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'It is like sitting on a cliff': September, schools, and pre-traumatic stress disorder in COVID times


The first one happened in early March, as the pandemic loomed and Harvard evolutionary psychologist Deidre Barrett first began realizing, “oh my god, this is really coming.”

Barrett found herself inside a beautiful old library in a house that seemed centuries old. There were gas lamps and old leather-bound books and a window with a curtain drawn behind it. It all felt so “safe and comfy” but from the very start she knew something bad was happening outside, “like, all over the earth.”

“Gradually I became more and more aware of this horror outside,” says Barrett, a dream researcher at Harvard Medical School. “At first it seemed like a war or riot or some conflict between people, but then it settled into being like the Black Death, like the plague in Europe.”

Barrett makes art from her dreams and when she woke the next morning she made an image of a Medieval plague doctor wandering through a landscape of abstracted COVID-19 particles. It’s the cover of Pandemic Dreams , her new book about what our “supercharged dream lives” are telling us about our unconscious responses to the COVID-19 calamity.

Barrett has been collecting pandemic dreams through an online survey since March. Nearly 4,000 dreamers worldwide have submitted more than 9,000 dream reports. SARS-CoV-2, the unromantic pathogen that causes COVID-19, is the star of many, “literally, or in one of its metaphorical guises,” Barrett writes. Invisible monsters. Morgues and evil morticians. Tarantulas crawling through mail slots. Giant grasshoppers with vampire fangs and bugs, lots of bugs. Swarms of bees and hornets, armies of cockroaches, masses of wriggling worms. “Lots of tiny entities that cumulatively could harm or kill you makes a perfect metaphor for COVID-19,” she writes.

Barrett says it’s little surprise our dreams are more vivid, more epic, more wild than usual. Any big, dramatic event tends to stir up dreams, but negative ones dial up anxiety dreaming even more. “We saw more dream recall and more anxious dreams after 9/11,” says Barrett, who has also collected the dreams of Kuwaitis after the Iraqi occupation in the first Gulf War. “We’re thinking more intensely and emotionally by day,” she writes, “so of course, our dreams are also more intense and emotional.”

They’re also shifting, her analysis shows, from fear of an unknown threat, frustration and exasperation over stay-at-home orders to more anxiety again as the world and workplaces and schools reopen — scary, anticipatory, anxiety dreams about offices with wet germy carpets people have to walk across barefoot to get to their desks, dreams of desks that, instead of spaced out, are moved closer together with Plexiglas barriers trapping everyone in the same air space. A woman homeschooling her 10-year-old dreams the school decides she will have to homeschool the entire class. Another dreams the pandemic is over, but the city has decided to close schools permanently and have kids taught by parents until they’re 18. Dreams show us emotional reactions we may not be completely in touch with, Barrett says, and five months out, COVID-19 continues to hold us in its grip.

In British Columbia, where cases are surging with worrying single-day jumps, Premier John Horgan has raised the spectre of “severe penalties” for people flouting COVID-19 rules. Parents across Quebec and Ontario are petitioning for smaller class sizes. Some teachers say they’re scared to go back into class, Calgary elementary school teachers are predicting physical distancing will last three or four days, and everywhere parents are wondering, “is it safe to send my kid back?”

It’s this pendulum that swings between risk and benefit and it has to be a calculated trade-off

“It is like sitting on a cliff,” says Dr. Judy Illes, Canada Research Chair in neuroethics at the University of British Columbia. “For parents, it revolves around the central question: Am I doing the right thing? What is the right thing for you when the ground is a long way down or shifting under you constantly?”

The anxiety may not just be colouring our dreams. Illes says the stress of waiting for the next surge in the pandemic and preparing for the unknown could be a trigger for pre-traumatic stress, the anxiety that can occur “as the body reacts to perceived future dangers,” she and UBC neurology resident Dr. Chris Feehan wrote in May .

“Real or imagined, these dangers activate the nervous system in preparation for a burst of activity potentially necessary for survival.”

Pre-traumatic stress disorder isn’t explicitly in the official manual of mental illnesses, but Illes and Feehan describe it as the mental burden of waiting to have to act, “and not knowing what that act will entail, or when.” Their focus has been on frontline health workers, but Illes says the principles are relevant to parents “and just about everyone else who is confused about the fall, and waiting for the next shoe to drop.”

In Barrett’s book of pandemic dreaming , nightmares tortured frontline health workers: A breathing tube slips out. A ventilator malfunctions. An Italian anesthesiologist dreams of putting a breathing tube into a dying man, and then falling out of a sixth floor hospital window, dragging his patient with him. People doctors are frantically trying to save suddenly morph into colleagues, families, friends. Many frontline workers were reacting to real, daytime drama.

For typical dreamers, it was more anxiety dreams, fewer nightmares, and as the pandemic plods on “more dreams come into the survey that envision our future,” Barrett writes, some sunny, like dreams of cleaner water and lakes, or a “positive second coming,” and some not-so-sunny (zombies, ravaged populations). In Canada, the latest federal modelling of the future released Friday includes a “reasonable worst-case scenario”, a large fall peak, followed by more peaks and valleys. The number of new cases reported daily is increasing, and with schools set to reopen,”everyone is on nerve,” says Montreal cardiologist and epidemiologist Dr. Christopher Labos, because when it comes to kids and COVID-19, not all the evidence agrees.

This week alone, Dr. Zoe Hyde of the University of Western Australia wrote that early and optimistic assumptions that kids are much less susceptible to COVID-19 infections than adults and don’t play a substantial role in spreading the virus are “unfounded.” Among other studies, Hyde points to a paper published in JAMA Pediatrics that found that the amount of viral RNA, or genetic pieces of the virus detected in nose swabs of children aged five to 17 was similar to that of adults. Children under five had viral levels 10 to 100 times higher. “Children may therefore have the potential to be substantial drivers of the pandemic,” Hyde writes, and the authors of the JAMA paper point out that while the first early reports out of China didn’t find kids as major vectors, school closures early in the pandemic “thwarted larger-scale investigations of schools as a source of community transmission.” Hyde argues that while children experience much less severe illness from the virus — only a minority of kids infected with SARS-Cov-2 require hospitalization and the case fatality rate is very low — “there is no reason to think that children are less likely to transmit the virus than adults.”

One day later came word of an opposing perspective from Western University experts, who, in a commentary published in the Canadian Journal of Public Health, said that children remain “remarkably unimpacted by COVID-19” and that there is no evidence kids are epidemiologically important in community transmission. “The stereotype that children are just germ-spreading machines goes back to influenza, but we know now that COVID-19 is very different than influenza when it comes to kids,” co-author Dr. Michael Silverman, chief of the division of infectious diseases at Western’s Schulich School of Medicine & Dentistry said in a statement.

Against this backdrop of confusion, Illes is noticing another emerging phenomenon, what she calls anticipatory fatigue. “Part of the energy that is surrounding current protests — as inherently important and timely as many are — is about getting out of the house, getting together, screaming together,” she says.  In part, a reflection of the fatigue of the unknown.

It is like sitting on a cliff

There’s no playbook, Illes says.  Our approach has been more scattershot — today we’ll do this, tomorrow we’ll do that. “It’s exhausting, and I think it is increasing stress and anxiety and the mental fatigue that we experience when we have to deal with life-critical things and don’t have a solid, consistent basis on which to make decisions.”

If we can’t be strategic, because the science keeps moving, at least we can be principled, Illes says, meaning identify, “what are the values and priorities of families as they face just too many unknowns.”

Is the priority that the children stay home because there are grandparents in the house? Risk mitigation, at all costs? “One could argue that’s a high priority, given the home situation,” Illes says.

With a younger family with two professionals desperate for some quiet time in the house, having kids at school part may be a better risk-benefit trade-off for the health and welfare of the entire family, she says. Kids kept home, some studies suggest, have a higher risk of anxiety and depression.

“There’s no black and white. It’s this pendulum that swings between risk and benefit and it has to be a calculated trade-off,” Illes says.

There are ways to buffer the confusion and anxiety, she says. “Think about what’s important to you. What you value.” Reframe negative thoughts of the future into positive ones. Rely on evidence-based information. Avoid drinking too much or other unhealthy behaviours and recognize symptoms, like constant, vivid worry or disturbed sleep.

In most crises, people lose sleep.  After an earthquake or hurricane, we pick up the pieces of our shattered homes and bury the dead. There are all sorts of things to take care of, Barrett says.

This was the one crisis where, “go home and lie around was the command for the majority of people, though not everyone,” Barrett says. People are sleeping more, on average, and the strongest correlate with dream recall is hours of sleep.

“We go into rapid eye movement sleep every 90 minutes, but each period gets longer through the night,” explains Barrett. “So, if you sleep four hours instead of eight, you’re not getting half your dream time. You’re getting, like, 20 per cent of your dream time.”

For Barrett, the most intriguing finding was that women’s pandemic dreams seemed much more affected by the pandemic than men’s. Women showed bigger shifts away from the norms. Both sexes had fewer positive dreams, more negative emotions, more anxiety, but all the trends were stronger for women. They also had more sadness and anger in their dreams.

True, women tend to report more anxiety and depression during non -pandemic times. “But if you also look at it from a practical standpoint, women are overrepresented in the people who’ve lost their jobs, the people who are doing extra child and elder care. In almost every bad way the pandemic has affected them more,” Barrett says, though she adds that being male seems to be a slight predictor of dying of COVID-19.

Copyright Postmedia Network Inc., 2020

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1 being least likely, and 10 being most likely

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