Reopening, Immunocompromised Individuals, And Stigma

As stay at home orders ease and New York phases into re-opening, a percentage of the population is feeling especially anxious: those of us who are immunocompromised.

New York City is one of the hardest places to social distance. Most of us regularly commute by way of public transportation, as cabs and car services equal traffic and high cost. We walk on the streets amidst crowds; we use elevators and laundry rooms. It’s difficult to imagine how to navigate returning to the workplace and spending much wanted time with friends.

Additionally, if social distancing stops being something everyone is expected to do, and becomes something only "other people" have to do, will employers favor those who are lower-risk? What should we do to ensure that people aren't penalized for needing to stay home for longer than the rest of the population?

How to be supportive of people who are immunocompromised:

1.  You likely have a friend who is immunocompromised, but you may not know it.

Don’t take it personally if someone you care about declines invitations to hang out. They might want to spend time with you, but doing so would put them at serious risk.

People who are immunocompromised already self-criticize and are likely feeling guilty about missing much needed time with loved ones. Instead of digging for information and asking why, be supportive and understanding. Saying something such as “Aw, we’ll miss you. Is there another way we could catch up?” can go a long way.

2.    There is a dilemma regarding self-disclosure.

Many people do not want to disclose that they are immunocompromised for fear of being judged or “othered”.

These fears are valid.

Let’s remember that diagnoses which can render someone immunocompromised have a long history of stigmatization -- especially HIV. They can also involve parts of our bodies and bodily functions that we don’t particularly want to discuss.

While this dilemma is nothing new, it becomes especially relevant in the wake of COVID-19, where exposure can be deadly. When supervisors expect their employees to return to the workplace, those with compromised immune systems may feel forced to disclose their health diagnosis when they do not want to. Being immunocompromised in a post-COVID world makes job options more limited than they were before.

The state and city have urged employers to be flexible. Hopefully, this will be a reality.  

If you are immunocompromised and anxious about NYC reopening:

1. There is a connection between our minds and our bodies.

Anxiety can negatively affect physical health especially as it relates to blood pressure, breathing, and GI issues.

If you are experiencing anxiety about the phasing-in process, therapy can be a huge help. As therapists, we are trained to be caring and nonjudgmental, and to keep what is discussed in session confidential. It’s our job to provide you with a safe holding environment where you feel cared for.

What’s more, therapy can be done completely online. This means you can receive support from wherever you feel safest and most comfortable.

There has unfortunately been an old-time belief that online therapy is somehow less effective than in-person therapy. These assumptions are not grounded in evidence. We know from multiple studies and personal testimonies that online therapy is effective and legitimate. It’s also not a new medium of providing therapy, as therapists have been conducting telehealth for years, long before the COVID epidemic struck.

Many therapists who previously had a brick and mortar office are now choosing to continue practicing telehealth because they’ve seen how well it works, and the number of therapists offering online sessions will only continue to increase.

2.    While the risk of becoming seriously ill is an unfortunate reality for people who are immunocompromised, suffering from severe anxiety doesn’t have to be.

There are tools you can utilize to alleviate anxiety, which can in turn improve your health.

Breathing.

Breathing is a tool you can use in any place and at any time without needing something tangible.

An easy breathing technique to start with is square breathing, also known as the 4x4 technique. Take 4 deep, controlled breaths in through your nose and out through the mouth. Count to 4 on your breath in, hold your breath for 4 seconds, breath out for 4 seconds, wait 4 seconds, then repeat.

A nighttime calming ritual.

Anxiety is often at its worst during bedtime, when a lack of structure and distraction can lead to catastrophizing. This anxiety results in lack of sleep, and sleep deprivation decreases immunity.

Try listening to a recorded, guided meditation to calm down before going to sleep. This can include a soothing sound, such as rain or ocean waves. Utilize objects that incorporate scent and touch which you enjoy, such as rubbing your hands, feet, and chest with scented lotion.

Writing.

Writing is a cathartic exercise. It helps us to visualize what’s going on internally and be more reflective. Try journaling your thoughts and feelings. Notice when your anxiety is highest, and when it’s lower.

As a person with a chronic illness, I have personally experienced how a diagnosis can affect both work and social circles. When I take a look at my life, I see a clear distinction between what it was like before my diagnosis and what it was like afterwards. I could no longer be the young adult partying in the way my friends expected me to -- drinking alcohol through the night or staying out late when I wasn’t feeling well. When searching for work, I had to take certain things into consideration that I hadn’t before (proximity to a restroom, work schedule flexibility, work from home options). I am thankful that I have since found ways to navigate this and embrace a new kind of life which is still abundant.  

Please remember that if you are immunocompromised, you are not alone. You are likely not the only person amongst your friend circle, in your building, or in your neighborhood who is immunocompromised. Reach out to people and resources whom you trust. If you are feeling anxious or discouraged about your illness, seek out a therapist for help. Most importantly, take care of yourself.