As 2020 comes to a close, the phrase that seems to best represent it is Whisky Tango Foxtrot (or, more commonly, WTF?). It seems to capture well the weird combination of incredulity, despair, frustration, fear, and resignation, all combined with a tentative hopefulness that 2021 will be much, much better. The COVID-19 pandemic has ravaged most regions of the world, and despite all we could have learned from the admirable ways that some countries (such as Australia and New Zealand) have dealt with it, we in the US missed that opportunity. The price of our government’s willful ignorance and a large segment of our citizenry’s inflated sense of entitlement to unrestricted freedoms at the expense of social responsibility has proved to be deadly in more ways than one.

As a consequence, the pandemic has given us some meaningful insights into mental health issues. When I wrote Depression is Contagious a few years ago, I made the point in a variety of ways that depression, the number one emotional disorder on the planet according to the World Health Organization, is much more a social than medical problem. The fields of genetics, epigenetics, epidemiology, cognitive neuroscience, and others as well, all reached a similar conclusion. I further made the point that no amount of medication as a sole intervention was going to be an adequate response to the social forces giving rise to the spread of depression and would therefore be, by definition, undertreatment.

Given the data being updated weekly here in the US informing us of the rates of anxiety and depression more than tripling since the pandemic’s onset, the view that depression is far more about one’s circumstances (and one’s response to them) than one’s neurochemistry is significantly bolstered. Social isolation, loneliness, disruption to the normal flow of our lives, the uncertainties about the dynamics of virus transmission and the potential for a cure, the loss of loved ones, the economic devastation and financial uncertainties, the societal polarizations arising from the inability to distinguish public health from political issues …whew! It’s just been too much for too many of us and the widespread suffering is already taxing our profession’s coping abilities. Too many therapists are struggling right alongside their clients.
Some people have managed to thrive, however, finding effective ways to stay connected to others and become more creative about developing themselves in ways they feel good about. Given the current levels of distress and dire predictions about the mental health crisis continuing to escalate, these are the people we should be paying especially close attention to and learning from as we prepare to meet the needs of all those who are precariously close to the edge.

Looking forward to 2021, far too many of the same ambiguities plaguing us in 2020 will likely continue to do so. We are hopeful that the vaccine really does have a better than 90% effectiveness rate with no serious side-effects, and we’re hopeful that the vaccine distribution will be managed efficiently. We’re also hopeful that skeptics and conspiracy theorists will change their minds about the vaccines being an instrument of mind control of the citizenry and do their part to help.

Psychotherapy has and will continue to have a more important role than ever before, hopefully providing a stability and comfort not easily found in many other contexts. People will need effective and practical tools that can meet the current crisis and its damaging sequelae directly: Now isn’t going to be the time to analyze peoples’ childhood or divert from helping them build critical thinking and problem-solving skills. The opportunity for the psychotherapy profession to rise to the occasion and prove itself to be both practical and readily available is right in front of us. Fortunately, the ways that mental health services will be delivered is rapidly evolving now as mental health apps proliferate (full disclosure: I’m associated with an app called Mindset; and online therapy becomes the norm. Many of my colleagues now realize that having an office is no longer either desirable or necessary in order to do high quality psychotherapy. Research data affirm the effectiveness of online treatment, showing that it virtually matches the success rates of in-person treatment. Thus, some of therapy’s most cherished beliefs about how therapy “should” be done are falling by the wayside. Now, that is progress! Whoever said that “necessity is the mother of invention” clearly knew what they were talking about.
It’s good to start this New Year with high hopes and the wish for better lives for everyone. I hope yours come true!


This blog was originally written for the January 2021 issue of the Science of Psychotherapy  magazine.

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