When Home is Not Where the Heart Is By Maggie Mulqueen, PhD on 4/6/20 - 3:37 PM

Whenever we invoke the archetype of “home,” we are expected to conjure up Hallmark scenes of happy families sharing a bountiful meal together. Unfortunately, this is a far cry from reality for many. Social distancing, along with hand washing, is the best course of prevention the medical community has to offer at this point in time. These practices deserve and require our full support to promote physical health. But a close cousin to social distancing, social isolation, is the antithesis to supporting mental health.

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Social distancing is defined as staying a minimum of 6 feet apart from others. Social isolation, on the other hand, is a psychological state of mind. It can occur when people are alone or in a crowd, with strangers or family. Whenever and wherever we can’t reveal our true feelings or don’t feel safe to share our thoughts, we are socially isolated. The mental health ramifications of social isolation are well documented. But in these unprecedented times, a much larger group of people are at risk of suffering from this condition.

For my patients who live alone, there is concern for both their mental as well as physical health. One patient, a physician, is a young, healthy woman who has created an independent life. This view of herself is an important part of her self-esteem; but her denial that she herself is at high risk for getting the virus is impeding her decision-making. During our last session, I repeatedly pressed her about what she would do if she got sick. Although she was seeing patients in the hospital too sick to get up, she couldn’t imagine being in that condition herself. Her only plan was to order delivery to the lobby of her apartment building to retrieve takeout food or medications if she needed. By the end of our session, I had her name three people who she would call and ask to be her emergency contacts. Her homework this week is to connect with each of them and ask if they are willing to serve in this capacity.

But those living alone are not the only ones suffering from social isolation. I have patients stuck in dysfunctional marriages; others are estranged from their roommates. Many young adults have moved home, to everyone’s dismay. Injunctions to stay home fail to acknowledge the harsh reality that for some people, home is where they feel most isolated.
One patient who lives apart from her husband, within their home, now finds herself at home with him all the time. She asked him, “Can we put aside all the ways we’re not who we want each other to be for the time being?” He has been depressed for years and unwilling to get help, but she feels a renewed sense of responsibility to look after him during the pandemic. For privacy during our session, she sat in her parked car. She wonders if “the door will have closed” for her to move forward with her own life by the time the pandemic is over.

A number of my patients have moved their sessions to early in the day so they can talk while their children are still asleep. One patient, a mother of two young children who is barely speaking with her husband, locked herself in her bathroom with the fan running while we spoke. She was afraid to ask her husband to take time away from his work to watch the children for an hour.

I am particularly worried about the families I know with children living at home who used to be in residential educational settings. Oftentimes these children need a level of care that is beyond the capabilities of the parents, especially if the parents are expected to be working from home. Families living with special needs children face extreme challenges. One patient in this situation is working from home, and so they are all living in close quarters. We talked about how he needs to stay aware of his anger and to find outlets like physical exercise before he loses his temper. Feeling uncomfortable around his own child makes him depressed and disappointed in himself. If financial worries pile on top of this situation, I fear it could become explosive.

To complicate matters even more, in many homes there is a disturbing new reality, where adult parents are working (often from home) and their young adult children aren’t. Home from school, taking at most a few hours of online classes a day, disappointed to have lost out on a spring semester or graduation, waiting for summer or permanent jobs that may never materialize, they are facing an economic downturn which is disrupting normal developmental milestones. Their sleep patterns are often opposite those of their parents. Negotiating time spent on screens, chores that need to be done and rules of behavior are challenging in the best of times. Although the physical space may be the family home, oftentimes it is not the place these grown children think of as home anymore. Taking directives from their parents is an affront to their own budding, developmentally appropriate independence.

One college senior I work with called in tears from his parent’s home. One week earlier he had been living in an off-campus apartment with his two best friends, planning a spring break and interviewing for jobs after graduation. Now he is home, connecting with his friends remotely and trying to avoid his parents as much as possible. They are working from home and were forced to cancel their own travel plans. I counseled him not to view his parents as the source of his disappointment and sadness. In time, I may do a family session to help with communication patterns in the home. This never would have happened had his college years ended as expected.

A patient who is in the food industry has already been laid off and her prospects, once very bright, now look dim. Her parents, who were never supportive of her career aspirations, are pressuring her to move home to save money. In tears she told me, “To move home now makes financial sense; but I fought so hard to leave the first time, I’m not sure I’ll have the energy to do it again.”

As the consequences of the pandemic worsen and the financial fallout continues, many people are at risk for losing the actual place they call home. These legitimate worries are worse for those already without a strong financial foothold, but by nature of a pandemic, no one will be completely spared. As one patient said, “My sense of peace has splintered. I am looking for a way to reground myself.”

To move forward wisely in these uncertain times, it is imperative that we recognize how we can help each other. We need to combat social isolation just as fiercely as we practice social distancing. By reaching out through phone calls or virtual visits, standing 6 feet apart at the end of a driveway, whatever it takes to strengthen our interconnectivity.
People with heart issues are at greater risk from Covid-19. We should expand that category to include all those whose hearts are suffering emotionally. None of us know how long we will be home, nor what home will look like when we are finally free to leave. If we increase our social connections, be it within or outside the house, we may lessen the heartache of those suffering isolation.


File under: Musings and Reflections, COVID-19 Blogs