Illustration by Steven Shik

You can measure the physical toll of the coronavirus pandemic (with proper testing, of course). But the mental and emotional toll? That’s trickier.

Grief, illness, job loss, disrupted schooling, isolation and community concern aren’t calculable. Anxieties about the pandemic, which disproportionately affected Black Americans, have more recently become entangled with a nationwide reckoning with racism and police brutality. The killing of George Floyd in Minneapolis sparked protests in Detroit and cities around the country, and preceded a spike in depression and anxiety among Black and Asian Americans.

Social justice issues of race, gender, sexual identity, class and more are “directly connected” to mental health issues and emotional well-being, said David St. John, a psychologist and executive director of the FairSky Foundation, which offers psychological care services in four locations across Metro Detroit and Ann Arbor.

Black Americans in particular are dealing with a “double weight,” he said, as protests are drawing attention to racist systems and adding depths of emotional trauma on top of the disproportionate number of COVID-19 cases and deaths in Black communities.

Meanwhile, even as people tentatively return to some pre-pandemic activities, mental health concerns fueled by coronavirus linger.

“I think we’re all being kind of invited to pretend that COVID is gone, but the throb of the trauma in the background is still there,” St. John said.

When the COVID-19 caseload and death rate were formidable in the Detroit area last month, Detour spoke with about a dozen individuals and mental health professionals about how we’re doing, really. We heard stories of confusion, fear and sadness, intertwined with determined efforts to give and receive help in new ways. Indeed, what’s happening now could lead to a profound reimagining of mental health care.

Mental health providers go into crisis mode

The good news is that therapists pivoted quickly to social distancing and telehealth services. Insurers added coverage for video and phone services in their policies. The Radical Well-Being Center in Southfield developed a nonprofit arm so that clients, some of whom have lost insurance, jobs and incomes, could continue services. Henry Ford Health System turned around its clinical psychology department to serve the hospital’s own staff with three virtual therapy sessions a day and a 24/7 hotline. Wayne State University’s social work and nursing departments set up a similar hotline designed for first responders.

The state of Michigan also opened access for residents to a mindfulness app. In the first week after the state’s launch of a crisis text line, hundreds of people reached out, with 1,144 total text conversations since early April, according to the Michigan Department of Health and Human Services.

One of the state’s warmlines (that is, phone services that provide support before a crisis begins) tries to offer the kind of peer support that used to be available at drop-in centers that have closed down. The peer-to-peer line made more than 5,300 connections through last week. About 8% of callers wanted specific resources and less than 1% were in crisis — most people just wanted someone to talk to.

“We were stunned, frankly, by the number of people who called,” said Allen Jansen, deputy director of the MDHHS’ Behavioral Health and Developmental Disabilities Administration. “It’s teaching us something unexpected.”

In addition, more than 75,000 people called or emailed the state’s general COVID-19 hotline and online support system between March 14 and June 19.

And this week, Gov. Gretchen Whitmer signed into law a package of bills that requires health insurers to cover telemedicine without an initial in-person visit, and also makes telemedicine fully available to Medicaid recipients, allowing those patients access to virtual behavioral health services.

The new normal of teletherapy, though, has mixed reviews. On the positive side, Jansen said that some clients speaking from home over video are sharing stories with their longtime therapists that they’ve never told before. Stacey Dalton, co-founder of Silver Linings Counseling in Sterling Heights, said many clients find teletherapy to be less intrusive.

Silver Linings has decided that everything it would need to do to restart in-person sessions — including wearing masks, which makes it difficult to see patients’ facial expressions — isn’t conducive to providing the best and safest care. Besides, after a few months, virtual therapy has become easier, Dalton said, as therapists have figured out issues like smoothly transitioning between sessions.

But others have retreated from contact with their therapists. “We’re worried about those folks,” Jansen said.

‘A flurry of what the fuck is going on’

For Lauren Tanabe, a Detroit writer, mid-March was “a flurry of what the fuck is going on.” Her daughter’s school was canceled. Her mom was in town and it wasn’t clear if she should stay in Michigan or leave. Both her small kids were getting over the flu. And, as the weeks went on, Tanabe’s sister canceled her July wedding and her 96-year-old grandmother died (not from the virus). The shutdown made it impossible for people to visit or memorialize her in the way they would have wanted.

On top of all that, Tanabe found working from home extremely difficult, especially with the demands of a five-year-old and two-year-old. Old gender roles began showing up, she noticed. Tanabe, a trained scientist and storyteller, has deadlines, but her husband is paid more, “so when push comes to shove, his work is more important.”

“I felt pulled back to a very dark place,” Tanabe said.

That’s why she transitioned with her therapist into video sessions, even though she found the technology alienating and home sessions distracting. “I hate it,” she said.

Tanabe has since found ways to adapt — the kids might be dispatched outside with her husband, just as she corrals them when he’s in a meeting. Regardless, Tanabe’s therapist can relate: she too has locked herself in a room, with two kids amusing themselves elsewhere.

“It’s very comforting for your therapist to say that what you’re doing is okay and it doesn’t make you a bad mother,” Tanabe said.

Indeed, this is an unusual time when therapists are going through a difficult experience right along with their clients. “It’s the first time we’ve shared a trauma,” said St. John. The stress colors everything. He too has had to carve out space at home for therapy — he sectioned off his bedroom with a divider and, since there’s a 13-year-old downstairs, he uses a sound machine.

At the Radical Well-Being Center, clinicians have experienced anxiety, hypervigilance, trauma-responses, difficulty sleeping and shifting between minimizing and panicking, said clinical supervisor Tanisha Moir and clinical supervisor Lainie Epstein in an email. As well, “Zoom fatigue is real for us,” they said. It’s hard on the eyes and especially tiring.

Missed connections

As a clinical social worker at Dream Catchers Therapy Practice in Dearborn, Erin Martinez said that therapists, especially those working with people who’ve experienced trauma, are trained to pay attention to nonverbal communication. “How do you connect, how do you help people, when you’re using different modalities?” One of the treatments she uses is eye movement desensitization and reprocessing (EMDR), which involves close proximity. She had to figure out how to do that through video. Her practice now offers limited in-person sessions when remote therapy is a significant hardship for clients.

Angela Lopez, a therapist, ordinarily works with kids ages 0 to six in their homes, mostly on Detroit’s west side. It’s hard to engage in play over video, especially when Lopez herself is in an apartment without a lot of space or toys. And patients, dealing with upended schedules, are more likely to miss appointments.

“Sometimes I still feel like I’m pulling teeth to get parents to talk to me,” Lopez said.

Video calls aren’t always possible either since not all households have wireless access, or phone cameras are broken. “The one family I was most worried about doesn’t have WiFi,” Lopez said. The six-year-old client is old enough to carry a phone conversation but “he isn’t interested at all.”

Still, Lopez said that the challenges of teletherapy are worth it. She’s adapted by doing shorter sessions twice a week instead of a longer session once a week. “The kids — even the ones who might only stay on the video call for five minutes or less — are seeing me and know that I’m thinking of them. It’s important to me that they know I’m still there and still going to show up every week, just in a different way.”

Relief over Zoom

Kate Nowinski, a 29-year-old who lives in the Jefferson Chalmers neighborhood, is thoughtful and intentional about self-care, but, especially since she doesn’t have health insurance, she’s had to be creative about meeting her needs, finding low-cost doctor care and working with a therapist who offers sliding-scale payments. She’s a somatic therapist who specializes in mind-body work, exploring embodied sources of energy, tension, and trauma, but they’ve still been able to adapt to Zoom sessions twice a week. The therapist’s clients also do monthly group sessions, discussing books they read together.

For Nowinski, continuing care in this new format is a form of self-preservation since the “diagnostic frame given to me” of being bipolar, “coupled with the conditions of radical upheaval, it seems like it could be Bad News Bears.”

Christin Lee has also found better support with a mind-body therapist. As a writer with a lot of vocabulary around therapy, she hit a wall with traditional talk services. “I felt like I was walking in, and telling a story, and sort of walking out again,” she said in May. Reading “The Body Keeps the Score” magnified her desire to try something new. So, after a difficult winter and some false starts, Lee got on the waiting list with a therapist she felt connected to.

Three months later, as part of the statewide shutdown, Lee temporarily closed Room Project, the Detroit writing center she founded. (Disclaimer: this writer is a Room member.) She also had a painful romantic break. Right then, the therapist offered her an open appointment.

Even on Zoom, Lee felt instantly comfortable as the therapist guided her through poses, stretches and breathing exercises.

“I sort of forgot I had a body for a month, and then I was like, oh, okay, I can still go on walks,” Lee said. She began doing morning yoga again, which feels really emotional. “Oh, I see: There was a reason I was holding back on that.”

Margo Dalal of Detroit found an unexpected benefit in teletherapy: there’s no insurance co-pay. That means she can see her therapist more frequently. “It’s been great,” Dalal said. “It’s offered me real space to reflect with someone … who knows me really well.”

That’s important because Dalal too is navigating a difficult space. In the early weeks of the crisis, she went heavy into helper mode. Being in a leadership role for three endeavors — Detroit Community Wealth Fund, the Detroit Kite Festival and Public Thrift — meant that Dalal fielded a lot of responsibility for reorienting them. She also jumped into mutual aid work, organizing a mask-making campaign. “I thought, this makes me feel good, I was helping, but then I quickly realized I was overextended.”

As the weeks slogged on, she said she had a harder time forcing herself into a routine, and her ADHD and dyslexia were as bad as they’ve ever been. “I’ve been in the longest funk I’ve been in a long while,” she said in May. Dalal and her partner started planning more excursions in the woods and long walks at night; just getting out lifts her spirits.

Shifting mental health challenges

There are other hopeful initiatives for expanding opportunities for care, both within and beyond the state of emergency. FairSky launched a prescient campaign last fall called “Helping the Helpers” to serve the mental and emotional needs of frontline workers. It reached out to organizations like Planned Parenthood and Growth Works to offer free trainings and sliding-scale treatment for staffers, and holds weekly group therapy sessions for service workers impacted by COVID-19. The idea is that by helping the helpers, that care reverberates out to everyone they serve. St. John said that they are planning to reach out to teachers and school staff as well.

In the meantime, St. John said, it’s worth acknowledging that people may still be in the phase of trauma where they are just surviving. It’s natural to dissociate from feelings of fear, anger and sadness until we’re in a safe place. Given the prolonged nature of the crisis, St. John wonders what will happen in the fall, or next year “when people have difficulty sleeping or having panic attacks, and they’re not necessarily connecting it with the pandemic.”

As summer breaks open, and some begin to restart their social and work lives, the long tail of the ongoing pandemic has brought new challenges.

In some areas, patients’ mental health concerns are increasing as people take on new anxieties about returning to work, said Dalton, the Silver Linings Counseling co-founder.

Lopez, the child therapist, noted that some of her coworkers have left work permanently or temporarily as they deal with child care.

“That’s hard on the team to lose friends and colleagues,” Lopez added this week. “That’s something that has come up in the last month and I’m absolutely feeling the stress of an increased workload.”

Looking for a new way forward

Nearly everyone Detour spoke with pointed to how this crisis is also a new opportunity to acknowledge social inequalities as a fundamental source of psychological suffering. The gaps and slippages in our institutions are more clear than ever, Nowinski said.

“A lot of us have already developed strategies for living in [and] gliding around on the margins, she said. “We’re also putting that into high gear now.”

Dalal’s professional work is economic justice, and she’s attentive to how the pandemic prompted people to see our economic system in a new way. “Like, essential workers were not being paid enough,” she said. “Teachers — their jobs way harder than parents thought. … Flex-time is possible.”

The conversations happening now are about what we want the world to look like, she said. “So many people are saying, ‘I’m not going back to the old way.”

Anna Clark is a journalist in Detroit and the author of “The Poisoned City: Flint’s Water and the American Urban Tragedy,” which was named one of the year’s best books by the Washington Post, the San Francisco Chronicle, Kirkus Reviews, Audible, Amazon and the New York Public Library. Her writing has appeared in Elle, the New York Times, Politico, the Columbia Journalism Review, Next City and other places. She has been a Fulbright fellow in Nairobi, Kenya and a Knight-Wallace journalism fellow at the University of Michigan. She received the Excellence in Environmental Journalism award from the Great Lakes Environmental Law Council.