Q. My kind and clever older sister barely leaves her flat. She says the world feels like it’s ending and she can’t cope with it all. She follows everything obsessively — climate change, war, politics, AI, injustice — and then just shuts down. She’s not sleeping well, she’s struggling working, stopped socialising and even making simple decisions such as going to the supermarket overwhelm her.

She used to be sociable and funny but now she seems almost paralysed by despair because she says that everything is falling apart. It upsets and scares me to hear her ask what’s the point of life but when I suggest she speaks to someone, she says this isn’t a mental health issue, it’s a rational response to a collapsing world.

We’re both in our thirties now but she was badly bullied and isolated as a teenager and I wonder if what’s happening now has tapped into that trauma somehow because she constantly talks about feeling unsafe living in a world that is cruel.

I love her and I don’t think she’s wrong, as it does feel as if the world is falling apart, but I want to help her as I worry that she has mental health issues even though what she is saying is logical and true. What can I do next? I don’t know what to do that won’t make her retreat further. How can I help her without minimising how frightening the world really is?
Willow

A. The term permacrisis, the 2022 word of the year (as chosen by Collins dictionary), describes the feeling of living through an extended period of crises, such as war, inflation, political instability, climate change, where one crisis seems to roll into another without any let-up.

What you describe is your sister’s response to global permacrisis, her despair reflecting the overwhelm of living in a world that feels constantly in turmoil. Her reaction is one that I am seeing increasingly often — not as a specific mental health condition, but more as a permacrisis-induced stress reaction or burnout. As you describe in your sister, the vulnerability that comes with such global overwhelm will be compounded by her history of trauma (via being bullied). Like so many she isn’t irrational, she is completely saturated.

Living with permacrisis-induced stress has an impact on body and mind. Our nervous systems are designed to perceive and respond to acute stressors: a predator appears, adrenaline spikes, cortisol floods the body, and we fight, flee or freeze to survive. Once that threat passes, the parasympathetic “rest and digest” system takes over, signalling that danger has gone and the body and mind can return to baseline.

In permacrisis threats are not short-lived dangers but instead constant and overlapping, meaning that the parasympathetic system never has a chance to kick in. This keeps us in a chronic activation loop where cortisol stays elevated, sleep is disrupted, inflammatory processes build up in the body and the emotion regulation systems work overtime. This continuing physiological state of hypervigilance maintains an overall sense of uncertainty and being unsafe.

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Inflammation caused by chronic stress significantly affects mood and behaviour by reducing serotonin and dopamine signalling (that is, the chemical communication between brain cells), leaving us more vulnerable to mental health difficulties. We become constantly tired, our brains foggy, concentration poor. Crucially the hippocampus (a brain area associated with memory and stress regulation) is affected by long-term inflammatory stress, weakening our resilience (our ability to bounce back). This all explains your sister’s low mood — she is trapped in a negatively self-reinforcing spiral where stress fuels inflammation and, in turn, inflammation worsens mental health.

Your sister’s despair at the scale of injustice and suffering is understandable but her exclusive focus on this will of course lead to feelings of hopelessness and helplessness, triggering questions about the point of life. Her state can be described as pre-traumatic stress (like PTSD but inverted), an inbuilt survival strategy where the distress experienced in anticipation of future suffering causes the brain to rehearse disaster before it arrives. Her hypervigilance is clearly fuelled by her compulsive news consumption, leading to what has been termed doomscrolling burnout — a survival strategy under the illusion of staying informed.

As you astutely pointed out, being bullied as a teenager will have created hypervigilance due to the trauma occurring during a time of significant brain development. A hostile, unpredictable and cruel world triggers and reactivates your sister’s earlier threat state — her past trauma has sensitised her nervous system to the detection of future fear.

Your sister insists that this isn’t a mental health problem and she’s right because her thoughts and feelings are neither irrational or illogical, and while her life has shrunk she is still able to function. The depth of her reaction, however, means that she is increasing the risk of collapsing into a clinical condition due to her endless scroll of catastrophe-maintaining constant hypervigilance.

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To push on the mental health lever would be, as you rightly point out, to risk losing trust and connection. She clearly needs support because she is stuck in cognitive overwhelm and I wonder whether trauma-informed therapy would be helpful because her past experiences are underpinning her struggles to cope with the present day. Of course you wouldn’t want to suggest that her feelings are all trauma-related but she might feel more able to engage with support if it’s framed around her previous life trauma, which makes her more vulnerable to the mental health effects of the permacrisis-linked anxiety that she is experiencing.

Of course we all have to be aware of our environment and what is going on in the world around us, but we also need to find a balance between the awareness of actual immediate threats to our safety and living our daily lives in a world where threats exist. If we all think too closely about all possible threats to our safety, we would never leave home and so must acknowledge our reality without being consumed by it. Mindfulness and grounding techniques (see: oxfordmindfulness.org; mind.org.uk) can help your sister remain in the present (ie not get caught up in catastrophic futuring) and find ways to increase her sense of safety and agency.

The more your sister avoids engagement with life, the more she reinforces the belief that she is not safe engaging with the world. Validate her concerns while gently enabling her to reconnect with her life. Start with small repeated steps that gently stretch her comfort zone — a walk around the block, a visit to a quiet café, even just beginning by sitting by an open window, and using mindfulness techniques to manage anxiety. This process (called exposure therapy), will retrain her brain to tolerate uncertainty without fleeing from it.

Encourage your sister to take time away from the news — she doesn’t have a moral obligation to be vigilant all the time. Indeed, help her to recognise that she is most effective when she can connect individually or collectively to address some of the injustice she rightly cares so passionately about. Joining with others with the same beliefs will help her feel less alone and also remind her that there is good in humanity.

We can’t eliminate uncertainty but we can retrain brain and body to manage it by utilising techniques to calm the stress system, restore recovery time and build habits that protect mental health even when the world won’t. I wish you and your sister well.