In February 2020, Jullie Hoggan picked up the phone to receive lifesaving news.
She had been on the list for a kidney transplant and, to her relief, there was now finally a donor. But that reassurance was quickly overshadowed by the looming threat of the novel coronavirus.
"I remember standing at my sink and thinking, what about this virus? Like, is this going to be a problem?" she said.
It was a question that would completely restructure the next two years of her life.
While the surgery was successful and Hoggan is now vaccinated and boosted, she is still severely immunocompromised and has to take significant safety measures.
"I'm so nervous. Like, my heart rate is through the roof when I'm out for anything," she said. "And I wonder if I'm ever able to be out safely again and be normal and go out to a store. Am I going to be feeling that forever?"
Hoggan works from home, rarely leaves the house, and when she does, it's incredibly stressful. Her husband and college-age daughter both wear masks at home and have to be extremely careful about who they see and what they do.
Hoggan's pandemic experience carries no violence and there have been no explosions or assault, which is why she has a hard time calling it trauma.
But Arthur Evans, CEO of the American Psychological Association (APA), says viewing the world as unsafe can be a symptom of trauma.
"I think for a lot of people, the idea of having a mental health challenge is there's something inside of me that's wrong," he said. "And I think the idea of trauma helps people to understand that, no, this is something that is happening to me and how I'm responding is a natural response."
Generally speaking, trauma is an emotional response to a terrible event. Usually, an event that threatens your life, or the life of someone near you, and results in feelings of significant fear or helplessness.
It is a feeling that is not unique to Hoggan.
For Lanny Langstrom, the early months of the pandemic were filled with stress.
"I was desperately trying to stay away from, like, this thing that I thought was going to kill me at any second," he said.
He recalls worrying that if he died from COVID, his 6-year-old daughter might not remember him. He was so stressed that he eventually called a mental health hotline, and they suggested he seek therapy — something he'd never done before.
To his surprise, his therapist told him his symptoms were consistent with trauma.
"When I think of trauma, I more imagine one of these brave young men that go over to Afghanistan and they're driving a Humvee and it gets blown up," Langstrom said. "I'm not a soldier, but you know, at this point we've experienced [nearly 1 million] people dying."
What Langstrom describes is a collective trauma, according to Roxane Cohen Silver of the University of California, Irvine.
"The event happens, there's great tragedy, and people pick up the pieces of their lives and start to figure out how they're going to move forward," she said.
But Cohen Silver said the pandemic was different. For one, there wasn't a single event — it was more like a "slow-moving disaster" that "escalated in intensity over time" but doesn't have a clear beginning or endpoint.
And that makes it harder to categorize, or even recognize.
Is it trauma?
These feelings of anxiety and stress are becoming increasingly common in the pandemic, Evans said.
"We absolutely are experiencing a mental health tsunami," he said. "And we expect that it will grow even more ... so we haven't even crested this tsunami yet."
A survey by the APA found a significant increase in the demand for mental health treatment in 2021. Providers are stretched thin, waitlists are growing, and people are reaching out for myriad problems, Evans said, but anxiety, depression and other trauma-related disorders were at the top.
But the uptick in demand for mental health treatment was not necessarily a rise in pandemic-related trauma, said psychiatrist and neurologist Dr. Bessel van der Kolk. He has spent his career trying to figure out how people adapt to trauma.
His 2014 book, The Body Keeps the Score, explores how the brain, mind and body process trauma. Eight years after it was first published, the book found itself on The New York Times bestseller list for months, and it was one of the most-sold books on Amazon during the pandemic.
Van der Kolk doesn't quite know what to make of the book's newfound popularity.
"I'm astounded by it," he said. "It's a very difficult book to read."
But he does have a few words for this moment. It is "painful" and it is an "ongoing stress," but he hesitates to call this pandemic a collective trauma.
"We need to be very precise," he said. "Because if we don't know what we are treating, we may give the wrong treatment."
Instead, he said this moment demanded a new term, a new language to fully encompass the scope of these circumstances.
"That's really what I'm encouraging us to do — to really identify what is making us all feel like we're barely hanging on," he said.
Warning signs and symptoms
Trauma usually presents months, sometimes years after an event, says Tamar Rodney, assistant professor at Johns Hopkins University School of Nursing.
She is already seeing symptoms on a small scale among some of her patients, although they are not "clinically significant." But she said that even as the pandemic eased, there was still a risk for trauma-related effects.
"We need to be paying attention to the warning signs, like irritability, trouble sleeping, drinking more than usual, fatigue, loss of joy," she said.
In other words, address the symptoms as they come.
"We do not need to get to full-blown anxiety or depression or PTSD before we deal with it," she said.
Evans agrees, especially because right now, there just isn't enough treatment to go around.
"We can't treat our way out of this," he said. "The magnitude of the problem is too large."
But there is a silver lining.
"People are paying more attention to mental health," Evans said. And he hopes this greater awareness of mental health issues will translate to more resources and investments.
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