Who Is "Essential" to Our Covid-19 World

"When he first came home, it was tough." So Aleha, the wife of an airman in Colorado, told me. She was describing her family's life since her husband, who lives with chronic depression, completed a partial hospitalization program and, in March, along with other members of his unit, entered a pandemic lockdown. He was now spending full days at home with her and their four children, which offered needed family time and rest from the daily rigors of training. Yet the military's pandemic lockdown had its challenges as well. Aside from weekly online sessions with his therapist (the third the military had assigned him in so many weeks), Aleha was left to provide her husband with needed emotional support, while homeschooling their older children and caring for their toddler.

Her husband, like the other 1.3 million active-duty service members in the United States, faces what most of the rest of the country is facing: orders to stay at home and distance themselves from those outside their households to prevent the spread of the novel coronavirus that has killed more than 82,000 Americans and more than 295,000 people worldwide.

It's striking how little effort our military's high command has put into understanding the effects of national crises on the health of military families.

Yet there's something distinctive about what members of the American military (whose suicide rates now surpass civilian ones) face: the stress posed by the threat of the most literal "front-line service" in these times of endless war and pandemic. They find themselves in uniform in an era of more frequent deployments and longer training days. Even in pre-pandemic times, they needed the support of psychiatrists and therapists like me and of their military community, including commanders whose default approach to mental-health problems has often been to coach them on what not to say to avoid being medically disqualified from duty.

Troops and their families have needed access to supportive social groups, including religious ones, antidepressants and other mood medications, and off-base mental-health providers who can counsel them in a more unbiased way. In many cases, they also need access to inpatient facilities for when the going gets really rough.

In the past months, daily life for our troops and their families has been transformed in previously almost unimaginable ways. For example, many new recruits are now quarantined when they arrive at military bases. Physical training is staggered and conducted in smaller groups. Given bans on movement, military spouses and kids scheduled to relocate (a common enough phenomenon in such a life) or families with a member deployed elsewhere in the world are living in striking states of isolation and uncertainty. They are increasingly unsure when they will see loved ones again or where they will live or study in the months to come. How starkly Covid-19 restrictions can affect already vulnerable members of the military was highlighted by the suicides of two students at the U.S. Air Force Academy last month. Those deaths came after that school's leadership decided to place the 1,000 seniors still on campus in single rooms, the equivalent of solitary confinement, for weeks on end to prevent the spread of Covid-19.

It's striking how little effort our military's high command has put into understanding the effects of national crises on the health of military families. After all, though it's seldom mentioned, such spouses and other family members have been subject to the same job losses, homeschooling issues, and lack of childcare as other Americans amid a spreading pandemic--and all of this has only been heightened by the loss of local social connections due to frequent moves.

In addition, as in the society at large, within military communities inequalities abound. The government has deemed both my husband, a naval officer, and Aleha's husband "essential workers." That means my husband must go into the Pentagon a few days a month right now to handle mysterious--to me, at least--matters related to our country's nuclear arsenal. In return for this modest risk to his own and our family's health, my "essential" husband is otherwise able to watch our kids almost full time while I pursue my work as a mental-health therapist from home. Our privilege in rank and pay places me in a very different position from the spouses of enlisted troops.

Social Distancing in a Mental-Health Crisis

Despite that position of privilege, given my work, I have a strong sense of how this national crisis has deepened existing social inequalities. In 2011, along with Catherine Lutz and Neta Crawford, I co-founded the Costs of War Project, a nonpartisan, multidisciplinary team of academic, health care, and legal experts who continue to analyze the costs of the U.S. decision to respond to the 9/11 attacks with full-scale military action, including the opportunities missed to invest in critical domestic areas like health care. I'm also a therapist who specializes in trauma-focused care for military veterans and their families, refugees, and immigrants to the United States, many of whom have been affected by armed conflicts in their homelands.

In addition, as a Navy spouse and mother of two young children who has completed four military-related moves in the course of my husband's career as a submariner, I know what social isolation and uncertainty can feel like and how they can affect the human psyche. I'm aware as well that, as the Covid-19 crisis drags on and more troops fall ill, my spouse could be sent back to sea or to one of the many increasingly Covid-19-destabilized places where our military has a presence or is fighting what are increasingly pandemic wars.

And believe me, when you're alone during a spouse's deployment, even in the best of times, which these aren't, the shit can hit the fan remarkably fast. In 2017, for instance, while my husband was at sea and out of contact, I contracted a nasty, vaccine-resistant version of the flu. I was single-parenting two toddlers and found myself Ubering with my children to the ER at three in the morning because I had a fast-rising fever that made walking, let alone lifting a baby, difficult.

A neighbor, the divorced wife of a Navy veteran, left Campbell's soup on our doorstep but shied away from taking my children long enough for me to get care. This was at a moment when my husband's ship commander (who could only be described as a "toxic leader") threatened spouses who frequented anything but command-sanctioned Family Readiness Groups, formed to support troops during deployments. This made it that much less likely that wives like me in that military community would establish friendships strong enough to lead someone to take a chance on helping a sick friend.

If an experience as fleeting and minor as mine felt as trying as it did, then what have the family members of the crew of the aircraft carrier, U.S.S. Theodore Roosevelt, more than 1,000 of whom tested positive for Covid-19 recently, experienced in their moments of need? During my own mini-drama with the flu, I continued to receive emails from the command's volunteer ombudsperson, herself the wife of an enlisted sailor, reminding me of my "essential role" in national security. Spouses like me were not to even think about writing our husbands concerning our own problems, including illnesses, lest we distress them and so endanger national security. I wonder if the spouses of the infected crew members of the Roosevelt felt similarly "protected" by a naval leadership that refuses to disclose significant information about the well-being of their loved ones, even as they no doubt struggle with the spread of this virus, too.

In our gender- and class-stratified society, you are usually deemed "essential" only when those in power feel they truly need you. The rest of us non-essentials are seldom sufficiently protected, valued, or seen, and in truth that turns out to be the reality for most essentials as well. (If you don't believe me, just check out the conditions in any meat-processingplant still open in your state.)

It's no secret anymore that one casualty of our national "war" against this pandemic is a mental-health crisis on a staggering scale. Among therapists like myself, it's widely known that being in a community where you feel you're a contributor offers genuine protection when it comes to suicidal urges. Among people I know who work in low-paid staff jobs where social distancing is impossible, the difference between feeling depressed and hopeless and having the energy to get to the next day is often the conviction that you're appreciated by coworkers and those you are helping.

One way of getting recognition for your struggles at work and elsewhere today is through group therapy and support. I've seen this firsthand at the community mental health clinic where I work, while also dealing with veterans struggling with post-traumatic stress disorder. Speaking in face-to-face groups gives you the opportunity to feel supported even as you support others. And in the social-distancing era of Covid-19, because so much communication is nonverbal and Zoom therapy captures only talking heads, such methods may be losing their power.

This makes military spouses, as well as janitors, medical aides, nurses, doctors, and care workers of every sort who must encounter people with health crises on a daily basis, so vital to our current struggle against this virus. They provide medical help, of course, but also deeply needed support at a moment when social distancing has placed on pause many other outlets for it.

The Essential, the Vulnerable, and the Unseen

Much ink has been spilled recently on the heroic nature of such care workers, and for good reason. They're up against an invisible pathogen and a president who empowers his supporters to shun the advice of medical professionals and scientists--including his own. A recent image of a masked retired surgeon with a homemade sign ("You have no 'right' to put us all at risk. Go home!") standing in front of a car to register his disagreement with last month's (largely white) anti-lockdown pro-Trump protests in Richmond, Virginia, catches the essence of this conflict.

Many of the tasks most vital to stemming this epidemic are going to be performed by low-paid workers with the least access to decent housing in which to socially distance themselves and to the money and social connections that would link them to the best medical advice.

I recently spoke with a young woman of color who cried when she saw that very image, because a family member of hers is a cafeteria worker in a military hospital ward treating Covid-19 patients. "People don't realize how their protests affect my family," she told me, explaining that they could be susceptible to any wave of Covid-19 infection resulting from such thoughtless protests. Yet none of her family members had either the knowledge, money, or connections to get the best health care, if infected. In an age of growing division between hospitals with ample funding, supplies, and staffing, and those where doctors, driven by a manufactured scarcity, are making arbitrary and discriminatory decisions about who deserves life-saving care, I understand her anguish.

As anti-poverty activist Liz Theoharis has pointed out, many of the tasks most vital to stemming this epidemic are going to be performed by low-paid workers with the least access to decent housing in which to socially distance themselves and to the money and social connections that would link them to the best medical advice. How can this country care for those the powers-that-be deem "essential," like doctors and military personnel, when we don't care for those who care for them? Similarly, you would have to include not just therapists like me, who find ourselves supporting an ever-more-isolated, stir-crazy, and stressed-out populace, but also the staff members and janitors who help us and clean our offices.

In the military, you would also have to include spouses homeschooling their kids (including those with special needs) while working or struggling to figure out how to pay their bills. Caring for all such people is important not just because the value of a human being should be absolute, whether you're essential or not, but because, in this pandemic world of ours, devaluing anyone's life will have consequences for us all.

The Costs of War, Pandemic-Version

In a recent op-ed, Costs of War Project co-directors Catherine Lutz and Neta Crawford argued that, no matter what President Trump says, we're not in a "war" against the coronavirus. War did, however, play a crucial role in getting us into this mess.

As this invisible pathogen spreads across much of the world, what families like mine worry about is that our nation's ever-expanding global conflicts will only continue to grow in scope and intensity, threatening food and medical supply chains.

Congress has allocated an average of $230 billion dollars annually to waging our hopeless wars in Afghanistan and Iraq, while only a microscopic fraction of such moneys have been going into health care and education at home. Costs of War Project economist Heidi Garrett-Peltier showed that, had this country invested the same amount of money in health care rather than its forever wars, twice the number of jobs would have been created and that's no small thing at a moment when the U.S. faces a dire shortage of doctors--more than 9,000 health-care workers have already been infected by Covid-19 -- and physicians are being called out of retirement in order to serve.

If there's one thing the Costs of War Project has made clear, it's this: war is about the destruction of the very institutions it purports to protect. At a time when health care, education, and other social services, including food aid, are so badly needed, why is the military still being funded at astronomical levels, while other agencies are gutted?

My husband and I sometimes argue about the designation "essential" worker. How can he be called "essential" when we spend most of our days together on our Maryland farm as he collects his Department of Defense salary? He always reminds me that redundancy in government allows us to function under the worst of circumstances. If, for instance, Pentagon officials responsible for dealing with threats to our nuclear arsenal were to fall ill en masse or be killed in a sudden attack, others would be available to take their place.

Yet the obvious corollary to that argument has certainly not been applied to our health care infrastructure in these years and we're paying for that today. If the president had not gutted the Department of Health and Human Services, perhaps there would have been enough people to ensure that our federal stockpiles of ventilators were properly maintained in preparation for a crisis we knew was coming. If the pandemic task force created under President Obama hadn't been disbanded, perhaps we would have been better prepared for the spread of Covid-19. And if so much of our money hadn't gone into the military-industrial complex, perhaps there would have been enough health-care workers to weather this crisis better.

As this invisible pathogen spreads across much of the world, what families like mine worry about is that our nation's ever-expanding global conflicts will only continue to grow in scope and intensity, threatening food and medical supply chains. Then, in the worst of times, with our military infrastructure in increasing disarray, many more families, including possibly mine, could once again be called into armed conflict.