The end of COVID is in sight but there are still months to go. Maybe you have been struggling with getting things done while working from home and de facto homeschooling your kids. Perhaps you’re feeling cooped up after a year of going only from your home to the grocery store and work. Or, maybe you’re chronically exhausted from the constant mental strain of the year and find yourself mindlessly surfing on your phone and avoiding the tasks you had planned to do more often. How can we persevere when our strength has been collectively sapped over the last year and our sense of grief at what has been lost will persist even when isolation and distancing are over?

To answer this, I’ve turned to three very different physicians and scientists. Here are practical ideas drawn from their wisdom, expertise, experience, and experiments for how to persevere through our current and future challenges.

1. Create meaning –  Viktor Frankl’s book, Man’s Search for Meaning, easily ranks on the list of top five life-changing books for me. In it, Frankl, an Austrian psychiatrist and holocaust survivor, explores what allowed some individuals to survive the unthinkable conditions of concentration camps without losing their humanity or giving up hope. After his liberation, he formalized his findings into a form of psychotherapy called logotherapy, from the Greek logos, or meaning/reason. He observed that when his fellow inmates were able to maintain a sense of meaning for their lives despite having been stripped of everything else: their wealth, connections, family, belongings, homes, clothing, health, and freedom, that they were able to maintain hope and their sense of self. He explains: “Logotherapy is composed of three basic principles. The first basic principle is that life has meaning in all circumstances, even despondent ones. The second principle is that the main motivational force is the desire to find meaning in life. Lastly, the third basic principle states that humanity has the freedom of attitudinal choice, even in situations of unchangeable affliction.”

Frankl articulated three main ways in which individuals create meaning for themselves even in the worst possible circumstances. Consider which one resonates most with you and how you could focus your energy on creating more meaning in that area.

i) Creative. This is through creating new things, whether it’s writing, or creating new online content, or creating new programs, or designing new ways of teaching, new care delivery models, or new protocols.  

ii) Experiential. He talks about how one evening in one of the camps, there was a beautiful sunset and the inmates called to each other to come outside and see it. They were able to find meaning through the experience of beauty in that moment even with all the horror going on around them. Experiential meaning can come from the experience of beauty in nature, music, art, or in the experience of inter-personal relationships and connections.

iii) Attitudinal. I think of this as the warrior mindset. You find meaning through being brave. You find meaning through courage, through the attitudes that you display, and the person that you are in the face of challenges.

So reflect on this: How do you find meaning in your life? When we don’t have meaning in our lives, we have an existential vacuum. Just like in physics, vacuums quickly get filled up. We tend to fill up our existential vacuum with other things: distractions, easy work, mindless entertainment, or unneeded food or alcohol.

We can create meaning even in the worst circumstances by bearing witness to our uniquely human potential.

We must never forget that we may also find meaning in life even when confronted with a hopeless situation, when facing a fate that cannot be changed. For what then matters is to bear witness to the uniquely human potential at its best, which is to transform a personal tragedy into a triumph, to turn one’s predicament into a human achievement. When we are no longer able to change a situation… we are challenged to change ourselves.

Viktor frankl

2. Combat ego-depletion. It takes energy to create meaning, to turn our tendencies towards despair and inaction into hope and action. It also takes energy to do difficult things. When you’re on a diet, have you noticed how you may be able to have a small, healthy breakfast and lunch, but then after dinner you have no willpower left and you indulge in ice-cream, brownies, wine, and Netflix? The reason for that, the psychology literature tells us, is because we have a finite amount of willpower.

Roy Baumeister has written many of the articles on the topic, and they’re summarized well in his book, Willpower: Rediscovering the Greatest Human Strength. The experiments show that when we exert willpower in one area, whether that’s at work or dealing with children’s school at home, it drains the willpower we have available to us for all other areas. I think of it like a pitcher. You have a finite amount of willpower, and as you use it, you’re pouring it out. By the end of the day, you’re in a state called ‘ego-depletion’. Your willpower pitcher is empty. In that state you both feel temptations more keenly and you have less ability to resist them. So, you indulge, collapse in bed, and vow to do better the next day, only to repeat the cycle.

To break the cycle of constant, complete ego-depletion, first, understand and notice what depletes and what restores your willpower pitcher. Resisting temptations depletes willpower. Removing temptations from your notice can preserve your willpower. For me, this means turning off notifications on my computer when I’m working so that I’m not tempted by their easy distractions. I turn off my phone or watch while working. I put the cookies in the pantry, so I’m not tempted by them. All of these small actions reduce my willpower expenditures throughout the day.

You also have to restore your willpower pitcher. That means taking time to do things that bring you joy. For me, exercising, being outside, connecting with friends, baking with my kids, or reading a good book restore my willpower. Self-care is not about mindless or selfish “ME-TIME,” it’s about meaningfully restoring your sense of self and your ability to continue to do difficult things.

3. Connect – One of the cruelest aspects of COVID is that it hamstrung our ability to cope with difficulties by isolating us from the very friends and family we usually lean on for support. It amplified and exacerbated the sense of loneliness and isolation that was already rampant. Prior to COVID about half of Americans reporting feeling lonely. Loneliness leads to worse performance at work, with 16% lower profits, 37% higher absenteeism, and 49% more accidents. In addition, the health effects of loneliness are staggering, with 30% higher rates of coronary artery disease, and negative effects on longevity that are equivalent to or worse than those caused obesity, drinking, or smoking.

I found that people who struggle with loneliness, that that’s associated with an increased risk of heart disease, dementia, depression, anxiety, sleep disturbances and even premature death.

Vivek murthy to npr

Vivek Murthy, the former and current surgeon general, wrote a timely book about the importance of connection, called Together: The Healing Power of Human Connection in a Sometimes Lonely World, released presciently in April 2020. In it he explains the importance of creating connection to our health and ability to thrive and overcome challenges. He argues that loneliness undergirds many of our current public health crises, such as alcohol and drug addiction, violence, depression, and anxiety. Often there is a sense of shame around loneliness. We avoid admitting to others and to ourselves that we are lonely because we thank that could mean we are unlikable or deficient. Instead, think of that feeling of loneliness as an indicator light reminding you to ‘refill your tank’ and spend more time meaningfully with others.

To combat loneliness and create connections, Murthy exhorts individuals to spend time with others each day in a meaningful way, giving them your full attention rather than trying to multi-task or scroll on your phone. He also encourages us to create connections through service to others and to understand ourselves better through intentional time in solitude or meditation.

Think about your own life. How much of an existential vacuum do you feel? How can you instead create more meaning? Do you feel constantly drained and in a state of ego-depletion? How can you protect and preserve your willpower and also refill your pitcher more frequently? How isolated or lonely have you felt? Where can you connect meaningfully with others through your work, home, or service?

We persevere better together. Join me, on a quest to constantly create more meaning, restore our sense of self, and foster intentional connections.

A version of this post was first published here on the medical blog, KevinMD.