Anxious about post-COVID life? You may have 'cave syndrome'

April 11, 2021 3:30 AM PT

A few weeks ago I wrote a column in which I briefly referred to the concept of “cave syndrome.” The term was coined by a psychiatrist in Florida to describe people who are feeling scared or unwilling to reenter post-pandemic society — even after being vaccinated — because they have grown too accustomed to isolation.

I mentioned it only in passing, having heard something about it on a local news broadcast. But when the column appeared, I was surprised by how many people wrote or spoke to me about it, saying it was something they were experiencing themselves.

“Thanks for giving me a name for how I’m feeling,” wrote one woman. “I love it when something has a name.”

Another reader said she was grateful to know she was not alone. “Simply knowing others have this reaction too makes it less overwhelming emotionally.”

At first it seemed odd to me that “cave syndrome” struck such a chord, until I realized that I was having some of these feelings myself. I’m not a person who suffers from social anxiety; I’m not particularly shy or introverted. But I too feel a measure of discomfort at the idea of being back in the same physical space with other people — in a restaurant or at the office or in a store or a subway car. Some of it is a result of not knowing for sure what is safe and what isn’t, but some of it is also about the return to the social status quo ante after more than a year of extremely limited interaction.

I began asking around. Dr. Michael Dulchin, a psychiatrist at Union Square Practice in New York, told me he has lots of patients who are reluctant to go back into the world, or at least are ambivalent about it. Some of them, he says, had actually felt relieved by the pandemic — by the respite from a competitive office, say, or the enforced hiatus from society, or the ability to put off decisions about the future. Some now dread resuming their soul-killing commute, or putting on an outfit for work and being judged for it, or simply reentering the rat race.

Jenny Taitz, a clinical psychologist and assistant professor at UCLA, says some people feel ashamed of how they spent their year. Perhaps instead of learning French, they just moped and drank too much and are embarrassed to acknowledge that to their peers. Perhaps they gained weight and now don’t want to face their co-workers.

Those who suffered from social anxiety before the pandemic are particularly fearful about reentry and the ever-present possibility of rejection or humiliation. But it’s not just people with preexisting phobias who are feeling conflicted.

“It makes so much sense to feel anxious right now,” says Taitz. “These are very extraordinary circumstances.”

Dr. Arthur Bregman, the Florida psychiatrist who says he came up with the term “cave syndrome,” agrees that it affects both introverts and extroverts. “Does this mean that you are mentally ill for liking the comfort of working from home and less social obligations? Not necessarily,” he wrote in an essay. “But the danger is in getting overly attached to the point where it interferes with life even in the face of a return to normalcy.”

I don’t think anyone was particularly surprised to learn over the last year that the pandemic was taking a toll not just on our economy and on our fatality rates but on our mental health as well. Of course it would. It’s abnormal to maintain a distance of six feet from one’s fellow humans. It’s unnatural to avoid touching. It’s unheard of for schoolchildren or college students or young adults not to have daily, in-person interaction with their peers. It’s downright weird to have dates over Zoom.

So it was no surprise when the U.S. Census Bureau announced at the end of 2020 that more than one-third of Americans surveyed reported symptoms of anxiety or depression, a substantial increase from the previous year. The numbers were substantially higher for young people living alone.

It’s a little less obvious why the end of the pandemic (assuming that’s what we’re coming to) would be traumatic as well. But coming out of isolation is difficult in its own way. Transitions can be hard, even when they’re what we want. Some inmates coming out of prison, for example, feel high levels of stress and anxiety.

In a February survey by the American Psychological Assn., 49% of adults said they felt uneasy about adjusting to in-person interactions when the pandemic ends. Some 46% said they do not feel comfortable going back to living life like they used to before the pandemic. Adults who had received a COVID-19 vaccine were just as likely to give those answers as those who had not been vaccinated.

A measure of ambivalence or even fear strikes me as perfectly natural. The therapists I spoke to, though, cautioned that people shouldn’t give in to it. Sure, you should follow guidance from the Centers for Disease Control and Prevention, and from local health officials as well. But don’t postpone reentry out of fear. Anxiety, Taitz says, feeds on avoidance.

“For people who have these sensitivities, it’s time to put your armor back on,” said Dulchin.

Remember the prisoners in Plato’s allegory who have been imprisoned in a cave, seeing only shadows on the wall? They begin to believe the shadows are reality. Even when one prisoner is freed and can see the real moon and sun, he can’t convince the others that they’re seeing only a facsimile of the world, not the world itself.

They were the original cave syndrome sufferers. Let’s not follow their example.

@Nick_Goldberg