A year into the pandemic, as virus concerns slowly move to the background amid the vaccine rollout, our undiagnosed parallel pandemic of anxiety, burnout, depression, stress, and trauma will hit hard front and center (for some of us, it already has). So Vogue caught up with Dr. Nadine Burke Harris, an expert in toxic stress who in 2019 became California’s first-ever state surgeon general and, by extension, one of the most powerful public health officials in the country. She’s just what we need now: a Fauci for a post-vaccine America. We discussed the #1 antidote to stress, parenting and partner debt, exactly what to do when the world is ending, and how to feel normal in these starkly abnormal times. This conversation has been edited for clarity.
As an expert on stress, trauma, adversity, and burnout, you must get people sharing their stress with you and asking the biggest question I’ve heard throughout this pandemic: Am I handling this okay? Am I okay? Who have I become? Am I normal?
For most people the answer is you're having a normal response to an extremely abnormal situation. I like to help people understand, for example, how the body responds to stress—things like difficulty sleeping, changes in mood, changes in appetite. I heard people were gaining something like an average of two pounds a month through the pandemic. The ‘COVID-15’ is a normal and predictable response to a stressor on this level. Even more challenging is that so many of the outlets from so many of our usual routines have been disrupted. The gym is closed. Church. Girls’ night out. Playing basketball with your pickup team. Even just hanging out with a loved one or a family member and being able to hug it out. There’s such a profound disruption not only to our routines, but also to our relationships. So, it’s really important for folks to understand that, number one: It’s not just in your head. There are really concrete reasons why a lot of people are feeling significantly more stressed. There was just a research study that came out in February from Kaiser Family Foundation that the number of people reporting being anxious or depressed went from 11 percent—in January to June 2019—to now, because of the pandemic, in January 2021, it was 41 percent. So that's just a massive jump. It’s not just in your head. There are real stressors. There are real reasons why so many people are feeling more stressed, more anxious, having trouble sleeping, putting on weight or for some people losing weight. What's really important about stress is that people understand that there's a lot that we can do about it.
This is exactly what I like about your approach. It isn't very Doomsday. It isn’t overwhelming. It’s actionable. You piecemeal it into doses of stress and doses of buffering. In that idea, burnout might be sort of like an accidental overdose of stress. Does our self-awareness of stressors overshadow our assessment of buffers and relief valves?
I like to be really active. I like to take very much of a strength-based approach and say, okay, we know that there are these risks out there because of all these stressors but let's start by looking at what we are doing right. What’s in my toolkit? What’s in my arsenal? For example, on a personal level, I have a really amazing bunch of girlfriends. We can literally not see each other for a year and I can call or text any of them like, “girl, lemme tell you what happened.” And they know me so well and they can walk me through the next three steps of what I’m afraid of, tell me why it’s going to be okay, and remind me of all the things that I know I can do to help myself and support myself. These trusted relationships—these connected, nurturing, trusted relationships are the #1 antidote to stress and adversity and I'm going to take that one step further, because you started this by asking ‘Am I normal?’ All it takes really is one person to feel normal. You could have just one person and that is enough, that person or those people in your life you can get really real with, you know? ‘I’m feeling awful right now.’ ‘I’m really worried about hurting myself.’ ‘I’m feeling so depressed.’ ‘I’m having a hard time getting out of bed.’ Trust enough to be able to be vulnerable with your people and to be able to ask for help when you need it. That is so important. Because there are real health consequences to this stress.
Are there any silent factors? Things we might not be thinking about as much as we should?
Many people recognize the effect of the pandemic on their mental health. We've seen huge increases in depression and anxiety, relapse of substance use and family discord. But many folks also don't realize how pandemic stress may affect other aspects of their health such as their sleep, their dental health—dentists are reporting record numbers of cracked teeth from jaw clenching—and other stress-related health problems like alopecia, which is hair falling out. Folks with chronic diseases that are worsened by stress, like diabetes and asthma, may find it harder to manage their health. That's why it's so important to include some strategies to combat stress hormones—like exercise, meditation or talking to a therapist—as part of their wellness routine.
I hear a lot of parents saying ‘My kid is 2 or 3 and that's when their brain is being shaped the most’ or they're nervous that their kid is growing up and they're going to be sort of stuck living a pandemic echo. You have four boys.
The youngest just turned five and the big twin boys just turned 18.
So you got both ends of it: on the flip side of worrying about infant and toddler development there are teenagers whose schools are almost hostile. Their prom is gone, their school musical is gone, their graduation is stopgap and make-do. Plus, we’re all sorta homeschooling now. Whatever the child’s age, there’s an anxiety that they’re getting spun on a different life trajectory because of how old they happened to be in 2020 or 2021. What did you do? How did you assess that? How did you act on it?
One of the silver linings of the pandemic was that, for example, I wasn't traveling as much as I usually do. My husband wasn't traveling as much as he usually does. And so we had more time home with the kids. When you're a parent and you sit down and ask your kids ‘How are you?’ you don’t always get the answer you’re looking for. But try checking in about the things that they really care about. Our big boys are super into sports. They were really disappointed that the sports seasons were limited or cancelled, especially at the beginning of the pandemic. And they also play sports, so their own getting together with their team and getting on the field—doing all the stuff that’s so important for them—was a big loss for them. So we were checking in not so much like ‘How are you?’ but more like ‘Did you hear what happened with that football player?’ or ‘Do you think the NBA bubble is really going to work?’ Drawing them out, bringing them into conversation about something they care about. It really helps to give you insight about how they’re coping with the challenges they’re dealing with.
You mentioned silver linings. People have been rethinking their careers in ways they wouldn't have before. They got a chance to step off the treadmill, even with social media. The fog of stress pre-pandemic was that there was so much going on that it all blurred together. Now, people have a sharper sense of things. That seems like something not to brush over.
It's important to find gratitude. There can be really difficult, painful, awful things that happen and almost invariably they come with these little nuggets that are just little Easter eggs that are really meaningful changes in the way that we look at things. For myself, you can imagine that being in the role of Surgeon General I thought my job was busy before. And then the pandemic just made it really, really clear that, oh, everything that was on my calendar got taken off my calendar. All that stuff that I was so busy doing and that couldn’t not be done, all of a sudden it was gone and was just pandemic all day every day. It was an amazing insight for me of what ‘have to’ means.
People used to say ‘You can’t work from home.’ Well, guess what? I have for a year, so that’s not a real thing anymore.
Often when we try to do these things that make us better—therapy or rehab or counseling, even just exercise or meditation—we get better and then we engage back into the stressful world. We wonder how to carry the good into the bad. Maybe I got better at cooking. Got into bath time. Got into gardening. Learned impulse control. How do I keep that? There’s almost a reverse of last spring’s anxiety coming up now like, oh, now I'm going to have to go back to the way things were. There’s light at the end of the tunnel, but we’ve made a kind of home for ourselves in that tunnel. We talk about this very traumatic shift ahead of us with this casually comfortable phrase of ‘returning to normal’ that cloaks how stressful it really is.
Yeah, that’s right. But another Easter egg of the pandemic is that just about every mental health practitioner in the United States of America now has Zoom or FaceTime visits, everything. Mental healthcare has probably never been more accessible. That’s something that a lot of people can integrate into their lives in terms of this re-entry and some of that re-entry anxiety. There’s an extraordinary opportunity for a lot of us now to calibrate where exactly feels good. Calibrating a certain amount of reconnecting with people, a certain amount of getting back out and engaging in activities that we previously engaged. Calibrating what feels good. And to actually feel that. Where does it feel good? And where does it get to feel like more than I want or more than I’m comfortable with? Mentally make a little mark with a Sharpie or something.
Pandemic, that is your side of the room! Stay on your side!
Really remember that. Write it down somewhere to say, when we had that opportunity to be still and to be more quiet, where was that natural boundary? Mark it down in indelible ink so that, when we need to recalibrate, we have that.
Self-care is hard for me. People scold me that I’m burning my candle at both ends—but always as if I'm the one lighting my candle when often it's my boss lighting my candle or my boyfriend or my governor has reopened too early and they're lighting my candle. And self-care exists in a ready-or-not world. Back to school, ready or not. Holidays, ready or not. Fly to a work conference, ready or not. So how can we think about these external forces more and not just put all the work on ourselves?
A part of it is looking at it and recognizing that those external forces are stressors and treating them like that, giving them the credit that we don’t often give. Recognize you have to—have to—deal with a stressful situation and know you need to create room to be able to do that. At the beginning of the pandemic, we were sprinting. We were working around the clock. There were days when it felt overwhelming and I remember thinking to myself that I need to give myself credit for the fact that I’m not just working a lot. I’m working a lot in a pandemic. It was a big thing for me to say, okay, there’s not a lot of give in my work life right now so I got so, sooooo deep into partner debt with my husband. You’re on again tonight. You’re putting the kids to bed. You’re making dinner. I had the tally in my mind and I was feeling awful about it and he just said, ‘Babe, you need to let me do this for you right now because you’re doing something that I can’t do, so you have to receive and you need to be okay with just receiving right now.’ With a partnership, you want to keep it balanced so nobody feels taken advantage of. So yeah, I’m going to be doing lots of favors for my husband for years to come because that man, wow, I’m not joking. It was hard for me.
You have a standing date night with your husband every Tuesday night.
We sure do. It was from before. We’ve always had that in our marriage. And in the pandemic we would literally pack a picnic, drive out to the side of some country road, and literally sit by the side of the road with an iPhone and one of those little speakers, sit on a blanket on the grass, play some music, and have a little picnic. Or maybe we would pick up some takeout from our favorite place. Maybe a little Sade. Get a little romance going. It was nuts. It was a hundred times more romantic than our typical date night because—I don't know if you've ever said this to anyone in a relationship, like, ‘If the world were to end I want to be with you.’ It was literally that and we are sitting here just chit-chatting like a bunch of kids from back in the day when you didn’t have any money and you couldn’t go out anywhere. We’re literally making the fun. You and me, a bottle of wine, some music, some food, and this is the fun. It was amazing.
I read that Barack Obama taught his daughters how to play Spades just so he could have people he could play Spades with in quarantine lockdown life.
[Laughs] That’s hilarious.
But hearing you talk about partner debt reminds me that the pandemic has been harder on women, especially moms. And women are often unseen or unattended in health. How much of a concern is that?
The pandemic put a lot of women in the impossible position of having to make choices between providing for their families economically and providing the support, stability and attention that children learning from home need. A disproportionate share of the household responsibilities is still falling on women, and the result is more women leaving the workforce. I'm especially concerned as we are reopening society because women, especially women of color, aren't experiencing the same recovery of jobs.
What can we do for people in need?
People have really been looking out for each other. I've seen so many situations of neighbors just delivering groceries to their neighbor. My mother-in-law had someone help deliver groceries. She’s in her seventies and wasn’t leaving the house, and there was a neighbor who just said, ‘Hey, send me your list and I’ll bring you the food.’ Little kindnesses like that just make such a huge difference. Just checking in with folks, even if it’s just by FaceTime or good old-fashioned landlines. You can keep your distance while still knocking on your neighbor’s door—especially for people who are single parents or someone who doesn’t have a family, or is single. Those little check-ins. Those ‘how are you’s. Those little ‘how can I help?’ I’ve seen the way that people have done that to extraordinary measure during the pandemic. And that’s something I hope doesn’t go away. I hope that it stays.
So much of this is feeling, I thought I’d ask about doing. Obviously people should watch your TED talk and read your book, The Deepest Well, but what are other books that you recommend to people?
Together by Vivek Murthy, the former U.S. Surgeon General. He wrote a book about loneliness and all the ways we can connect. It’s how we maintain connection in a world that can be really lonely. And I think if there's one thing that has really come out of this pandemic, it's this recognition that connection with others is a must-have. It's not a nice-to-have. It’s a need. It’s so fundamental. That's something that a lot of people are just recognizing when it goes away on a large scale. We recognize its absence. I think that’s really really really really critical.
I thought you were going to say Why Zebras Don’t Get Ulcers.
Oh my God, you know that's like one of my all-time favorite books ever. It really holds up. Rob Sapolsky is brilliant. I think he's a genius. But I’ve also noticed I've been reading more books that inspire me. I absolutely love this one called The Woman Behind the New Deal. It’s about Frances Perkins. The whole safety net. She created it as Labor secretary under FDR. It just shows the power for people to create change. All the stuff we have now: workplace safety and a 40-hour workweek and all that stuff.
Overtime! Social Security! Unemployment! Sprinklers!
Exactly. One of the things that happened in this pandemic is that employers who used to say, ‘No, you can't work from home’ now are like ‘Of course everybody can work from home.’ This is a moment when that type of sea change is happening. The world is changing and it’s been because of something terrible, but there’s also this opportunity for us to create change for good. And that’s what inspires me right now.
Are there just going to be glitches and snags in all of this? We shouldn’t expect all our answers and solutions to be perfect, so how do we let ourselves off the hook with that even as we commit ourselves to empathy and thinking outside of our norms?
You’re going to get it wrong sometimes. Have enough grace for yourself. Forgive yourself enough. Know you’re doing your best and you’re not going to get it right every time. That is what gives us the space to be open to when we don’t get it right. If you feel like you have to be perfect and someone tells you that you made a mistake, you feel bad about yourself. I just assume I’m making mistakes, like, all the time. [Laughs]
Oh my God, that’s me! You’re in my head! [Laughs] Get out of my head! Get out of my head!
I’m grateful when people point it out to me. We are creating a space for folks to make it okay not to be okay right now. The thing I keep saying over and over again about this pandemic is that, if it feels hard, that’s because it’s hard. It’s a once-in-a-hundred-years global pandemic! If it feels difficult, that’s appropriate.
That once-in-a-hundred-years part is so tough because what happens the next time a normal sniffle is making the rounds? I could see people almost having pandemic flashbacks.
A lot of people will be super triggered, yeah. We’ll all be very triggered for sure.
Is that just part of it?
That’s just part of it! That’s what happens! It’s something that we can anticipate that is really common and it's something that we can prepare for. And I think that one of the ways that we prepare for it is, again, going back to asking: What are our buffers? How do we support ourselves? What is our network of support? So when I’m freaking out over sniffles, who is my support system? Who do I call?
This is the difference between mental health, which is like going to the hospital with a broken leg, and what could be called mental fitness, which is more like hitting the gym to prevent frailty. We are not good at building mental fitness into our life and our day.
As you know, all the work that we've been doing in California with ACEs Aware and screening for trauma and adversity and all this stuff, the notion of moving from a frame of being reactive to being preventive—to doing prevention, early detection, and early intervention—is such a frame shift for so many people when it comes to thinking about mental health and mental well-being. I've just spent the last year battling COVID-19 and ultimately it's obvious our focus is on vaccines because it's about preventing the spread. But when I talk to people about screening for ACEs and responding early with evidence-based care people say, ‘Well, you can't screen for ACEs because there aren't enough licensed therapists for everyone who has experienced trauma.’ So, okay, is the answer just to leave people with no plan? No help?
Now that we’re talking about ACEs [Adverse Childhood Experiences], people are going to look up online what that is. Is that something you advise for self-diagnosis?
I advise people doing that and then talking to their doctor.
Will a typical doctor know what ACEs is?
Well, if they are a doctor in California they would because we just trained 20,000 healthcare providers on what are ACEs: What does it mean for health? How do we support people? And what does the best evidence say? But in terms of nationally, this is the thing that’s really nice: the training we’ve created for California is free for any doctor and any healthcare provider around the country. You don’t have to be from California. But we definitely have a ways to go. And this is a bit my mission in life because we know that ACEs trauma affect our health—our physical health, our mental health, our functioning, how we parent, how we show up at work, all of the above and yet, exactly to your point, when folks recognize and understand what’s happening they’re kind of left to fend for themselves. But this new understanding we have is as big as germ theory was. It is the root of the root. It is so fundamental and it helps people understand the whys. We see how the intergenerational cycle of trauma happens—of adversity and stress and trauma. We launched this ACEs training in January of 2020 in California. And then in March there was a pandemic. We still managed to train all those people in the middle of a pandemic because this information has never been more important or more relevant. That’s what the Roadmap to Resilience report was about. We are in the greatest crisis of stress, isolation, adversity, and trauma that most of us have known across multiple generations. But now we have the right tools. And we can actually prevent that generational harm. We can apply this science now to that two-year-old who hasn’t been around anyone except for their parents, or that teenager who missed their entire senior year of high school.
When was a moment your own trajectory veered off-course in this pandemic?
In January in the middle of the surge when it was really really really bad and I had just worked through what had been supposed to be a scheduled family vacation and then wasn’t, my meditation had slacked off. So, I normally get up at 5 a.m. and I just committed to getting up at 4:30 a.m. and hell or high water I was going to do a meditation. That act was really what kept me sane and functional in those worst, worst, worst moments. When I started doing that and doing it really regularly, I got my brain back. Your brain just gets caught up in the stress and I got my brain back. I got my ability to self-regulate back. I was able to land in myself again. I had been working through lunch every day and I told my assistant I’m going for a walk every day at 1 p.m. I can schedule a meeting then but I’m going to be walking while I’m talking to the person. It was like someone had put an oxygen mask on me and just brought me back to life.
I love that: ‘Land in myself again.’ I love that because a lot of people feel like they atrophied in this pandemic. ‘I don't feel so smart anymore.’ Or ‘I don't feel so strong.’ ‘I don't feel so vital.’ It robs your mojo when you feel so diminished and humbled and maybe even humiliated. But it’s good to have a little more armor in these daily battles.
Exercise, nutrition, mindfulness, mental health, healthy relationships, access to nature. Those are the things.
[Laughs] And Sade. Love me some Sade.
I’ll italicize it.
[Laughs] For real!