August 28, 2020

By Komal Gulati

“It’s nice to see all of you — virtually of course. How’s everyone doing?”
It’s noon on a weekday. I’m in a Zoom meeting with a compassionate committee of individuals doing community work to support our local Philadelphians through this time of difficulty and uncertainty.
I want to say that I am overwhelmed and exhausted but working on staying positive. This is not how I envisioned my first year of medical school. It’s not something I prepared for when I moved into my first real apartment last August as a twenty-something in a brand new city. I’m uncomfortable with the uncertainty and debilitation I’ve been feeling in the face of this crisis. And yet, I wish I was doing more in this moment because there is so much to do.
Instead, I say, “It’s all overwhelming, but I’m doing okay, considering.”
I doubt it’s what you planned either. I’m sure no expecting mother with a loving partner plans to give birth alone in a hospital bed with her husband cheering her on over FaceTime. I imagine no university hospital plans to convert an entire office building or sports arena into a temporary hospital. It’s unlikely that our local grocers or transportation workers ever imagined their jobs would become an act of courage and compassion. But as we all know, things rarely go as planned.
And I am okay, considering all that is happening in the world. I have supportive loved ones and enough sanitizer for the time being. I am going through the motions of everyday life — writing my thesis, trying to play my part in serving the community, taking walks, catching up with old friends online. But it feels passive, as if I’m watching someone else do all of it for me.
At times, I can’t shake this feeling of immobilization. Like I’m halted in a time where I’m acutely aware of everything I need to get done, and the mental pressure that comes with it, but I can’t move, despite what the internet yogi or productivity YouTuber has to say about it.
It has become apparent that this feeling of pause in our lives is not uncommon. Neither is the disheartening notion that maybe this means we are either too lazy or ill-equipped to handle the situation we are in. Fortunately, neuroscience has a better explanation.

Threat on the Brain

In 1994, Stephen Porges, a professor of Psychiatry at the University of North Carolina, proposed the Polyvagal Theory, describing how our experiences affect our nervous system and resulting behaviors. This theory forever altered our understanding of stress, threats and trauma and their impact on behavior.
The theory — named for the relevant vagus nerve in our bodies — says that there are three systems that make up the autonomic division of our nervous system, which is the division that helps regulate our bodies outside of our conscious awareness.

  1. The evolutionarily ancient system of death feigning or immobilization — much like a cat “dropping dead” at the vet’s office despite being completely healthy. The protective effect of this feigned death response comes from the ability to make oneself less appealing to a looming threat.
  2. The fight or flight system that helps us mobilize in response to a perceived threat.
  3. The social engagement system, which helps us detect and foster feelings of safety and connection with others, alleviating threat and improving overall mental well-being.

In the Context of COVID-19

Society places disproportionate value on fighting instincts and actions that are visibly productive and unfairly shames immobilization. We see it all around us in stories of trauma and survival, from abuse and sexual assault to war and PTSD. In fact, more often than not, survivors of trauma share their feelings of immobility, only to be confronted by a society that judges them and says, “But why didn’t you just fight it?”
By now, it’s clear that COVID-19 has been a source of trauma for many people and for as many different reasons — be it financial, social, medical, political or otherwise. While some of us are finding survival in taking on more responsibilities and boosting our productivity at a time like this, some of us just want to catch a breath and make it from one day to the next.
Whether you’re in the category that’s invigorated or the one that’s debilitated, it’s important to honor and respect both and everything in between for yourself and for others. Realize that a lot of your feelings are common, they are relevant and they are productive in helping your body weather this storm.

The Antidote

The polyvagal theory is appealing because it provides an explanation for the feelings of immobility or the shutdown mode that takes over following a life-altering event or trauma like a global pandemic. But more than that, it gives us an antidote. The opposite of immobilization is social engagement — the third component of the autonomic nervous system, according to polyvagal theory. Our healthiest state is the one in which we are connected and in safety with others, and neuroscience shows that it’s a reciprocal relationship. Simply put, the safety you foster with others becomes a mutual safe space.
Understandably, for those in isolation, this may seem out of reach. But a simple phone call or video chat can help us find our way out of shutdown and into connection just by way of a kind voice in our ears or a warm smile to see. These small social cues go a long way in helping our bodies return from a state of threat to a state of safety.

Putting it all Together

If we’ve learned anything from this pandemic, it’s that our health is inextricably linked. You cannot affect the health of one person, one neighborhood, one city, state or nation without having ripple effects on all those people and places that touch them. The same is true of our mental health and well-being.
Right now, our connectedness is forcing us to stay apart physically. But mentally and emotionally, we need each other to get through this. When we stay home, we’re protecting our world’s physical health. When we take the time to reach out to others through the means currently available to us, we’re protecting each other’s mental health and well-being.
In some sense, we are all becoming providers of health and care. As a health care professional in training, it is my sincere hope that this remains one of COVID-19’s lasting legacies.


Komal Gulati is a medical student at Temple University and advocate for mental health with NAMIPhilly. Her writing has appeared in Scientific American, KevinMD, and the NeuroLeadership Institute’s ‘Your Brain at Work’ blog. She is always open to collaborating with new people and looks forward to connecting on LinkedIn.

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