I don’t think that I would be telling anyone anything new if I said that the ongoing COVID-19 pandemic has dramatically impacted the lives of many around the country and, indeed, around the world. Nor would it be news to anyone that it continues to do so. What may, at times, be less apparent — at least to some — is the psychological impact that the pandemic has had. While many argue that we have had a mental health crisis in this country well before the pandemic hit — something that I personally believe to be true — there can also be no denying that the pandemic has taken this problem and made it that much worse. That, in short, is what served as motivation for me to once again chat with author and psychodynamic psychotherapist Rebecca Alexander, continuing a conversation that we began back in early 2020, as the pandemic was ramping up and the United States had gone into lockdown. Though we are now fortunate to have safe and effective vaccines, with pharmaceutical companies developing updated boosters that will also target certain newer variants of the disease — thus making them that much more effective at preventing severe illness and death due to COVID-19 — I think that the science also shows that the pandemic is not yet over nor, arguably, have we seen the last of the psychological toll that the virus has taken on this country.
Andrew DeCanniere: Thanks so much for speaking with me again. I know that a recurring theme in the media seems to be how there is this overwhelming need for mental health professionals, and not enough people in the field to meet this demand. It does seem like there already was a significant need for mental health professionals prior to the pandemic, and then the pandemic seems to have really pushed things into some sort of overload.
Rebecca Alexander: Yes. Everybody has wait lists. I have a few teens right now, who I am trying to get into treatment programs. We’ve gotten them in. We’ve done everything. Now we just need to wait for three months, because of the wait list.
DeCanniere: Right. I actually just saw a segment about the pandemic and the toll that it has taken on many people’s mental health. I think it has been very hard on everyone, but it seems like this time has been particularly difficult for children and teenagers — and then it has been particularly hard for them to find the appropriate care, as well.
Alexander: I think that another piece of that is that, on the one hand, we are in the midst of this pandemic, where we have been forced to isolate. We aren’t able to socialize, and they can’t go outdoors and be physically active in the way they might otherwise be able to do — not just for their physical health, but for their mental health. What I have found is that kids are in front of their screens for God-knows-how-many hours each day for school, and then it becomes sort of habitual. This is something they become accustomed to. So, when they aren’t online for school, then they are online for social media. I think that, for teenagers, in some ways social media has been more devastating than the pandemic — mostly because they are young. Obviously, many have lost loved ones and family members. However, for many, things are much more myopic as well. In order to socialize, they’ve turned to social media, and so they begin to have this warped sense of reality.
DeCanniere: Obviously, I was not a teenager in the age of social media. I think that Facebook really became a thing about a year or so after I graduated from high school, and both Twitter and Instagram just didn’t exist. That said, it does seem that so many seem to attach so much importance to the number of followers they have, the comments they get, and the number of likes each post receives. I think that adults realize that, at the end of the day, that really isn’t the stuff that matters. I don’t think that teenagers are as likely to view it in the proper context.
Alexander: Some of these social media platforms have made some changes, so that you don’t necessarily see the number of likes or whatever, in the hopes that it would have some sort of an effect on the impact on teens. I don’t think it actually makes much of a difference at all. You’ve also likely heard that pediatric optometrists and ophthalmologists have seen a much higher rate of myopia — or nearsightedness — in children. Their eyes are still developing, and so many are in front of screens because of their school, but they’re in front of screens for other things as well. There are so many things kids rely on technology for, and so many things that they are able to do utilizing technology. In many ways, it’s pretty incredible.
DeCanniere: I can still remember when we only had one shared computer in the house. It was in a bedroom — though we always had the door to the room open when it was in use, so that my mom could keep an eye on what we were doing and for how long we were using the computer each day. There had to be limits to how long we could each use it for, out of necessity, so it would be available for others to use. I’m sure that there were times, if it were allowed, we would have spent far more in front of it. It also had a wired, dial-up connection to the internet, which meant you had to connect to the internet. There wasn’t an always-on, high-speed internet connection. You had to start up the computer, log onto the internet, and then once you got online, everything was much slower. So, we certainly tended to spend less time in front of the computer. I think pretty much everyone spent less time on computers and online.
Alexander: I know. It’s so different now. There obviously are benefits, but there also are some real drawbacks. I think that COVID really did a number on young people. I don’t think we yet know the long-term implications of it.
Another issue, as you may know, many therapists gave up their offices. It just turned out my lease was not up for another couple of years. Trying to find a therapist’s office now is hard, because so many are working virtually. I’ll get many people who will reach out who will say “We’re looking for a therapist who is working in person.” I think that many people are fully remote. So, on the one hand, there are the people it has really affected, because of how they’re accustomed to socializing. They need to be doing things in person. For other people, who are much more introverted, it sort of feels like it has been a relief. I think that, for people who are developing, being in person can be really important. I have the highest number of teens in my practice that I have ever had but, oftentimes, when you are online with them, you can see they’re looking at something else. It’s like “What are you looking at? We are in a therapy session right now. I need you to close all of your other windows.”
DeCanniere: I have two words for parents: parental controls. I think parents need to familiarize themselves with the technology as well, and they can then be better positioned to understand what these various platforms are, how they work, and how they may be able to set limits on what their children are able to use on their devices, when, and for how long. I would think that they should be able to set things up in such a way that their child cannot do anything else on their device during their online therapy session.
Switching gears from social media, I think that it is fair to say that we’re seeing a significant uptick in gun violence lately. Personally, I do think that we are in much better hands with the current administration, but there is much that remains to be addressed.
Alexander: Think about what happened with all of these people, who’ve been pent up for God-knows-how-long. They have little to no resources, or they are not even seeking them out. The one thing mental illness thrives on more than anything is isolation. For people who are mentally unwell, to have been in isolation for as long as they were, it presents a huge issue in terms of the gun violence we’re experiencing now.
DeCanniere: Actually, that’s one of the things I was going to touch on. We’re hearing a lot about gun violence these days, and it is often attributed to mental illness in some way. Obviously, nobody in a mentally healthy place is going to go ahead and shoot up a school, a church, a synagogue, a mosque, a grocery store, or whatever else it may be. However, I was wondering what your take on the issue may be. What role do you think mental illness has to play, versus the person simply being evil or hateful or hate-filled?
Alexander: Well, we have the perfect storm, right? Manufactured facts or information — information people believe to be factual. You may like what someone says on TV, and therefore anything they say is viewed as fact, rather than opinions. People are too lazy, or else just don’t take the time, to form their own belief systems and opinions. So, what we have is a pandemic, where people are forced to stay home for much longer than anticipated, because our expectations were not managed. We were promised things that were not able to be delivered. So, we were set up for disappointment. Then you have people who are angry, and they take it out on whomever they see as being the problem — which, as we all know, is not based on facts, but is based upon opinion or whatever they read online, which is also manufactured. Then you have people going on social media, riling each other up. They get angry about certain things, and they have all of this made-up information. All of this is being fueled, and is festering, while the country is under quarantine and not able to work or socialize. It was like a cesspool that was being created of just really disturbed minds, with fewer resources. There wasn’t an ability to keep up with the demand. I think that is part of what makes it so difficult. Even the people who want treatment aren’t able to access it, or have it available to them, as quickly as they need it.
When we talk about gun violence, you have the those on the right saying that there need to be mental health programs in place to address people with mental health issues. These tend to be the same people who have no ability to understand just how detrimental having access to guns is to our society. These are the same people who tell you life begins at conception, but don’t seem to care enough about lives to save them by not having assault rifles or assault weapons available to the general public. I just don’t understand it. The problem is those of us who are in the mental health field, we are the ones who are left to face the consequences.
DeCanniere: Let me tell you, you and I are so very much on the same page with all of this. “Alternative facts” as too many have called them, aren’t facts. They’re opinions — and, all too often, are outright lies or, at least, distortions — masquerading as “facts” or “news.” Facts are facts. The truth is the truth. There cannot be multiple truths. There can be multiple perspectives on an issue, but that’s something else altogether, and it is important that opinion be presented as opinion. And I, too, have a problem with the right, which seems to still be singing the “guns don’t kill people, people kill people” refrain. The thing is, guns in the hands of the hateful, hate-filled, and sometimes the delusional, do kill people. Personally, I believe in equality and I believe in a woman’s right to choose. Women should have the right to make their own decisions. This narrow definition of what it means to be “pro-life” is so messed up. For far too many, “pro-life” seems to start and end at the act of procreation itself. There is disconcertingly little respect for life beyond the point of conception. For this reason, among others, I often refer to them as “anti-choice” rather than “pro-life.” It’s arguable that if someone were as “pro-life” and respectful of life as they claim to be, then you would logically expect that they would see the gun violence that we’re experiencing and would also be against easy access to guns, against the proliferation of weapons — and certainly would be against the sale of assault weapons and accessories that make weapons more dangerous than they are on their own.
Alexander: And this is the hypocrisy. It’s like banging your head against the wall. I don’t even know where it all comes from. I assume a lot of it is religiously-based, but again, I would love to hear from someone from the right be able to argue their case for exactly what it is we’re talking about, without it becoming an attack. I genuinely want to understand how you differentiate between the two. Also, if we are saying life begins at conception, what resources are you committing to be able to support people and families who now have to have children outside of their means? Do we not promote contraception? It’s like “No. We encourage abstinence.” Okay. Well, you’re not going to turn this entire country into one religion.
DeCanniere: I agree. Absolutely. Many on the right do tend to be very against social welfare programs. At least they have been, historically — too often disparaging those who are dependent upon government assistance.
Alexander: It’s just so messed up, isn’t it?
DeCanniere: It is. Maybe the problem is we’re looking for logic and reason where there is none at all. From my point of view, logic and reason seem to be in short supply.
Alexander: Not only that, but they have someone who was a leader for anything that was not factually based. Not being able to back things up with evidence was irrelevant. That’s where the intimidation and fear factor come in.
DeCanniere: It’s this ever rightward drift. It does seem that the Republican Party, in particular, has a certain segment within it that seems to be getting more and more extreme.
Switching gears, what should parents be on the lookout for when it comes to their children? When may it be time to seek professional help? With so much emphasis on mental health, and the mental health of kids and teens in particular, I thought it’s important to touch upon this topic.
Alexander: First and foremost, what I say to parents is that when it comes to their kids and wondering if they should seek a higher level of care — a professional, an evaluation — I think you have to ask yourself “What is my role in what I am seeing in my child?” Do I feel like there’s anything I’m doing to encourage this or allow for it? Am I enabling my child? Are there things I say or do?
In that case, yes. You want to be able to make sure your kids get evaluated, but you likely need some support yourself. Maybe it’s parental guidance. We live in a very different time and place than we ever did before. Having said that, it’s very difficult to hold ourselves accountable for the things we either allowed or taught to our kids. It’s not even purposefully, but unknowingly. Whether it’s etiquette around phone use or screen time, or it’s being more involved with your kids. Parents should be having real conversations with their kids, around the dinner table. If you’re not having dinner together because of everyone’s schedules, you need to schedule time where you sit with your kids, and you talk about these issues — the things that are going on in the world. Oftentimes, we see all of this stuff on the news, we hear about it talked about at school — sometimes in a haphazard way. A lot of kids are influenced by other kids at school. So, being able to have real conversations with your kids is so important. Know who their friends are. Know who they’re spending their time with. This isn’t reading their phones. This is actually having a relationship with your kids, and letting them know you’re available if they want to talk.
A lot of kids who don’t talk to their parents do not do so because they feel their parents aren’t available, or because they know their parents are going to try to offer a solution, as opposed to just allowing them to talk about their fears and concerns. They feel as if anything serious, anything they want to talk about with their parents, is something they have to talk about with a professional. Like it is secretive, something they should be ashamed of, and cannot discuss openly. I think there becomes this sort of culture of going to see a therapist to tell them about all of my issues, and that’s my safe place to do it. Teens should not have just one place where they go and share this stuff. They should have the ability to have open dialogue and conversations with their parents. Ask kids what they think and feel about things, instead of just telling them what you think, because they are developing minds. They need to develop their own opinions. That is a part of how we end up in the situation we are in, right? People are constantly learning from their parents, and just doing what they’ve seen their parents do, or just taking things that their parents may say at face value, as opposed to being able to develop their own opinions that will help them become people who can make decisions for themselves — not because this is what somebody told them that this is what they should do, and they can’t really tell you why.
DeCanniere: Right. I’m not a parent myself, but when I was a teenager — and even now — I feel like, in my experience, there really wasn’t anything I couldn’t discuss with my mom. I never really felt as though there was anything that was off the table. I never got any message that such-and-such is something we can’t talk about with one another.
Alexander: I had a similar upbringing. I came from a divorced household, but that was something that remained at both households. We had open conversations about what was going on. My parents would engage us. They’d turn the TV off. If they were watching TV when my mom was making dinner, they would turn it off during dinner, and we would have conversations together. I know there are people who are like “But it keeps my kids calm, and they’re not bouncing all around.” Well, they have conditioned you. They have conditioned you to allow them to have those screens at dinner. That’s something you have to understand you had a role in creating.
DeCanniere: Right. And there is evidence that suggests it is just healthier, overall, not to watch TV while you’re eating. Eating in front of the television has been linked to mindless eating. So, there are other additional benefits to eating with the television turned off — and going without other screens as well — during meal times.
What signs of distress should kids/teens be on the lookout for that might indicate that they (or their friends) are not in the healthiest frame of mind? What can pre-teens / teens do if they think they (or a friend of theirs) might be experiencing some type of mental health crisis (e.g. they are engaging in reckless behavior, or they are engaging in some type of self-harm)? Where would you recommend they turn?
Alexander: Anxiety, depression, and mental health issues can present in different ways for different people. Some people become more introverted and less engaged in their social, academic, or extracurricular activities. Others may engage in riskier behaviors like drinking, smoking weed, doing drugs, self-injurious behaviors, developing an eating disorder, or hanging out with people who don’t respect boundaries or encourage them to be their most authentic selves. Teens and young people often think they are supposed to have the right things to say to their friends or know how to advise them. The best thing you can do is validate how your friend(s)/loved one feels. Remember, you can’t fix the situation but you can be there to listen and also suggest that they seek out help from a professional like a therapist by asking their parents, caregivers, or even a trusted person at school, like a school counselor.
DeCanniere: What does one do if one lives with somebody who clearly needs the help of a mental health professional but may be in denial about that fact, who does not care how others may feel, or who does not care that their behavior is negatively impacting those they live with? Is there any approach that you would recommend that could lead them to get the help they need? While it is possible that a parent could compel a minor to see a qualified mental health professional, when we’re talking about an adult, then the situation could be quite different.
Alexander: We can’t force anyone we love or live with to seek professional help if they don’t: a) believe they need it, or b) aren’t willing to pursue it themselves. The best thing you can do is recognize the role you play in enabling the person’s behavior. Lead by example by seeing a therapist yourself and letting your loved one know that you are going to seek professional help to address some of your own issues. Or, perhaps let them know you’ve been seeing a therapist and you’ve found it to be particularly helpful. The more you try to impress something upon someone else, the less likely they are to pursue it. It has to be something that comes from them. The best thing for you to do is change the way you handle issues in your own life and let them see the difference in you. More importantly, I strongly encourage people to read the book Codependent No More by Melody Beattie. It was written many years ago for loved ones, significant others, close friends, caregivers, etc of alcoholics and other types of addicts or people living with mental health issues. It’s a recommended read for those who attend Al-Anon meetings. I believe that everyone could benefit from reading this book when it comes to living with people who are struggling with any type of mental health issues.
DeCanniere: I also feel as though it is hard for the insured to access the mental health resources they need — at least at times. Then you throw these companies that employ independent contractors, who aren’t insured through their employers — or who else may be underinsured — into the mix, and things get really difficult. Is there any place for people who are underinsured or uninsured to get the care they need?
Alexander: That’s sort of the conundrum in which we find ourselves. There are a lot of training institutes. You can have people providing therapy, who then have supervision. I supervise people. I think that if more people were to go into the field, and know they could get some supervision, and not feel too afraid of the issues that they would face — feeling like they were inexperienced — that would help. This is why the community programs are so important, right? Because of the uptick in drug and alcohol use, there are a lot of people going to twelve- step meetings now. I don’t know if you’ve heard of it, but there is a website called Alma — online at helloalma.com. That’s one good one. Another that people have been using is ZocDoc. This is the hardest part. We rely so heavily on community programs, and for a lot of these communities, these programs are through the church you’re affiliated with. However, some people are unaffiliated. Where do they go? I wish I had a perfect answer or solution to it, but I think mental health has been undermined for so long in the medical field, and with insurance companies, that they were very ill-prepared for something like this.
DeCanniere: It truly is ridiculous. I think that Washington has a huge role to play. This is another thing that, if they devoted more time, effort and energy to the issue, providers would not have to fight to get the pay they very much deserve, and those in need of help would not need to struggle to access those resources.
Alexander: Even being able to offer some sort of need-based assessment for people, who could then pay what they could afford. We have these conversations so often, and it is just so difficult, because we always come back to this one issues of “But how can we do this if we don’t have this, that or the other?” I do think that, especially now, anything related to being able to buy an assault weapon — or a weapon of any kind — it’s so upside down to me. I just don’t understand it. If you’re able to use a gun, or you’re qualified, you should have to go through the steps to prove that. I don’t mean that you’re a sharpshooter. I mean there should be a background check, complete with a mental health check. We need to have actual, tangible steps you take, as opposed to saying that this is a God-given right or that this is a part of the Constitution.
Now, if we were to ask the people who wrote the Constitution about the questions we have today, they wouldn’t understand it. They would not even be able to comprehend what we’re talking about, yet we’re still trying to apply those same laws and Constitutional rights to something that just doesn’t exist anymore.
DeCanniere: What I also find particularly frustrating is those people who come along who suggest that only they know the original intent behind the Second Amendment, and they seem to insist that what was meant was that virtually all Americans should have the right to bear arms if they so wish, with exceedingly little to no restrictions as to the number, of weapons the type of weapons, or the accessories that they can purchase for those weapons. They seem to say “Only I can interpret it appropriately and as intended, and the meaning of the Second Amendment is that everybody and their child should have the right to as many weapons as they would like.”
Alexander: But why? Can you tell me why?
DeCanniere: Isn’t that interesting? They never seem to be able to articulate that aspect of things.
Alexander: Right. If you tell people the only way to protect yourself is through being armed, then how do you teach people conflict resolution?
DeCanniere: I don’t think that conflict resolution is what they have in mind. They rather peddle this absurd notion that the only way we can be safe is if everyone has a gun pointed at everyone else. But that’s not safety. Not really. That’s certainly not peace. It’s as if they are throwing fuel on the fire.
I guess we kind of touched upon what could or should be done to improve what resources are available to those in need of mental health care, ensuring they have access to the care they need. The other thing is that I think you don’t need to be in the midst of a mental health crisis to think about your mental state and to engage in self-care. So, I was wondering if you have any advice for those who feel as though they are in a good place mentally and emotionally, so that they can remain healthy. As they say, an ounce of prevention is worth a pound of cure. Do you have tips for people to maintain their mental health?
Alexander: I think one of the things that we undervalue is self-care. In this country, working yourself to the bone is a status symbol. How hard you work, or how many jobs you have, or how rich you are. We don’t have a real sense of what I think is actually important and sustainable. I think that for people who have a lot, it is so important to know what you have, and to be able to give back. I was raised in a Reform Jewish family. One of the things that we learned about was tzedakah. You know, you have a tzedakah box where you would collect money, and you donate it to whatever your charity was. It wasn’t that you were being charitable. “Tzedakah” means justice — like the balancing of the scales.
For people who don’t have as much as you do, or who don’t have as many resources, to be able to give back and to be able to make things a bit more equal. I think that if people were more focused on doing that, rather than focusing on how full their lips are or how beautiful their makeup is, or rather than focusing on what the next thing that you need to buy to make yourself feel full or whole or complete or enough is, and we focused more on how awesome it is and how awesome it feels to be able to be a part of something bigger — to give back. The reason why consumerism and all this social media stuff thrives so much is because nobody ever feels that they are enough. Whatever it is that you’re buying, whatever it is that you think of yourself, go on social media, and you are just reminded that whatever you have is not enough.
I think that being able to process the things that make you feel good about yourself, and don’t feed that sense of not being enough, is so important. I think that everybody, to the best of their ability, should take five minutes a day — whether it’s sit and meditate or breathe. I know that’s an uphill battle I’m never going to win, but even if people took the time to breathe every day — even for five minutes — people would notice that they might handle things a little bit differently, because they are not working on such impulse, but they are actually taking the time to slow down and think about what they want to say or how they feel.
The other thing I was going to say is that the communities that thrive the most are the ones that are heavily rooted in interdependence, as opposed to independence. In so many places we teach our kids and we want to become as independent as possible, but the communities that thrive the most are the ones that are interdependent — the ones that understand that they have a responsibility to their community, as much as they have a responsibility to themselves. We all need to be able to support each other, to be there for each other, as much as we have to for ourselves. If there are people in your community who need rides somewhere because they’re blind or whatever, I think it is so crucial to be able to lend yourself to the needs of other people. We end up doing so much to make ourselves less of a community, and more of a “to each their own” or “may the best man win” kind of society.
DeCanniere: Not to sound cliché, but I think that it is true that nobody is an island unto themselves. We are all interdependent upon one another. The sooner we recognize that, the better. And I agree that it is extremely important to engage with and give back to the community.
Alexander: I think that when we have more interdependence, and more of a sense of responsibility for others in our community, then we’re much more affected by the things that happen in our community — as opposed to “I hope this doesn’t happen to me.” How do we ensure that this doesn’t happen to you or to others? What are the changes that need to be made, or what are the responsibilities that we need to take on? When anything happens, we look at who did what wrong. Nobody ever looks at themselves and says “How was I part of this?” or “How can I be a part of making sure this doesn’t happen again?” Really, what is my role in my community that prevents crime — or that doesn’t? I think that, for many people, they keep to themselves. I think that it is important to hold ourselves accountable for whatever our role is in our community. You absolutely should get involved in a way that isn’t about you, but is about helping or empowering other people. That’s where confidence is built from, too. Knowing that the work you do makes a difference or has an impact on people — not trying to make people jealous or envious.
Last, but not least, is there anything that you wanted to discuss that we haven’t covered? You are the expert, after all.
Alexander: That’s a good question. I’d have to think about it. I think the biggest piece has to do with accountability. The more we hold ourselves accountable for our role in anything, the more likely we are to see change — as opposed to looking to everybody else. What you do matters. Your actions are really impactful, and we have a lot more power in ourselves to do good, and to make changes, than we give ourselves credit for or than we even believe. I think that if everyone started to take the approach that they have the ability to exact change, we might actually see that. More than anything, just how crucial our mental health is to everything.
Rebecca Alexander, LCSW-R, MPH, is a psychodynamic psychotherapist specializing in individual, couples, family, and group therapy. She currently maintains her private practice in Manhattan.