Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 375
  • Home
  • Print this page
  • Email this page

 Table of Contents  
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 134-135

It's all in your head

Department of Psychiatry, St. Luke's University Health Network, Easton, PA, USA

Date of Submission14-Apr-2020
Date of Acceptance06-May-2020
Date of Web Publication29-Jun-2020

Correspondence Address:
Dr. Christine Marchionni
St. Luke's University Health Network, 1700 St Luke's Blvd, Easton, PA 18045
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJAM.IJAM_33_20

Rights and Permissions

How to cite this article:
Marchionni C. It's all in your head. Int J Acad Med 2020;6:134-5

How to cite this URL:
Marchionni C. It's all in your head. Int J Acad Med [serial online] 2020 [cited 2022 Dec 10];6:134-5. Available from: https://www.ijam-web.org/text.asp?2020/6/2/134/287952

We get exposed to illness every day in medical care, but being in psychiatry, I get to have some distance from physical ailments (“no touching!”) and associated health-care risks as opposed to my husband who works in critical care. In the hospital, I provide emotional support to peers, to trainees, and to patients. I would dare not say “it's all in your head” to them when they are expressing anxiety or distress over the pandemic. I have recently seen more and more patients after suicidal attempts solely due to the new anxiety and despair caused by the COVID-19 and real financial losses due to the pandemic and the subsequent social disruption. But, when I get home and my husband is complaining of cough (and night sweats, stiff neck, shortness of breath (SOB), chest pain (CP), nausea, you name it I heard it), my first instinct is to withdraw “it's all in your head.” Why does my empathy, my compassion, and my patient-centered care end as I get home? Why do I utter the very thing that makes me cringe when I hear it come from a colleague's mouth to a person I love, value, and support? Seeing someone who I admire as a physician, as a man, and as a husband become worried about the unknown, unseen pandemic that has altered our lives and the US health-care system has made me have the counter reaction of pushing away, to protect myself from having to think of the possibility either one of us could be counted among the health-care workers who succumbed.

”It's all in your head”

I was away at a conference when the pandemic was still far away from home and not something that would impact us. By the time I returned home, it was creeping Eastward, but still not something that we would need to worry. Then came the school closings, the shelter in place order, the restriction on visitors on the inpatient units, the donated masks, the need to change rotations for residents and students, the end of sports…. I began playing out and observing the stages of grief on the personal level and on the global level. While I was away, I was in denial since I was at a conference and it was not impacting me. I was angry that our family trip would need to be cancelled. I bargained that had I not gone away for a trip, then my family would be better mentally prepared for the changes we are now faced with.

”It's all in your head”

”Optimistic bias,” or “unrealistic optimism,” shows that people systematically underestimate their risk of succumbing to threats.[1] Overestimating ones' control over events is thought to increase optimism because people believe that if they have the ability to control future outcomes, they can steer themselves in the right direction. While healthy individuals tend to overestimate the extent of control they have over events, depressed individuals do not show this tendency.[2] Perhaps, when we focus on the constant news cycle, we feel as if we have control; the frustration at work with changing protocols makes us feel as if we care losing that control and the cycle continues. I was joking with peers, I was safe in the fact I am in a field that can use telemedicine easily, that does not have as much contact with the virus given the need for medical clearance for our psychiatric inpatients. I tried to project the optimism, tried to convince myself of it.

”It's all in your head”

Then came living during the rule out – with his persistent symptoms and his contact with known patients in the intensive care unit (ICU) he was tested for COVID. I would wake up hearing the sound of the thermometer, checking his temperature in the middle of the night three times. I would be asked to touch his face to check for a fever. Now, I would practice social distancing in my own home to avoid having to listen to his complaints and would leave to sleep in another room. I am now in the depression stage, this is not how I expected my life to now be. I am blessed that my loved ones are healthy, I am healthy, I have a job I loves that lets me leave my house every day, and I am going to stay employed but I am unable to avoid this virus. It has insinuated itself into all parts of life. Having to change my work flow, alter my rotations for my residents due to the virus is a part of the job and I adapted. But, being unable to escape the virus when I get home is too much to bear. I take up different exercises, I try online therapy, I forgo intermittent fasting, but nothing lets me escape the feeling of hopelessness. I avoid going home. Can you imagine wanting to stay in a hospital during a pandemic rather than going home? I know how to be a psychiatrist, I do not know how to deal with a pending potential positive result in my husband.

”It's all in your head”

I have mentioned four of the stages of grief. I am grasping for acceptance. I try daily to reach it but have yet to get there. When I think it has arrived, when the test result was negative, there was fleeting relief and happiness. But, now, he is rotating in the ICU again, my interns have to see more COVID patients, and I have to staff consults on COVID-positive patients. It is inescapable. We enter our home through the basement, we go right to the shower and can't hug our boy until we scrub down. My 6 year old now asks “can I see my friend after the virus?” and wants to look at the pictures of COVID-19 online. What I need to accept is my projection of my fears and anxieties onto my husband is keeping me from finally completing my stages of grief. It is keeping me from being able to find relief at home and having some semblance of home life and separation from work. It is keeping me from being vulnerable and supportive.

”It's all in my head”

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research

The author of this manuscript declares that this scholarly work complies with reporting quality, formatting, and reproducibility guidelines set forth by the EQUATOR Network (http://www.equator-network.org). Within the broader context of narrative medicine, this article discusses individual stories and patient encounters as integral aspects of the lived experience of health and illness.

  References Top

Sharot T. The optimism bias. Curr Biol 2011;21:R941-5.  Back to cited text no. 1
Helweg-Larsen M, Shepperd JA. Do moderators of the optimistic bias affect personal or target risk estimates? A review of the literature. Personality Soc Psychol Rev 2001;5:74-95.  Back to cited text no. 2


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article

 Article Access Statistics
    PDF Downloaded63    
    Comments [Add]    

Recommend this journal