The provision of mental health services during a pandemic changes the perspective. A couple of weeks ago I happened to be working with three clients in a row, offering advice through telemedicine. COVID-19 has opened a door and a need to be creative in how we provide mental health services and support. It also made an interesting parallel.
When I was working with these three college students struggling with issues related to depression, isolation, lack of energy, and anxiety, I found that they were all consulting from the same environment: a basement or a bedroom, out which they had none left all day. Not because of the debilitating effects of a clinical diagnosis, but because they didn't have to.
It is known that casinos spend considerable resources in order to improve the psychology of their gaming venues and to develop the five senses of the player. Casino designers create an environment that puts their customers in a trance where they can lose their financial capital as quickly as they lose their sense of joy, self-esteem, and peace of mind. There are no clocks or windows. Fragrances are used that research has shown can increase gaming by up to 53%. Customers are well stocked with free drinks and snacks. All of this is done with the aim of encouraging players to pull this lever or roll the dice again.
I noticed that COVID-19 had similar effects on our psyche. When this is recognized, we can use these observations to improve our understanding of some of the psychological pitfalls our customers are currently experiencing, much like we are made aware of the ins and outs of organized gaming.
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Photo of an interior of a casino in Las Vegas, Nevada with a woman sitting at a slot machine with her back to the camera.
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Time
Casinos work hard to get customers excited about their games. One way is to remove anything that tells the player about the time. Clocks and windows are almost never seen as these objects could alert players on the field that they have been there too long or have other things that require their attention.
The coronavirus required many of us to work from home or go to school. It has been shown that our living conditions can affect our sanity in ways that we do not readily see. Many people's workplaces are in dark bedrooms or basements where natural light is limited or completely turned off. To improve contrast and reduce screen glare, those who work from home or go to school can draw their curtains. The information that daylight provides about the time of day – morning, noon, night – is practically lost.
It used to be the custom to get our news and entertainment through predictably scheduled TV shows and movies. Some even had time stamps (e.g., messages at 6 p.m. or 10 p.m.), which made us think about our closeness to bedtime. Now we stream our news and TV shows without thinking about a set schedule. We routinely engage in "binge-watching," which is like looking at a slot machine rolling around and giving us "just one drag" before we go (and then still don't go). Whether it was rush hour traffic, catching a school bus, coming home from work, or participating in evening activities, these actions subtly informed us about the time of day and biologically regulated us and made for healthier livelihoods until the threat of COVID -19 arrested this was told.
COVID-19 affects our sense of time and thus our biological regulation of sleep, nutrition and exercise – three ingredients that can either protect us from depression and anxiety or make us more vulnerable. For these reasons, I recommend individuals to consider their work and entertainment environment more carefully. Hire structures that encourage relocation and movement. While this may be less practical, consider viewing your conversation on a different screen and in a different room from where you work or sleep.
Maintain morning rituals and evening activities that provide information about what to do at each point in the day. Consider investing in a twilight simulator alarm clock and watch out for sunrise and sunset and how they fit into your daily routine. Committing to a balanced and regulated lifestyle during the pandemic promotes improved mental health, calmness and rejuvenation.
Comfort
If you want to help a person lose their money or their mind, keep them as comfortable as possible. The casinos offer free food and drink with incredible customer service so players never feel the pressure to leave. Sitting at a slot machine or card table while devouring hard-earned resources is a sedentary existence.
Similarly, the COVID-19 pandemic has confined us to our living quarters. At first this was a celebrated consolation for some – simple and seemingly weightless. Those few extra minutes in bed. Never have to get out of your sweatpants. Your living room becomes your office, your entertainment center, and your bed. Days and weeks can pass when groceries are delivered to a home.
All of a sudden, leaving the house feels like a chore for a short period of time, or worse, the home has become a security blanket and leaving becomes anxiety. The more comfortable we feel, the more everything else seems to be “work” – and certainly less pleasant.
Metaphorically I thought that this resembles an astronaut whose "antigravity muscles" (neck, calf, back) begin to wither after five to eleven days in a weightless environment due to underuse. On returning to Earth, gravity suddenly feels like a heavy weight, and what used to be normal is now crushing, uncomfortable, and fearful. To mitigate these well-known effects, astronauts purposely exercise in space every day, using resistance bands and other adapted machines to keep the muscles going.
Similarly, individuals need to keep training their social and mental muscles. I fear that after the end of the COVID-19 pandemic, some people will have to struggle with the "gravitational pressure" of social engagement because this muscle has atrophied during this time of physical distancing due to insufficient use.
Mental stimulation
Casino floors are noisy. Between lights, colors, bells, sirens and laughs, it's no wonder they are often referred to as "playgrounds". The first time you step into such a place it seems full of opportunity and excitement, but it doesn't take long to numb that sound. Game design research shows that casino games are designed to "sound like a win" in order to increase a person's engagement with the engagement. Casinos, from the games to the artwork, are designed to pull you like a moth into a flame. I imagine this is like receiving a "like" on a social media account, the new dopamine hit of the 21st century.
It's no surprise to hear that living through COVID-19 is boring. So many people and places that we took for granted have been taken away or locked up. The world was frightened and in many cases technology was the answer to keeping us safe.
As we continue to use our digital "slot machines" to connect with the world around us, an unintended effect is that we keep increasing access to passive but exciting communication. It reminds me of learning how groceries can become a sugar delivery system that tastes lovely and provides an instant burst of energy but soon becomes tired and sluggish. And when we feel tired, we use more sugar for a quick pickup, which creates a vicious circle. During the COVID-19 pandemic, we are tempted to watch more lights, more colors, and more bells to encourage silence and isolation when our brains are bored. Much like a casino, this can make us feel like we are winning when in reality we are throwing ourselves into the ground due to a lack of true novelty.
Dopamine, sometimes referred to as the pleasure neurotransmitter, is actually increased when we think of or engage in something new. Technology can be an amazing novelty delivery system. During this time, however, it is important that we also find new products outside of the “casino”.
I asked customers to create their own magazines called “Things I Learned During COVID-19” and then fill them with experiences, activities and photos. Creating novelty doesn't have to be difficult. It can be as simple as making your own campfire and roasting the manners, cooking or baking, or learning something new. The process of planning and physically completing new tasks increases exercise and engagement, and uses our entire neural network to improve mental health. The process of delayed gratification – thinking about something exciting or interesting in the future – also increases dopamine.
Living in a pandemic is a challenge in many ways. But if we allow it, it can also generate creativity, intentionality, resilience and new insights. Even if we sometimes wander through our houses in a seemingly numb state, it does not have to mean that “the house always wins”. My encouragement for you and your loved one is to shut down your laptop or smartphone, get up from the bells and whistles, step away from the artificial light, and go outside to reconnect with a world that is missing you.
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Todd Monger is a Licensed Professional Clinical Advisor, Certified Consultant, and Recognized Clinical Supervisor who has provided clinical services for 20 years. He is currently in private practice at Stable Living LLC, where he offers horse-assisted psychotherapy. For the past 17 years he was also the Executive Director of Student Development at North Central University in Minneapolis. Contact him at [email protected].
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