What do ‘mental health’ problems actually look like?

Frequent headlines in the news report “the level of mental health” among Americans is declining or “mental health issues are a primary concern” as a long-term consequence of the COVID-19 pandemic. But what do mental health problems look like practically in our daily lives?  The issue may impact us personally, as well as our family members and/or our colleagues at work.

Defining ‘Mental Health Problems’

As a psychologist, I often bristle at the use of generic terms in the mainstream media (and those who comment on the topics in social media) without really defining what the terms mean. One government agency describes mental health as, “our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices.” A key aspect to understand about a person’s mental health level is to not equate it with the idea that “everything is ok” but rather, that the person has the ability to function relatively well (not perfectly) in daily life, able to handle the stresses and challenges of typical life demands.

Conversely, we demonstrate mental health challenges when: a) we are not able to successfully cope with the daily demands and responsibilities in our lives; b) we experience significant ongoing negative feelings in response to what is going on in our lives; and/or c) we turn to ineffective and self-defeating strategies to try to cope with the stress and demands in our lives.  Ultimately, the results are demonstrated by an inability to function successfully in our daily responsibilities, our relationships with others, and managing our moods and behaviors.

What Mental Health Problems Look Like in Our Daily Lives

Let’s identify some of the most common behavior patterns and mood disturbances that are signs we are struggling.

Depression: When we feel overwhelmed and have little sense of hope that circumstances will get better, the result is often some level of depression. This can include discouragement, apathy, and a desire to “give up.” Depression expresses itself in different ways (both in different individuals and across time). Behaviors frequently associated with depression are a sense of sadness, feeling “blue,” not experiencing pleasure (when you normally would), sleeping more, not being able to sleep, crying, feeling overwhelmed, social withdrawal, and passivity. A core aspect of depression is hopelessness, which can lead someone to think about ending their life. (“Why try? It will never get better.” “No one cares and no one will miss me.”)

Anxiety: At the heart of anxiety is some sense of fear that something bad is going to happen. As I’ve described elsewhere, anxiety is always about the future – what will happen (or won’t, if we want it to). The experience of anxiety ranges in intensity from mild concern, to being nervous, to intense fear and possibly panic, to the level that one becomes paralyzed or incapacitated in living functionally in daily life (for example, being so terrified you cannot leave your house, or interact with others). A challenge with anxiety is that it is often rooted, to some degree, in fragments of reality (yes, you could get COVID and die) but often takes the fear and resulting actions to an extreme (not ever going outside, wearing a mask while on a Zoom call).

Irritability / Anger: For some individuals, when experiencing either long-term stress and/or a combination of intense stressors in their lives, their coping mechanisms become worn down and less healthy behaviors start to occur – being easily irritated by normal “little things,” having a quick temper and angry outbursts, being more verbally abrasive than usual, hitting things or throwing objects, and, unfortunately, sometimes being physically aggressive toward others. (The flip side of this – being worn down which is affecting many of us during COVID – is related to difficulty in replenishing our emotional energy through normal rejuvenating activities – sporting events, eating out with friends, going on a weekend trip, social activities.)

Overuse of Alcohol and Drugs Some individuals attempt to bolster their coping abilities by using alcohol and drugs – for differing reasons: deadening the emotional pain one is experiencing and creating a sense of distance from others and the demands of your life are two common ones. Like any coping mechanism, alcohol use (and pain killers) may often start out as an innocuous way to manage the stress of everyday life, but can subtly grow into a more intense dependency that creates secondary problems (not being able to get up and think clearly the next morning, using the drug just to get through the day). Obviously, more significant use and dependency create numerous difficulties in many areas of one’s life (physical, social, vocational, emotional).

Other Forms of Flight into Fantasy and Withdrawal from Responsibility: Drug use and overuse of alcohol are not the only unhealthy ways individuals use to cope with the experience of excessive demands in their lives. Traditional, individual video games, online interactive gaming, binging on movies and television series, continual watching of sports and their derivatives (talk shows, fantasy leagues) are common examples. In fact, almost any healthy way of rejuvenation and reaction can become unhealthy when the frequency and duration of the activity becomes so great that it interferes with normal, daily-life functioning – not interacting with family members, staying up late and losing sleep, not doing the laundry, grocery shopping or cleaning the kitchen.

What Can Be Done?

I would predict that all of us experience some level of challenge in at least one of the areas described. Why? Because we are all human, aren’t perfectly healthy, and are in the midst of a long-term experience of greater-than-normal demands and the inability to access many of the ways to replenish our emotional reserves that we have used in the past. The result? Reduced capacity to deal with the stressors in our lives in a healthy way.

While we aren’t going to be able to address all of the possible actions that we can take, both individually and as parts of a community, let’s outline some global steps to start:

1. Do a self-assessment. As always, it is best to start with yourself – even though it is easier to identify problem behaviors in others. Which of the behavioral and emotional responses do you tend to use or express when you are struggling to cope with the stress in your life? Which are occurring more than you would like? When are they most likely to occur?
2. Consider those around you. Approach this process from a perspective of seeking to understand rather than blame or condemn. When someone (a family member, friend, or colleague) is displaying behaviors which aren’t healthy for them and for those around them, realize these are signs of stress in their lives. They are experiencing these moods or using the behaviors to cope with the stress they are experiencing in the best way they know how to currently.
3. Identify and connect with resources to help. Again, start with yourself. Find resources (online ones from reputable organizations are best) to help you better understand what you are experiencing and ways to better manage your stress than the unhealthy ways you may use.

If sharing with others, either share the resources globally with the group (“given the long-term stress we’ve all been under, I thought it will be helpful to have some places to turn to help each of us manage the stress well”), or, if sharing with an individual make sure you have first listened well and have an understanding of their current life situation and make clear your concern for them and desire to be helpful.

We can get through this difficult season, but doing so taxes our personal resources. Having occasional glitches of not handling situations well is to be expected. But do your best to pay attention to early warning signs and symptoms. Do what you can to engage in those activities (hobbies, hiking, music, talking with friends) that re-energize you. And seek out support to deal with your challenges in a healthy way – both from those around you as well as professionals.

Resources for Further Reading:

World Health Organization, Mental Health and COVID-19, resource page with news stories, advice for staying mentally health while at home, and coping techniques for adults and children.

U.S. Department of Health and Human Services, Mental Health and Coping during the Coronavirus (COVID-19) Pandemic, resource page, information on identifying signs of mental health issues, contact information for support services help lines, advice for coping, and a section on talking to children about coronavirus, supporting older adults, supporting veterans.

Kaiser Family Foundation, The Implications of COVID-19 for Mental Health and Substance Use, February 10, 2021, includes information about prevalence of mental illness and substance use disorder during the pandemic in adults, youth, and communities of color.

Centers for Disease Control and Prevention, Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic – United States, June 24-30, 2020.

American Academy of Pediatrics Healthy Children, Mental Health during COVID-19: Signs Your Child May Need More Support, October 23, 2020.

Healthline, 11 Things to Know about Domestic Violence During COVID-19 and Beyond, November 4, 2020.