What Do I Do Now? Making Decisions in a Postpandemic World

Psychiatric Times, Vol 38, Issue 9,

The pandemic changed the way individuals think and caused adjustments in our worldviews. How is that impacting our decision-making ability?

COMMENTARY

"Why can’t I just make a &$%#ing decision?” asked my new patient through gritted teeth. Let’s call her “Cindy.” As an accomplished high-stakes investor, Cindy had made, on behalf of her clients, countless big decisions with ease and alacrity. Now, in our emerging post–COVID-19 world, even the smallest of choices stymied her.

“Why should I buy a new chair if I am going to move? But if I moved, where would I go, anyway, and when? Is any of my life going to work like it did before COVID-19? Will anything be any better?”

Cindy was as ashamed as she was angry at herself for her paralysis. In prepandemic times, she was a master in detecting economic and sociopolitical patterns and turning those into successful investment decisions. But now, her compass could no longer find true north. How the future would unfurl escaped her grasp.

As my patient recounted her long list of unmade decisions, I felt my heartbeat quicken, in step with hers, even over our Wi-Fi connection. As a psychiatrist, I often deeply feel the emotions and experiences of my patients. This has never been truer than it is now. Many of us, I imagine, are struggling to claw our way out of the COVID-19 disaster, seeking to find—or build—a different, better existence.

The weighing of risks and benefits, central to decision-making, is not the same anymore. I knew, as did my patient, that I needed to move on from my pandemic existence, but I could not see a way forward. I, too, remained passive, snared in a persistent nightmare of not knowing how to believe in a secure future. Without that faith, I was unable to imagine my path to any future.


The weighing of risks and benefits, central to decision-making, is not the same anymore.


Physician, Heal Thyself

I kept asking myself, why do I feel so unskilled at making decisions? That is not who I was in the past. At the dizzying start of the pandemic, as a psychiatrist, I faced life-and-death decisions for myself, alongside my patients. Those piercing moments sharpened my vision; options were clearer and simpler. But then, even for a serial planner like me, I could not plot out anything beyond the week ahead, sometimes only days or hours.

I reminded myself that the pandemic’s forced, sometimes brutal, prioritizations and mandates kept others alive and kept me from becoming ill myself, or infecting others. Yet, as the world began to open up, it was hard to remember that. The motto first things first morphed into indecision, excessive commitments rather than choices, and a manic frenzy of many postvaccination firsts. Within a few weeks—into which I packed an exuberant haircut, several giddy indoor dining experiences, and a tentative airline flight—I had to ask myself what comes next. I still had the clear vision that life is too precious to waste a moment, but I could not see how to spend my time wisely.


Could this be our answer to staying healthy, enjoying our lives more fully, to avoiding calamity when the next disaster inevitably strikes?


Change Everything

For many folks, postpandemic life invites a new imperative—change! Maybe, in fact, change everything. Could this be our answer to staying healthy, enjoying our lives more fully, to avoiding calamity when the next disaster inevitably strikes? I think this type of thinking is a mirage, a fantasy of freedom, one that can swiftly ensnare us and make us lose sight of who we are and what matters most.

My fantasy was this: Leave medicine and the northeast winters, move to Key West, and become a scuba instructor (at least I know CPR). This mirage wiped away my former, clear-headed, pragmatic self, who would have told me not to rent a U-Haul and head south. Or, for my patient, to keep her keen eye on the market, and start to trade again.

My prepandemic self would have whispered, “Stay the course; not much has really changed.” When I could revive this part of me, the false promises of big change were clear. There was no certainty, hardly any direction, to be made from forging a completely new life. I instinctually wanted to flee the unceasing COVID-19 world of stress, powerlessness before a deadly virus, the heartaches of isolation and loss, and the fears of becoming ill—or worse, infecting those I loved. That was what I was struggling with, imagining I could overcome, that I would heal my psychic wounds by sipping wine on a beach after teaching scuba in a warm ocean (not that I would mind having a vacation like that right now).

Unsettled and unable to “make a &$%#ing decision,” I knew I needed to resolve the warring forces inside me: Run away as fast as I can! Stay the course!

My fog cleared when I realized that my dissonant, quite paradoxical demands were equally valid. They both deserved the screen time of my mind, so that I could live with both. This was how I needed to absorb the impact of this unprecedented year of disaster.

Psychiatrists and psychologists refer to the process of holding and bringing together seemingly disparate feelings and thoughts as a “dialectic world view.” Opposites exist, are unescapable; it is we who have to live with both sides of the proverbial coin. I had to remember that the one constant in life is change. That change is replete with opposites, which are additive, and the prescription for thriving.

The pandemic drove extreme, if necessary, changes in just about every aspect of our lives. Yet what did not change is who I am—my fundamental beliefs and values. When I can live a life that does not try to avoid contradictions or paradoxes of all sorts, I stand a good chance for a fuller, more self-directed existence, instead of the paralysis that COVID-19 wrought in me, and many others.


Disaster and tragedy can open us up, sometimes in big ways—ways that enliven, as growth can follow destruction.


“I Know What You Mean”

Those of us who suffered as frontline workers, physically and emotionally, in caring for patients with COVID-19 and their families, have survived an unprecedented disaster. While the virus is mostly dissipating in the United States, its longer-term impact on human distress and mental disorders is not. The pandemic has forced us to adapt to uncertainty, to bear the fears of infection or spreading it, to tolerate social isolation, to endure losses, and (for many) to find ways to live despite financial hardship. That is plenty to stir a compelling need to fashion a new life, shimmering like a mirage because it is diametrically opposed to our past. But that is a trap—it is going from one untenable existence to another.

I see now that I need not craft and pursue a dramatic next act, bursting with glittery confetti, although some measure of that would be pleasing. In fact, like my patient, I was not doing so badly before COVID-19. Disaster and tragedy can open us up, sometimes in big ways—ways that enliven, as growth can follow destruction. In my case, me but different—better, I hope, and made stronger and braver, forged in the furnace that COVID-19 produced.

Now, when my patients tell me how difficult it is to make a good decision, I say to myself, “Oh, yes, I know what you mean.”

Dr Shetty is an assistant professor of clinical psychiatry at Columbia University Medical Center. She treats children, adolescents, and adults in her New York-based private practice. Dr Shetty strives to learn from and offer help to her patients through a narrative approach to understanding experiences.