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Ele-Mental: Stay Positive for a Healthy Finish to 2020

Photograph by Mimagephotography/Shutterstock

Written by Stratton Lawrence

“One star — would not recommend.”  If years received online ratings, 2020 would be a dud. Despite a year that’s brought a pandemic, societal unrest, financial instability, hurricane stress and a heated election, there’s still time to close this chapter with smiles on our faces. Because collectively, we desperately need to find ways to be happy.

Even before the pandemic, statistics on mental health in America looked bleak. Mental Health America’s annual report revealed that major depressive episodes in youths had increased four percent since 2014, and more than 10 million adults considered suicide (a year-over-year increase of nearly half-a-million people).

Sadly, South Carolina is a major contributor to those grim numbers. A state-by-state ranking, compiled by reported psychological incidents and treatment in youths and adults, places our state 44th in mental wellness, sharing the bottom with places such as Alaska and Nevada, where factors like winter darkness and gambling addiction are obvious challenges to mental health.

What’s even more striking? That report was released early in the year, before COVID-19 and the isolation of quarantine set in. When 2020 mental health case data are released, existing anecdotal evidence indicates that the documented surge in suicide, depression and general melancholy may be unlike any other year on record. We’re living in a time of uncertainty, where the information needed to make important decisions is constantly subject to change.

Dr. Sarah Coker
(Photograph by Amy Luke)

Dr. Sarah Coker, a Roper St. Francis Healthcare affiliated psychiatrist, cites a dramatic uptick in suicide attempts and alcohol and drug abuse in the Charleston area. “We’re seeing patients who have never considered themselves to have issues with depression or anxiety before,” says Dr. Coker. “We’re seeing people in the ER who have relapsed from an addiction, and first-time drug users trying to cope.”

The surge in sadness has also resulted in increased prescription drug use, as patients are prescribed stimulants (a hallmark of anxiety is the inability to concentrate) or benzodiazepines like Xanax to cope with the constant worry. Although medications help patients overcome stubborn mental blocks, they need to be accompanied by a shift in mindset to have lasting effects. And unfortunately, we may not see a “fix” to problems like the pandemic anytime soon.

So how can we keep from being constantly bummed out? The secret, simple as it seems, lies within us. If we focus on feelings of connectivity, find ways to build our self-esteem and adopt an attitude of gratitude, we can turn 2020’s frown upside-down.

Resilience: Learn to Ride the Waves

Think of your mental health like treading water, out past the waves in the ocean. It can be blissful, alternating between different techniques like back and side strokes. But eventually, if you don’t get back to the beach, you’ll become exhausted. That’s when life happens.

“Imagine that you’re keeping your head above water. Waves pass, but they’re blips—little stressors that you’re managing,” Dr. Coker describes. “But what happens when a big wave comes, and an even bigger one after that you don’t see coming, like a pandemic? Suddenly you’re gasping for air and you feel like you’re drowning.” In these situations, medication works like a life jacket. It lets you catch your breath. But to reach the sand, we have to learn how to see the waves coming, why they’re coming, and how to float or get around them. “That’s therapy,” says Dr. Coker.

Resilience requires acceptance and creativity, explains David Bethany, a Roper St. Francis Healthcare clinical therapist. “Accepting whatever is going on is necessary for us to find new solutions or approaches to dealing with it. While it’s tempting to take comfort in simple or familiar solutions, we become fearless in the face of change not by taking refuge in certainty but rather accepting uncertainty.”

David Bethany
(Photograph by Amy Luke)

When we build resilience—the ability to manage unexpected wave after wave—we set ourselves up for good mental health. It’s a trait we teach our children when we encourage them to solve a problem on their own rather than fixing it for them.

Soft skills like simple do-it-yourself repairs create knowledge that builds confidence and makes us less afraid, but Dr. Coker emphasizes that it’s critical to pair this ethos with empathy, especially in children, who may be afraid of something and not know why. “We can’t build resiliency by being frustrated in ourselves or others,” she says. “It requires understanding that we’re all in this together, so let’s work on it together. And if you make a mistake, don’t beat yourself up about it. Instead, focus on what you can do differently next time.”

Gratitude: Find Things to be Thankful For

During a year (and holiday season) when so many things have been taken from us—the ability to gather, financial stability, perhaps our own health—it’s critical that we focus attention on the good things in our lives. Finding silver linings may not feel easy, but they’re critical to shaking a mental funk. “Hope and gratitude are sister and brother,” says Bethany. “Without gratitude, what we have left is despair.”

Dr. Coker uses the example of a person with reduced work: instead of constantly worrying about the money you’re not making, look for what may be good about the day. “How is your health? How is the weather? What are you still able to do? What can you now do? For some it may be a project you’ve put off or time with family you haven’t previously had, or maybe it’s more time outdoors,” she suggests.

TIP: Each morning, write down one sentence describing something you’re grateful for. This starts the day on a positive note and often leads to finding more things to be thankful for throughout the day.

Self-Esteem: Choose Activities That Build You Up

If you’re alone—whether due to quarantine, bad weather or just not having plans—spend that time in ways that bring value to your life. “One of the first questions I ask patients is, ’Have you been able to get outdoors?’” says Dr. Coker. “You should be out getting fresh air and exposure to vitamin D.”

When you’ve gotten outside, it’s easier to put the time inside in perspective and to find productive ways to spend it, whether it’s learning or practicing an instrument, sewing, baking or whatever skill you want to pursue. Dr. Coker recommends keeping a journal to list little successes and adding to it each day. But keep your progress in perspective. “A lot of times, people don’t show themselves enough grace,” she says. “If you try a new thing and don’t really succeed, focus on the fact that at least you tried.”

Bethany adds, “In such uncertain and stressful times, our familiar routines may be missing altogether, and we may be deprived of our usual sources of affirmation and self-esteem. We have to remember that our self-worth is intrinsic and doesn’t have to be earned.” If you pursue an aspiration, like learning the piano, you can enjoy the process more than if you set a goal of playing a particularly difficult song.

One of the biggest enemies of self-worth is comparing ourselves to others, a problem that’s exacerbated by social media—especially during a year where our actual human-to-human contact is greatly diminished. “People just post the good—they don’t post all of the struggles it’s taken to get there,” says Dr. Coker. She counsels patients not to judge themselves by what other people appear to have accomplished. “You don’t actually know what they’re experiencing or going through.”

Connection: Make Friends and Family Part of Your Daily Life
Lack of interaction with loved ones has a direct effect on depression and suicide rates. “Connection is how we stay in touch with our humanity,” says Bethany. During a quarantine, feeling connected to others requires planned, intentional proactivity. That can mean physically distanced outdoor gatherings or a scheduled weekly video chat with family and friends. Put it on the calendar so that it’s expected and looked forward to.

This is especially challenging for seniors, who are more likely to have been isolated throughout 2020. “Many people think their memories are declining or that they’re developing dementia, but one of the most common symptoms of depression is memory loss,” says Dr. Coker. “That’s important to acknowledge if you’re not firing on all cylinders and can’t remember things as well.” The fix is cognitive stimulation—learning new skills or knowledge. This also provides something to be excited over and talk about during distanced or virtual gatherings.

Teens are another group at high risk when social interaction becomes challenging (see “Teens & Quarantine” below). “It’s human nature to interact, and to teens, socializing with parents is not socializing,” says Dr. Coker. “Parents need to convey that they may not understand, but that they’re willing to listen and be flexible and encourage them.”

Retired nurse and cancer survivor Barb Kellner (on left) volunteers weekly at Roper St. Francis Cancer Center, where she befriended volunteer coordinator Joan Perry (on right).
(Photograph by Mira Adwell)

“My key to staying in the light is to be active in mind, body and spirit—being grateful for all I have, helping others and staying off the couch!”

—Barb Kellner

Holistic Health: Take Care of Your Whole Self

Diet and exercise are directly connected to our mental health. People joke about the “COVID 15” (a few pounds gained during the pandemic), but weight gain can quickly lead to depression if we don’t feel healthy or lose pride in our body image. When we’re indoors and alone, it’s easy to slip into bad habits, whether that’s binging junk food or drinking excessively. This is the time to adopt an exercise routine—give yourself a reason to get outside and get your heart rate up.

It’s an especially challenging time for addicts who rely on group meetings like Alcoholics Anonymous. Without the accountability of a daily meetup, it’s easy to give in to destructive urges. Abstaining is much easier if you’re also eating right, exercising and scheduling regular social interactions. “If you’re having an unhealthy craving, immediately go outside and go for a walk,” says Dr. Coker.

To avoid slipping into bad habits, Bethany underscores the importance of structure. When we’re working from home—or unemployed—it may seem natural to sleep until noon, but allowing our schedules to dissolve can lead to idleness and anxiety (and wakeful quarts of ice cream consumed at 2 a.m.). “Resolve to get up at a certain hour and have some sort of activity planned for the day,” says Bethany. “It can be as simple as talking to a friend or cleaning out a closet.”

Reverend Rosalind Riley, a board-certified staff chaplain, serves on the pastoral care team at
Bon Secours St. Francis Hospital.
(Photograph by Mira Adwell)

“As I reflect on all that we have gone through, my faith sustains me. Even though we struggle to see Him at work,God remains the mover in our lives.” —Rev. Rosalind Riley

Moving Into 2021: Give Love When You Need Love

Has there ever been a year when we’re more in need of a hug? At the same time, we’ve had opportunities to connect with friends and family we may have previously drifted away from.

If every extracurricular activity is canceled, it’s not a completely bad thing—it may mean more meals together as a family. It could lead to getting to know your spouse, child or parent in a way you didn’t before. Or you may finally take up photography or journaling.

There is plenty to be optimistic about. The flood of new patients that Dr. Coker and Bethany treated during spring and early summer has already subsided as people become adjusted to the new realities of life during and after a pandemic. In fact, Dr. Coker worries that a ramp back up to pre-COVID-19 levels of busyness could prompt as much anxiety as learning how to calm down.

If you’ve lost your job or feel you don’t have control over your path in life, take proactive steps toward something new, but don’t dwell on it for hours. If you’re spending more time alone, consider that instead of pining for a new flat-screen TV, you’re seeking something meaningful. Take solace in the reduction in consumerism, energy consumption and pollution that the pandemic has allowed.

“We have more time to become connected right now, not just to each other but to the natural world,” says Bethany. That’s an opportunity that doesn’t come along often. Call an old friend—even if you’re not feeling lonely in that moment, they may be.

Resilience, gratitude and self-esteem occur within us, and connection holds it all together. Encourage positive mental health, for yourself and the people around you. Finish 2020 by giving love.


Love You: 9 Simple Tips for Self-Care

Being sad or anxious doesn’t necessarily mean you’re depressed, but it still takes a toll on your health. If you’re feeling down, these tips can help you practice mindfulness and cultivate a positive outlook:

  1. Journal, and let your writing focus on the here and now rather than speculation about the future.
  2. Get outside for a walk or bike ride. Physical activity is good for the brain.
  3. Plan and cook a healthy meal. Prepare enough for leftovers for the next day.
  4. Adopt a daily routine, even if you’re quarantining. Consistent meals and bedtimes help avoid boredom that can make us sad.
  5. Set a small goal each day and work to accomplish it, even if it’s as simple as organizing the spices in your cabinet or cleaning the bathroom.
  6. Think about the things for which you are grateful. Spend a minute reflecting when you wake and before bed—or talk about it over a meal with your family.
  7. Foster spirituality. Faith is a huge support for many people. In a time when churches may be closed, find a way to make your faith part of your daily life.
  8. Carve out special time for yourself. Quarantine doesn’t mean time by yourself for everyone—some parents may have never felt less alone! Even if it’s just a shower after the kids are in bed, find time to yourself doing something you enjoy.
  9. Turn off the news. Watch enough to know what’s going on, and then let it go.

Teens & Quarantine

Our teen years are when we establish our sense of self, an understanding that’s built around our connections to other people and our adoption of purpose. Isolation from others can make this exceptionally challenging for young people, leading to frustration for both teens and adults, especially when teens strain against the limits. A teen gathering with friends (typically normal behavior) may now be seen as rebellious by parents concerned about putting the family in danger. Find a compromise by allowing one or two safe quarantine buddies, with mutually agreed-upon rules to keep each household safe.

Photography by Mira Adwell


Suicide Prevention: There Is Always Another Way Out

A recent study published in World Psychiatry estimates an additional 3,000 to 8,000 suicides have occurred in the U.S. due to the pandemic. Having someone to talk to makes a person less likely to take this fatal action, but many fear that calling a suicide hotline will bring the police to their house. Dr. Coker emphasizes that unless you say, “I am going to hurt myself. I have the means to do it, and you can’t do anything to help me,” that’s not the case. The hotline’s purpose is to provide someone to listen. If you are having suicidal thoughts, positive distraction is a powerful tool. Take a walk, listen to music or read a book. Find a way to move around, and never hesitate to call a friend or the lifeline if you want to talk about what’s on your mind.

Suicide Warning Signs: If you’re worried that someone you know may be considering suicide, look for these red flags:

• Giving things away, or saying things like, “I wanted to give this to you when I pass, so I’m going to go ahead and send it to you.”
• Losing interest in passions, like an avid photographer who is all of the sudden not interested in their hobby
• Sleeping all the time
• Not eating and significant weight loss

Avoid being confrontational with a person you’re worried about. Instead, be encouraging. Acknowledge that they may be struggling, and then ask questions so they feel connected to you.

The National Suicide Prevention Lifeline, 1-800-273-TALK, is available 24 hours a day.

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