Although state lockdowns have served governors well as a heavy-handed show of force, the policies are a patent neglect of the many nuances inherent in human action.
They have led to a host of unintended consequences, including the emergence of a new health crisis - a dangerously sharp rise in mental illness. Though states are gradually wading out of lockdown, the damage has already been done and is here to stay.
Distress and Disorder
The science is clear that having meaningful human interactions is an inherent, biological need that all people share. But in the name of "public health," people are prohibited from freely and peaceably congregating. There’s no church, no "nonessential" shopping, no going into work (for many), no girls’ nights out, no going to the gym, no visiting friends, no family get-togethers. Nothing. No sacrifice can be too great in the age of COVID per the “experts.” And that's taken a harsh psychological toll on the nation.
Extensive study has, for years, correlated social isolation with poor mental health. The need for connection is as real now as it’s ever been. Since the US had already long suffered from a loneliness crisis, the stark and sudden crop up of stay-at-home orders made this immediately much worse. As Drs. Betty Pfefferbaum and Carol North found,
A recent review of psychological sequelae in samples of quarantined people and of health care providers…revealed numerous emotional outcomes, including stress, depression, irritability, insomnia, fear, confusion, anger, frustration, boredom, and stigma associated with quarantine, some of which persisted after the quarantine was lifted.
Being whisked from normal life into the repressive conditions of lockdowns is understandably damaging. The anguish people are feeling is at astronomical levels. Schoolchilden recently surveyed in Wuhan and Huangshi during stay-at-home orders reported symptoms of depression and anxiety at a rate far higher than normal.
The same seems to be holding true for the general US population. The Crisis Text Line—a free service providing crisis counseling over SMS—has reported a 40 percent increase in recent volume, averaging over 100,000 text conversations each month. In a Kaiser Family Foundation (KFF) poll from the end of March, 47 percent of respondents under stay-at-home orders reported that COVID-related stress had negatively impacted their mental health, compared to 37 percent of respondents not facing such orders. Twenty-one percent of stay-at-homers described that impact as "major," compared to 13 percent those not locked down. Statistically speaking, that’s quite a significant gap, especially when scaled to a population of 330 million. Though there has been no reliable polling data since then, it’s easy to imagine how much worse the situation has become as the weeks have worn on.
Combine that with the financial aspect of the lockdowns, and there’s a recipe for absolute disaster. Under mandatory closure, an untold number of "nonessential" businesses—particularly small businesses—have gone insolvent or are on the brink thereof. That’s led to tens of millions of new jobless claims in just the past two months—amounting to the worst employment crisis in American history.
A vast literature connects economic downturns to a number of psychological issues, including anxiety, stress, and depression, which often spur on various high-risk behaviors. Although recessions are inherently stressful, mental health challenges usually emerge within the personal context of income and employment insecurity. With the economy in free fall, many millions of Americans have become worried about their ability to continue paying bills and putting food on the table going forward. The psychological impact that recessions have is capable of lasting for years, even after economic difficulties themselves have disappeared. With entire states having been locked down for weeks and months on end, public activity is only reemerging under the scourge of intense mental disturbance.
Self-Harm and Suicide
Although everyone is potentially at risk of developing symptoms of mental illness, those already struggling may be the most vulnerable. One user in a depression support group on Reddit recently posted, “I am going absolutely insane battling with my mind and being locked up in my house.” Another said, “Lockdown is making my depression the worst it’s ever been….I'd rather be dead than stuck in my house alone with my thoughts.” Rock-bottom feelings such as these are very often accompanied by a number of different maladaptive coping strategies, among them nonfatal self-harm.
For individuals already overloaded with anxiety and desperation, economic hardship is often the “final straw” leading to self-harm behaviors. An Irish study found the self-harm rate to have increased across the population following the Great Recession, with men between the ages of 25 and 44 impacted the most. Although this is far outside the usual age and sex demographic for self-harm, it may be explained by the heightened that stress working-aged men felt in their roles as primary breadwinners. A study in Britain after the crash also noted a spike in self-harm, associated particularly with areas seeing greater amounts of job loss. In an economy with people out of work more than ever before, that’s of considerable alarm.
Even without financial trouble, many may turn to hitting and cutting themselves just out of sheer loneliness. With face-to-face interaction hard to come by, there are few support systems for people to rely on. Despite serving a vital role in many capacities, Zoom calls clearly aren’t a cure for people’s woes, usually leaving users more exhausted than connected.
And although many health providers are providing patients with over-the-phone coverage, that sort of help may be much less effective for self-harmers. A 2013 Taiwanese study on the etiology of self-harm reasoned that “the structural conditions and quantity of support” may help alleviate the urge to self-harm more than “the quality of support received through specific networks.” Sheltered away from friends, many sufferers are left feeling that there is no escape, and telehealth services can do little to change that.
In all the lockdown mess, many have even reached the brink of suicide. The 2003 SARS outbreak led to an significant uptick in the suicide rate in Hong Kong—up to 18.6 suicides per 100,000 residents. The elderly population there was hit the worst, likely as a consequence of increased social isolation. Now, with community activities interrupted, many have become isolated from the gatherings that give their lives meaning—such as church, whose regular attendees face a suicide rate of one-fifth that of the rest of the population. “Living” means more than mere biological life—it involves a complex array of relationships, activities, and goals. But under lockdown, the world has been sapped of any semblance of true living.
Financial struggles are another common theme in suicide etiology. During the Great Recession, suicides spiked across the globe. Across just the US, the European Union, and Canada, research revealed more than ten thousand suicides connected to the downturn—again, particularly among men. Some fear that worse numbers could arise from the current economic crisis.
The Meadows Mental Health Policy Institute recently estimated that for every percentage point that the unemployment rate rises, the overall suicide rate rises 1.6 percent. Considering that last month the real unemployment rate rose to 22.8 percent (and possibly even higher), the US probably had nearly one thousand additional suicides in April stemming just from the economic shutdown. As job loss continues this month, more people are bound to take their lives—not to mention the untold effect that social isolation is having. Although national data isn’t yet available, many local suicide prevention centers have been reporting significant increases in hotline usage—around 20–30 percent on most days and as high as 100 percent on others.
Substance Abuse and Addiction
To manage lockdown stress, many have found themselves self-medicating and kicking back on old habits, which is exactly what prior research suggests. When the economy falls, the use of alcohol and other drugs tends to spike—especially among those who lose their jobs. Along with many financial stressors, spending more time at home intensifies the propensity for use, which stay-at-home orders and social distancing guidelines have only helped worsen.
People also seek out many addictive substances to find relief from social disconnection—which the brain can interpret as physical pain. That’s why it’s no surprise that the lockdowns have helped spell doom for those already suffering with addiction. Alone, it’s more difficult to resist relapse and misuse.
For the week ending April 25, year-over-year total off-trade alcohol sales were up 26.4 percent, down from a high of 55 percent in March when the lockdowns began. Online sales have exploded—recently growing in excess of 500 percent. But that’s not all because of people stocking up. The data has shown that more people have been buying more alcohol, of a higher proof and at a more frequent pace. That means that both consumption and sales have faced a significant uptick. Even as the rate of sales growth has slowly decreased in mid-April, year-over-year increases have remained quite high.
Alcoholics Anonymous and other nonemergency addiction resources have not been deemed “essential,” leaving those recovering to find help online or over the phone. Activity on internet support groups has shot through the roof, as have calls to addiction helplines. Many former addicts have fallen into relapse after years of sobriety, sending them back into the mire of struggles that they long thought they’d escaped.
Hard drug use is also on the rise—which is frightening, as the opioid crisis had already been wreaking havoc across the country. Call volume at the Substance Abuse and Mental Health Services Administration (SAMHSA) National Hotline was five times higher at the end of March than it had been at the beginning of the month, and harm reduction centers are operating at limited capacity. That’s left addicts with little recourse besides continued use.
Research indicates that even in periods of decreased income, drug use remains constant. Throughout the present crisis, addicts have remained addicts and still need their fix, despite recent disruptions in the meth and heroin supply chains. To avoid withdrawal symptoms, many switch to different substances, dealers, and means of ingestion—making use more imprecise and risky. There’s also the fear that addicts who have stockpiled substances are using them at a quicker pace. As with suicides, national data has yet to emerge, but some municipal and county offices have already reported a substantial jump in overdoses since the lockdown began. Although lockdowns are temporary, their effects can be irreversible.
Other addictive behaviors also seem to be on the rise. Tobacco sales, for one, have absolutely boomed. Industry giant Altria reported that in Q1 (quarter 1), shipments of its smokeable tobacco products rose 6.2 percent and oral tobacco shipments rose 2.8 percent. Although it's unclear how much of that is due to people stocking up, both convenience stores and online sellers have recently noticed a significant uptick in demand as well. And an increase in use would follow the same pattern as what happened during the Great Recession.
Stressed and stuck at home, people have also ramped up their porn consumption. Since the lockdowns began, PornHub traffic has consistently been above average—with a high of 23.2 percent at the end of March, when the company offered all users free premium access. When used frequently, porn can rope users into a powerfully addictive cycle, engendering psychosexual difficulties such as low libido, sexual dissatisfaction, and erectile dysfunction—even in young men.
Online, many have also begun to try their luck at gambling. Global Poker—a popular online poker room—saw a 43 percent spike in use following lockdown orders, with a remarkable 255 percent increase in first-time players. Much of that may be new traffic from gamblers who had frequented brick-and-mortar casinos—a mere shifting of activity from one channel to another. But it comes at a cost: online gambling is associated with a number of increased risks for becoming addicted. The fallout from that could take decades to move past.
The politicians and medical experts basking in the COVID spotlight have traded the façade of an effective public health response for the hidden realities of mental illness. As talking heads repeatedly prattled the “flatten the curve” mantra, the curves for stress, suicide, and addiction all steepened. A study by the Well Being Trust concluded that “deaths of despair”—which include all suicide and substance-related fatalities resulting from fear, unemployment, and isolation—may total seventy-five thousand by the end of the COVID crisis. Their death knells rang out the moment governors committed their states to shutting down.
And among those who live, the residual psychological and behavioral effects will remain long after the lockdowns are over—possibly for the rest of their lives. Indeed, by overstepping individual judgment, the government imposed a one-size-fits-none solution so debilitating and unprecedented that the country will never truly recover. In the long run—aside from the blips and bumps of infection and disease—the state remains the true risk to the health of the nation.