Covid19 Made You Weary, Low Energy, Lassitude?
If you are feeling fatigued, bored, or just downright lazy after a few months of sheltering in place, then you are like very many others. My interest was piqued after a comment from a friend that is usually very engaged in activities but expressed her “lassitude.”
My wife and I live in a continuing care retirement community (CCRC) of 2000 residents just outside of Baltimore, Maryland. 1800 of us are in independent living with about 200 in assisted-living, rehabilitation, long term nursing care or memory care. The average age is 82 years with many in their 60’s and 70’s but 24 are over 100 and 140 are between 95 and 99 years old. Although some people look at Charlestown and its kin from the outside as “pre-nursing homes,” such is in no way the case. Here the attitude is living life to the fullest with many venues for continuing education (lectures, small group teaching), discussion (current events, Bible study,) entertainment (bridge, chess, movies) and health promotion (gyms and indoor Olympic sized pool.) There are six restaurants on campus and plenty of space for outside walking in nature on the 124-acre campus. A beautiful church turned chapel is used for Catholic and Protestant services and Sunday afternoon concerts. A medical clinic with on site primary care and visits by specialists means there is little need to go elsewhere for care.
I’ve written previously about avoiding the virus , maintaining resilience, looking at isolation though an artist’s eyes and whether it is appropriate now to no longer shelter in place.
As the coronavirus began to spread, the community managers began to institute various steps to keep the virus outside the gates. They’ve done a splendid job. Only five residents in independent living have become infected and each from visiting a relative or friend off campus who was asymptomatic at the time but infected or from an infected but asymptomatic visitor to their apartment. Despite these unfortunate incidents, the vast majority of us feel safe and are grateful.
Sheltering in place was instituted around April 1 with residents largely staying in their apartments. Among other precautions, visitors were banned, the restaurants were closed and we were brought a meal a day plus some snacks directly to each apartment. In addition, they had staff members bring packages delivered from UPS, FedEx, Amazon and others along with the mail directly to our apartment door. In short, there was little need to leave the apartment or go off campus although many did for daily walks and some did so to do shopping or see a medical specialist — or those relatives. How have we fared under this form of social isolation? I’ve done an extensive but clearly unscientific survey of residents. Here is what they have told me.
My survey began when a friend, an excellent writer and artist, said that she had wanted to clean up her closets and, now that she has the time, she has just not done it. “It’s a sense of lassitude.” Lassitude is defined as a state weariness, a lack of energy. Other words of similar meaning are listlessness, sluggishness and wearisome sometimes accompanied by a sense of overall mental distress. These were all terms, along with boredom, that I heard repeatedly, but not from all.
The watercolor at the beginning of the article, Surreal by Carol Schimpff, speaks to this weariness, low energy, lassitude. It depicts a perfectly nice day but everything is just a bit “off.” The colors are not true; nothing seems in focus. Something is not right. Nothing is right.
A musician said that she had intended to clean up her music room but just hadn’t gotten around to it yet, even though she has plenty of time. An artist was asked if he was painting. “No, I just haven’t gotten inspired recently,” he said in a sort of dejected tone of voice.
On the other hand, another woman very active in community affairs, said she was delighted to have the freedom away from all of the meetings and responsibilities. She was having a wonderful time reading books that had piled up. Another woman said “sheltering in place is an introvert’s heaven.” She suggested extroverts probably would be stressed by sheltering in place but, for an introvert like herself, she’s finding it just fine. That’s not to say that she and her husband don’t ZOOM with family members and friends but she doesn’t feel particularly isolated. Others found that they are bored, fatigued, wanting to sleep more and are just not inspired.
One person said that she’s basically used to being rather isolated ever since her spouse died a few years ago. Her health is not good, she needs an electric mobility vehicle to get around and so in general she is used to being nearly isolated from others. The one major positive is that now she talks to her son via Skype each week and feels she’s gotten substantially closer to him as a result. She also communicates with friends by phone, engages in a ZOOM discussion group and now gets outside occasionally to meet with other residents, all masked and at 6 feet distant. Still, she feels isolated.
Her reaction is in stark contrast with a woman who lost her spouse just days before sheltering in place was instituted. “I’m thriving. I must use crutches to get around or use an electric mobility vehicle when I go out. My husband always took care of basics for me. Now, since no one, family or friends, can visit, I have had to learn how to carry a meal on a plate to the table, carry my drink and make the bed, all while on both crutches.The “lock-down” restrictions probably benefited me in that nobody was leading a “normal” life; thus I could feel less sorry for myself than if I had watched friends and acquaintances, after expressing condolences, resume their everyday activities, making me feel more alone. At least now we had something to share and get used to: A new way of life. I do get outside every day to find one or more people to talk with, masked and social distanced, of course. That has been a big help. Of course, I do find myself with tears many times, many days. These come with a sense of utter exhaustion, of grief. But overall, I am coping well and expect to come out the other end in good mental condition, stronger than before.”
Boredom was a frequently expressed feeling. “Out of My Skull — the Psychology of Boredom” by Eastwood and Danekert, reviewed in Science Magazine, defines boredom as “the uncomfortable feeling of wanting, but being unable to engage, in satisfying activity.” They postulate that it arises from some combination of monotony (that certainly fits sheltering in place,) constraint (ditto,) along with lack of purpose and a lack of optimal challenge (both of the latter may be stifled by sheltering.) They emphasize that boredom cannot be simply erased with various social media, video games, computer activities, etc. as they do not address the underlying causes.
After a few months, things loosened up some with visitors again admitted, the gym open with careful monitoring but still no group meetings, lectures, movies, etc. The restaurants remained closed; meals were still brought to the door.
“I’ve never been much of a reader,” a man told me, “but in the past month I have probably read more books than in the past ten years. And I have enjoyed it and learned a lot. I’m generally a content person but I have missed my twice weekly golf outings with friends. Now, finally, we can get out to the golf course again and that has brightened my overall mood.
“What do you want to do with your life? What is your purpose? These are thoughts that have gone through my head as I have been isolated in our apartment. I like to help people but what can I do here now?” These were the comments of a person who loves to be out helping others in the community; that is her purpose. “I decided I could write notes of caring and thanks to friends here that I can’t get together with anymore. I have also been writing to staff members. They have been terrific and we all appreciate, or should appreciate, what they do for us.”
My wife and I are definitely not bored. We have multiple projects ongoing and the extra time has allowed us to tackle more of them. That said, we too have items on our “priority lists” that have been there for months and will likely remain there. We ZOOM with friends on a regular basis and each weekend we ZOOM with our daughter, son-in-law and grandchildren who live on the other side of the country. We really enjoy it, look forward to it and feel that we know them better than we ever did before. We’ve come closer together. But certainly, as another told me, “this is a lot less satisfying than being in person.”
Many Americans, according to a recent Kaiser Family Foundation poll, report that worry and stress from Covid19 is affecting their mental health. Those sheltering in place reported 47% being mentally impacted by coronavirus anxiety compared to 37% who were not isolated. Epidemics have always been associated with stress and anxiety but sheltering in place exacerbates the stress. It is known that loneliness is associated with poor health outcomes and lessened longevity. Retirement communities often have lonely individuals. Adding isolation only further challenges these individuals and exacerbates their loneliness.
Sheltering in place is a form of isolation and somewhat akin to solitary confinement. This may be especially true for the older widow or widower who is not easily conversant with technology such as email, ZOOM, Face Time or Skype. As one resident told me, “My wife and I at over 90 years of age are still together with reasonable health. We are blessed that there are two of us. We can help each other. For a single person, especially a widow or widower, being alone in one’s apartment for long periods can really bear down.”
Not getting out for a walk or just some fresh air can be stifling. Many develop anxious and depressive feelings in a short period of time. That said, most people I spoke with have tolerated sheltering in place but as the days and weeks dragged on, comments of difficulty became more and more frequent. The implication is that we all can, or at least most of us can, tolerate a short period of privation but only if it has a clear reason, a defined endpoint and a sense that it is worthwhile for self or others. People can tolerate a lot, especially if they get a clear message of why. But they quickly realize if the message is garbled, if the leaders are inconsistent. “We as of yet have no endpoint,” I was told, “and no good leadership outside of Charlestown so we end up with conflicted directions. Confused messages about important matters like wearing masks are disquieting. And uncertainty is anxiety provoking.” To its credit, Charlestown management has been highly diligent in explaining by circulars, emails and via the in-house TV channel their rationale, their expectations and what they are be doing to assist residents during the sheltering in place period.
But we are also going through a period of multiple anxiety provoking situations, crises even — a sharp economic decline, a Congress and president that can’t to come together even for battling the coronavirus nor working together on steps to combat racism/ social justice despite clear desires for leadership by the populace. Add to that “a ground swell of human desire for more equality of opportunity, better availability of health care, and better education. And we sure need more kindness and cooperation, and less hatred of our differences.” While Congress dithers and the president gives conflicting messages, I am left to wonder if any of them are fit to represent us, especially in times of crises. All of these add together with our anxieties about Covid19 making us “all more anxious and even depressed than our usual coping mechanisms can easily handle.”
Maybe it’s not lassitude; maybe cleaning the closet or straightening out the music room was never high on the priority list. Now, with free time you feel guilty for not doing what you always said you would do if you had the time. Your motivation to do this task was low for a reason and the advent of some free time does not overcome your lack of interest in tackling it.
Another problem is that many of us have just too long a priority list and it is probably not really prioritized — it’s just a list. Because there is now some extra free time does not mean that you really want to clean that closet. If you really cared about the closet you would get to work on it or probably found time to do it long ago. Maybe now you would only be doing it because you feel that others expect it of you. So, your motivation is to please someone else but not yourself. That often does not work except in an employer/employee situation where it is the job, like it or not. Now, retired, your motivation depends or should depend on your own internal needs.
It’s clear from these interviews that some people are generally positive despite negative settings and others are generally negative anyway; both being characteristics they brought with them to sheltering in place. The negative ones complain about everything but nothing in particular. They have lost control of their lives, as they see it. The positive people are inherently “survivors” while the others have grown to be “victims.”
A last observation from a friend. “I wish I had started a journal or diary when this all began. Someday it would be interesting to those who come after us to learn directly what it was like to experience what we are experiencing. But,” she added with a laugh, “I just can’t seem to get started!” So, it is her dream but not a driving priority since, as she told me, she had plenty of time.
Accepting that this survey is not comprehensive, some observations nevertheless come through. How a person reacts emotionally to sheltering in place and the general anxiety of a deadly yet invisible invader seems to depend on a combination of overall emotional health, whether one has inherently a survivor or a victim personality, how one usually reacts to stresses, one’s current physical/health situation including loneliness, whether a person has a continuing sense of purpose and how bored one is without the usual external stimuli. In other words, it is complex. But clarity of leadership with “what and why” makes a tremendous positive impact.
Most importantly, here is what you can do to regain some energy, your moxie:
· Begin with the basics of a sound diet (lots of veggies and some fruit and but as little sugar as possible), adequate exercise (a 30 minute walk each a will do wonders,) stress reduction (try one of the free meditation apps like Insight Timer) and plenty of sleep (dark room, quiet, keep to a schedule.) See my earlier article for details. Be sure you are not consuming too much alcohol; it can be alluring when you are chronically stressed.
· Set a goal or two for the day. Something simple will do but make it something that you can complete and feel satisfied that you accomplished that task. As a bonus, start by making your bed when you first get up. (Watch this short video by Admiral McRaven addressing a commencement of his alma mater.)
· Stop and consider that you (and all of us) have lost control to a large degree. Accept that the pandemic and the reactions to it may be tough now but you (nor anyone else) are not able to fix it.
· Don’t let yourself become the “victim.” You can adjust your outlook toward the “survivor” mindset. Accept that you still can have a positive life, just different than before. The situation stinks but you don’t have to “stink” with it.
· Limit your time with “the news.” 30 minutes per day should be plenty and should be from reputable outlets. Avoid the TV hype. They design it that way so you want to come back again and again for more. Don’t let social media get you caught up in the controversy or conspiracy theory of the day. That will only exacerbate your negative feelings
· Remember that social engagement, although different now than before, is vitally important. Stay close to relatives and friends by whatever mechanism.
Finally, remember that “Opening Up” does not mean that the virus has disappeared. Quite the contrary. Be extremely cautious when meeting with anyone (I termed it “Trust No One”) — mask and social distance plus good hand hygiene is critical to avoiding the coronavirus.
Stephen C Schimpff, MD, MACP, is a quasi-retired internist, professor of medicine, and former CEO of the University of Maryland Medical Center. He has written 6 books for the general public on medicine, health and wellness including “Longevity Decoded — The 7 Keys to Healthy Aging. He is the coauthor with Dr Harry Oken of the new book BOOM — Boost Our Own Metabolism which offers advice on combating the health issues associated with sheltering in place.