors sharing meals and fellowship to maintain connection.  Emotional support groups and 12-step recovery groups are meeting via video consultation, hoping to avoid “Zoom burnout.”

Members of the LGBTQ community have been actively supporting Black Lives Matter events engaging in non-violent protest about racial injustice.  Advocates are strategizing about how to ensure that November 3rd ballots are received, returned, and counted. 

Resilience includes keeping your interpersonal connections with your allies and confidantes who are present and support you through times of adversity.  Do not hesitate to seek therapy for supportive counseling to cope with the emotional impact of COVID-19, racial inequity, or economic uncertainty.  We are all in this as one rainbow community united together!

Recommendations from CNN Medical Analyst about Thanksgiving 2020

(CNN)If you want to visit your family for Thanksgiving and avoid passing coronavirus on to them, experts say you need to quarantine for 14 days.

That's two weeks of doing even less than we're doing now, and it needs to start today.

CNN talked to CNN Medical Analyst Dr. Leana Wen, an emergency physician and a visiting professor at George Washington University Milken Institute School of Public Health, to find out what that entails. Here's her guidance.

CNN: Why do we need to quarantine before seeing relatives?

Dr. Leana Wen: The United States is suffering through the worst part of the pandemic that we have seen yet. We have added 1 million new infections in just 10 days. Hospitals in multiple states are already diverting patients because their emergency rooms and intensive care units are too full.

Remember that people we love can carry the virus as much as strangers can. When the level of virus in the community is so high, it's not safe to get together in person, indoors, with anyone not in your immediate household bubble. 

If you want to get together with other households for an indoor Thanksgiving, you need to quarantine for 14 days and then get tested.

CNN: Why is quarantine 14 days long?

Wen: Fourteen days is the maximum incubation period for the virus that causes Covid-19. If you quarantine for less time than 14 days, you could be infected and not know it. I am certain that none of us would want to inadvertently spread Covid-19 to those we love the most. Taking a test too early -- before a 14-day quarantine -- may not pick up on the infection.

CNN: What can we do during our quarantine?

Wen: In this case, quarantine refers to staying away from others and minimizing your risk as much as you can. It doesn't mean staying locked in your house. Getting fresh air is good and important for your physical and mental health. So it's fine to take walks and exercise outdoors. Try your best to stay away from other others, and keep at least a 6-foot distance when outdoors.

We know Thanksgiving can involve a lot of cooking, and therefore grocery shopping. Going to the grocery store can also be low risk, although you should try to go during off-times and try to go just once during your 14-day period. You could also try to order groceries or the entire meal to be delivered to your home.

CNN: What should we not do?

Wen: Here's what's high risk and should be avoided during this period. Do not go to indoor bars or restaurants. Avoid gyms. Most important: do not get together with anyone else outside your household for anything indoors -- no dinner parties, no birthday celebrations or any other get-together indoors. If you are socializing outdoors, make sure you keep a 6-foot distance from others at all times.

If you're getting together with other households for the holiday, you should discuss what other activities you would be OK with. Many doctors' offices have put in place precautions and it's probably low-risk to visit the doctor. Many workplaces have instituted many protocols to reduce risk, and it may even be very low-risk to go to work if you can keep at least a 10-foot distance from others and wear masks at all times.

CNN: Does everyone have to quarantine?

Wen: Yes. The key is that every member of every household that wants to get together must participate in the quarantine for 14 days. If one person breaks quarantine, that person is exposing everyone else to their risk. This requires a lot of trust, so set that expectation in advance.

CNN: What about daycares and schools?

Wen: This is a tough one. Daycares and schools may be necessary for a lot of families when it comes to childcare for working parents. They may be relatively lower risk for transmission, especially for younger children. However, there is an infection risk, especially given the high level of coronavirus across the country. I would not consider a family that's still sending kids to daycare or school to be low risk enough to be part of an indoor celebration. But if kids stop daycare or school now and then get tested in 14 days, they could see other relatives indoors.

CNN: Can we still see one another if we don't quarantine for 14 days?

Wen: Yes, but you can only see them outdoors, with households spaced at least six feet apart. You can still host safely and have fun! But do not get together indoors.

CNN: Are there other ways to celebrate if we can't get together with our family?

Wen: Yes! Being safe doesn't mean we should stay isolated. Maybe we can't get together in person with family. You can plan an outdoor "Friendsgiving." Bundle up and bring warm blankets. Be flexible if it turns out that we can't celebrate Thanksgiving on that day because of the weather.

CNN: What if we have to travel to see family for Thanksgiving?

Wen: I'm less concerned about the travel itself than the activities before the travel. The 14-day quarantine period should happen before the travel. Then do everything you can to minimize risk while traveling.

CNN: Is driving better than flying?

Wen: Driving will be safer than flying because you can control who's in your car. Keep rest stops to a minimum. Make sure to wear a mask if you're using a public restroom and sanitize your hands after leaving. Even flying has relatively low risk, with only a handful of infections reported for flights where everyone is wearing masks. Make sure to wear a mask the entire flight, ideally an N95 or at least a 3-ply surgical mask.

Still, I urge everyone to reduce nonessential travel. Even though the travel itself is low-risk, I worry about people coming from all over the country, since nearly every part is a coronavirus hotspot at this point.

CNN: What about college students coming home for the holiday?

Wen: Many colleges have had outbreaks. Young people tend to be asymptomatic spreaders, and returning college students should be treated as being very high risk.

It's probably not practical for students to quarantine for 14 days before they return. In that case, they need to quarantine once they return home. That means staying in an area of the house that's totally separate from anyone else. They should not be in any indoor areas with other people for 14 days. They can socialize outdoors only during that period.

CNN: This is a lot. Is it really necessary?

Wen: Yes. I know it's a lot. But we have to get through this winter. There is hope on the horizon, with a vaccine and therapeutics likely next year. We need to get to that point. That means we have to keep up all these precautions. Wear masks. Physical distance. Wash our hands. Avoid indoor gatherings.

We've already endured so many sacrifices. We can get through this winter, together.

Recommendations for Coping Well During the COVID 19 Pandemic

For Couples:

Collaboration:  As challenges emerge within your home, joint decision-making is crucial.  You and your spouse are the co-owners of your family business, and each of you will have portions of duties related to being CFO, Chief Technology Officer (which may get delegated to a smart teen), Head Chef, Chief Environment Officer, Classroom Teacher for those with younger children, School Principal for those with
teenagers, and Chief People Officer trying to keep everyone safe and happy.  Carve out a few minutes each day independent from children overhearing to check-in on how each of you are doing with the assigned duties.

Establish routines:  Understand and respect each other’s work schedules; consider a large calendar with markers to show what times your spouse is truly unavailable.

Embrace Space:  If you have not done so by now, ensure you each have your own “office” and your children have their own “play spaces.”

Avoid Pushing for Sexual Intimacy :  Stress hampers libido in 85% of adults.  When you feel interested, then
create a safe and nurturing environment with no strings attached to see if the desire is mutual. 
Focus on Small Blessings:  Gratitude is essential for experiencing hope.  Thank your spouse for how s/he
contributed to the day going well.  Don’t have meals in front of the TV, but rather share a meal talking together as a couple keeping the conversation focused on our blessings and how we are helping each other

Strategies when Unsafe:  If you have been a victim of domestic violence, no quarantine is more important than your health. Local resources are available through Broward County’s Women in Distress 954 761 1133.

For Parents:

Create a Plan:  Be clear with your kids about the local guidelines about what’s allowed and what’s not including curfews, off limits spaces like pools and gyms, wearing masks if helping with errands,
and the risks associated with sharing sports equipment and toys with friends who don’t live with you.

Make it Fun:  Board games, card games, rotate who chooses a movie or program for everyone to watch and discuss, take a family hike or bicycle trip

Keep Kids Close:  You can hug those you are living with; those are the only people that your kids can hug right now, so your affection and reinforcement of comfort is critical.  Depending upon their age and level of responsibility, decide whether to have children accompany you to a grocery store or pharmacy

Be Honest with Your Children:  Communicate about the facts of the situation.  For middle school and high school students, consider watching the local news together and then discuss as a family .  Let children
express their feelings and comfort them when expressing worry or sadness.

Give Kids Control:  Give kids choices about what game to play what song to sing, what meal to cook together,

Read Books:  This is not the best time for scary books, but uplifting, fun books and those whose storylines are encouraging and uplifting.

Let Kids Help:  Delegating cleaning chores, and cleaning up after pets are a wonderful way to teach responsibility.  Teenagers are likely to embrace showing compassion, particularly for grandparents, other families in need, and their close friends.  Find the balance with being creative and helpful whole staying physically safe.

Be Patient:  Sometimes children regress; those who may have successfully moved forward in stages of development may regress to bed wetting, aggression, obstinance, or screaming uncontrollably.   This will test your patience; if you are fortunate to have a spouse or partner who shares the home, collaborate together.

For Singles:
This is the time when people learn the depth of friendships   Allies are people that you rely on during difficult circumstances.   Confidantes are persons that you entrust with difficult emotions or decisions such that you will typically accept their feedback and still apply the constructive criticism. 

Outside of work hours, please engage with social opportunities online:  Zoom gatherings, discussion groups related to or having nothing to do with COVID 19, online recovery meetings are examples of great outlets. 

Keep updated with CDC guidelines related to sheltering at home, symptomology of COVID v allergies v flu v colds, wearing of masks and gloves outside of home, social distancing recommendations, and local guidelines about accessing businesses and recreational activities. 

Without recommending anyone turn into a hoarder, ensure you have 2 – 3 weeks of food and supplies should
local authorities further restrict options for leaving our homes.  In this area, we have often withstood several
days at home without power post hurricanes; this time we have access to our refrigerators, our ovens, our microwaves, our washers and dryers, our crock pots, our laptops and our cell phones.  This is a great time to practice your cooking or baking skills.

Build those endorphins:  go outside for a bike ride or run, practice yoga, do some calisthenics (push ups, abs, burpees, etc.)

I’m old enough to remember the marketing phrase, “Long distance is the next best thing to being there.”  Choose supportive family members and friends (likely meeting the criteria for allies and confidantes) to speak with by phone for encouragement, for sharing funny stories and coping strategies, and to
affirm that you are managing your COVID response. 

For those of you under the age of 50, the late 1970’s & early 1980’s was a period in history in which HIV and AIDS first became prevalent.  Single persons had to make decisions about risk factors associated with romantic expression and the use of condoms skyrocketed to reduce risk of becoming HIV Positive.  With COVID 19, a hug, a kiss and any form of touch can spread this virus.  Many of us are hopeful that we can return to “normal” in the next few weeks.  For now, I encourage you to be extremely cautious about making any exceptions for intimacy.