The right feeling at the right time: a professional perspective on mental wellbeing during COVID-19

Photo courtesy of Sick Kids Hospital

Sara Chiarotto O'Brien

Editor in Chief

*Name has been changed for privacy reasons

Dr. Therese Zarb, a child psychiatrist, watches as six year old Max* selects dinosaurs and tigers in lieu of cows and chickens from a bin of plastic animals during a play therapy session. He plays aggressively with the animals and his siblings, acting out angry, violent stories with the toys. Most children are drawn to games filled with action, but week after week, Max’s play is combative, reflecting his behaviour outside Dr. Zarb’s office.

Like many who come to see Dr. Zarb at the SickKids Centre for Community Mental Health, Max’s family is struggling to understand and manage his behaviour. He is different than a typical rambunctious little boy, getting into fights at school and coming close to expulsion from kindergarten. As part of the play therapy, Dr. Zarb has given the parents clear instructions to “follow [Max’s] lead in the play...and to not insert [their]own ideas.” They do not reprimand him when he bashes the animals together or attempt to steer him in another direction when the play turns aggressive.

When Dr. Zarb debriefs Max’s parents after the observation concludes, she explains to them that “how a child chooses to play is actually a communication of their internal world.” When children act out the way that Max does and are told they must stop, the feelings that cause the outbursts have nowhere to go, and further outbursts are nearly inevitable. 

Now, Dr. Zarb’s job is to help the parents, “reflect on...the big angry feelings the child might have and why that might be,” and then to help Max understand his own feelings and give him an outlet to express them. “When you work things out through play the child doesn’t feel like they need to enact it or make it happen in real life,” she tells me over the phone one afternoon.

While most of us may not express our emotions through plastic dinosaurs anymore, there is value in Dr. Zarb’s explanation of human emotion and behaviour: if you don’t address negative feelings, where do they go? 

By now, you’d be hard pressed to find a person who hasn’t struggled emotionally with the isolation brought on by the COVID-19 pandemic. Of all the age groups, Zarb admits she believes the emotional toll of the pandemic is “probably the hardest for teens.” Indeed, while prolonged isolation and feelings of helplessness have triggered mood swings and negative emotions for all age groups, teenagers “are missing their peers,” who act as “their coping system” under normal circumstances.

Grade 12 student Julia Goldthorp is familiar with that sense of loss,  After eleven years of  “waiting for that amazing senior year promised by the movies,” Goldthorp is coming to grips with the fact that she can’t “lie on the field with her friends when it [gets] hot outside, live out prom, or walk across that stage in a cap and gown.”  

Mostly, she mourns the way she took her final school days for granted.“I wish I could go back to those final days and know that those times were going to be my last.”

In a study published in the Journal of Behavioural Brain Research, Dr. Elena Varlinskaya and Dr. Lisa Spear found that when rats were kept in isolation for seven days and then released to interact with each other, the “effects of social deprivation... were most marked in early adolescents,” manifesting in greater aggression, displays of physical contact, and overall social interaction. 

More than simple isolation is the added stress that comes with losing the milestones teens spent years anticipating, such as prom and graduation, and facing unprecedented uncertainty about the future of their education, their employment opportunities, and the health of loved ones. “This is the first real trial of their lives,” says Lisa D’Amour, psychologist and columnist for The New York Times. “A lot of young people are experiencing a real loss right now.”

With that in mind, D’Amour adds that an increase in uncomfortable emotions doesn't necessarily mean that previously healthy teens are at risk for developing mental illnesses. “Many people have come to believe that mental health, like physical health, is about feeling good all the time,” she says. However, “psychological health is not about being free from emotional discomfort...mental health is about having the right feeling at the right time.” With so much uncertainty, it is only healthy that “people should be troubled in troubled times.” 

The response to  such discomfort should not be to cower from it, but to understand its roots and adapt our expectations for our emotions similarly to the way we have adapted our expectations of productivity or physical health.

There remains, however, the risk of more permanent psychological damage for those with pre-existing conditions or for those with unresolved traumas. “There are so many losses associated with this [pandemic] that it can trigger previous losses, whether it’s the loss of a loved one or the loss of a previous job” explains Dr. Zarb. Right now, much of her work as a child psychiatrist revolves around helping parents manage their own stress while coping with the challenges of parenting, financial loss, and other uncertainty. When she resumes in-person sessions after physical distancing measures lift, she anticipates that there will be setbacks for many of her patients.

But they, at least, have support in the interim. Dr. Zarb’s greater concerns lie with those who do not have access to the mental health resources they need right away; Child Protective Services have experienced an uptick in reports of child abuse since lockdowns were implemented across the country and Dr. Zarb believes that “people who don’t have [mental health] support are more likely” to lose their temper at their children than those who receive the care they need.

Already, Dr. Zarb says “people just aren’t getting the services they need.” Her clinic has had to triage their patients, leaving some parents to “limp along” through depression and anxiety while they focus their attention on families with children who are “cutting themselves or are suicidal.”

In the long term, the mental health issues exacerbated by quarantines will likely cause many people to “struggle in school.... struggle finding jobs... and struggle with their health.” With budgets shrinking across the world, it is unclear whether Canada’s health care system will be able to keep up with demand for mental health services during and after the pandemic.

For now, both Dr. Zarb and D’Amour advise people to accept that any emotions they may be feeling are valid, and to do their best to focus on the present and the things they can control by practicing mindfulness and building a routine.

Overcoming mental health challenges is a gradual process, but after a few weeks of play therapy and consultation with Max’s parents, they say that while he still struggles with feelings of anger and aggression, he understands his emotions better and can express them through words rather than violence.

We may not be playing with dinosaurs, but creating space for our emotions remains the best way to manage how we feel.