Shuey Mirkin
In so many ways, 2020 has been a really challenging year. Rather than thinking of specific ways that COVID-19 has affected us all, it’s almost harder to think of areas that this pandemic HASN’T touched. Concepts that would have seemed so strange in 2019 are now part of our new normal: social distancing, Zoom school, not spending time with our friends and family like we’re used to. And all of this is taking a toll–according to a recent WHO survey, almost every country in the world has experienced some interruption in the delivery of mental health services, along with a vastly increased demand. “Bereavement, isolation, loss of income and fear are triggering mental health conditions or exacerbating existing ones. Many people may be facing increased levels of alcohol and drug use, insomnia, and anxiety.” For us medical students specifically, we’ve been dealing with the normal stress of maintaining our demanding workload of courses and exams, while also dealing with the disruption of our normal outlets that help us cope and stay sane. If you’re at a traditional medical school, where your first two years are preclinical and spent mostly in the books, this has probably been a particular issue for you. So, I thought it would be interesting to talk about some of the research on what loneliness does to us.
Loneliness and the Brain
Two recent studies give us some insight into what’s going on in our brains during all this, and can hopefully give us some tools to stay healthy and sane, both physically and mentally, through all this. The first, an fMRI study done by neuroscientists at MIT, showed essentially that loneliness triggers the same area of the brain as hunger. To demonstrate this, the researchers compared two groups of people–one that was deprived of all food and drink besides for water for 10 hours, and another that was deprived of social contact (including internet use) for the same period of time. At the end of the 10 hours, the researchers took fMRI scans of the participants, and also had them self-report their level of craving. Brain scans in both showed increased activity in the substantia nigra pars compacta and the ventral tegmental area, both of which are associated with so-called “aversive motivation.” We are, quite literally, hungry for connection with other people.
Quarantine stress and the Brain
Another study, done by a team of neuroscientists at Tel Aviv University in Israel, compared MRIs taken from a number of healthy young adults before the pandemic began to MRIs taken in those same people after Israel’s first quarantine period. The researchers found a marked increase in the volume of the amygdala compared to the pre-quarantine scans. Normally, this increase in amygdala volume is seen in individuals suffering from panic and anxiety disorders. Similar to the previous study, this highlights the very real effects of all this uncertainty and fear.
As an interesting aside, the researchers pointed out that this has important public policy implications. Instead of governments framing COVID-19-related restrictions and instructions in a negative way—”you are in danger, you should be afraid, and if you don’t listen to the rules things will get worse”–they should use positive campaigning, stressing the importance of taking care of each other and how being responsible will help us all reach a better position.
So where does this leave us? Now more than ever, we need to put more work into maintaining our connections with friends, family, and colleagues. Here’s some practical ways I’ve found that have helped me in the last few months:
- Scheduling it: Just like anything else in a med student’s life, it’s gotta go on the schedule if you want to ensure it gets done. Take a 30 minute break from studying and call a friend. Trust me, you’ll feel much better than if you spend that 30 minutes watching a show.
- Use video calling: Before all this started, like most people, I would just text friends, and would rarely video chat. But now, I video chat whenever possible. It’s of course not like being with someone in person, but it’s the best way under our current circumstances to feel connected to the people in your life.
- Walk and Talk: Often, I’ll want to call a friend, but I’ll convince myself that I don’t have the time. But if I call someone while going for a long walk or a run, I get a much needed break from the screen, while also connecting with friends and family. Also, most med students I know take pride in being efficiency machines, so nothing feels better than getting done two things at once.
- Study Groups: For the most part, me and most of my classmates prefer to study on our own. It allows us to go at our own pace, and focus most on what we think we need the most help with. During a normal year, this worked out pretty well–we had our lectures, social events, and other activities to keep us busy, so it was actually nice to have some time on our own. Now though, with most other things being put on hold, most of our days are spent sitting in front of our computer screens, with the occasional Zoom call to break it up. Getting together with small groups of classmates has been essential for me to have some “people time,” and it’s actually been great for my studying as well! Sure, we definitely don’t spend all our time studying, but it feels so much better spending some time with people that it’s more than worth it.
And Giving Back
One more thing that I think is so important to remember during these times is to find ways to give to others. For a more thorough and thoughtful perspective on this, I recommend the Physeo blog that Robert Cannon wrote a few weeks ago titled “Medicine Needs More Givers.” To that, I’ll just add the following: often in med school, and especially the preclinical years, it’s all too easy to forget that at the end of the day, the reason why we chose medicine is to ease suffering and make people’s lives better. In between all the flashcards about obscure diseases and stresses about getting a 250 on Step 1, our time in medical school can sometimes start to feel, well, selfish. We spend so much of our time trying to optimize our own schedules and resumes and ace our exams that we can sometimes forget about the importance of giving back. This, in turn, encourages us to focus inwards and think too much about our own concerns and problems. The minute we take the time to worry about someone else and get out of our own heads for a bit, we’re much more able to put things in perspective and focus on all the good things happening in our lives. So, my last tip, and the one I think is more important than all the others, is to find a way to volunteer. My local synagogue has an amazing program where younger people are paired with older members, who understandably are more worried about their health and even more isolated than the rest of us. Every week, the younger person calls the person they’re paired with and checks in, sees how they’re doing, and makes sure they have the groceries they need for the week. I have some friends in my school who started a group to organize babysitting and other needs for frontline healthcare workers. If you’ve had COVID-19 and recovered, you can go donate plasma. There’s no shortage of ways to help, and I guarantee that if you get away from your computer screen for a little and do something for someone else, you’ll feel so much better.
It hasn’t been an easy year, and the only way to get through it is by staying connected to each other. And as we continue our journey learning how to take care of others, we have to remember that we can only do that if we first learn to take care of ourselves.
https://www.who.int/news-room/detail/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey
https://www.biorxiv.org/content/10.1101/2020.03.25.006643v2
https://www.ynet.co.il/health/article/H1Mr2LDrP?utm_source=m.ynet.co.il&utm_medium=social&utm_campaign=whatsapp&fbclid=IwAR2-P8y74d8winEJr3gaTr9gwrV_vmXBnjlyYoVQ-Iyq2naOyfblAR0LpRM
The pre-pandemic MRIs had been done for a number of reasons not related to COVID-19