How can we cope with isolation?

Interview with a Submarine Captain Marquet - shared on NHS Networks, Primary Care Improvement Connect

Like many people around the world, I am currently in a state of self-quarantine.

This is stressful on several levels. My wife and I both work full time, our three-year-old daughter insists, rather greedily, on routine care and feeding, ceaseless domestic and professional demands, coupled with an inability to ever go outside our long, narrow apartment, itself coupled with the knowledge of the silent nightmare coursing through the city just beyond our walls… well, it's taking a toll.

Hoping to gain some useful tips staying sane while confined inside a dim, pressurized space for days on end, while stressed out, tired, irritable, disoriented, and quite likely living off dwindling supplies of fresh food, I did what one does: I called a legendary submarine captain.

"I'm kind of an introvert anyway, so this is perfect," he said.

Check-in with people…

Life on a submarine, Marquet says, "is hard to describe. You're underwater. You're in this steel tube, and if you think about it too much, it kind of freaks you out. But we're so busy with the work that you don't sit there thinking, Oh, there's 500 pounds per square inch of sea pressure on the other side of this one-and-a-half-inch steel plate. And oh, by the way, there's a nuclear reactor 200 feet behind me that could incinerate half the world. You just dive into the work."

What makes this pressurized existence survivable is how the crew members check in with each other. "When you're walking around the submarine," he says, "people are like, 'Hey, how are you doing?' 'How you feel?' That's what you hear, and you hear it a lot." This sort of chatter can ease the stigma someone might feel for admitting that they're having a hard time, and it creates cohesion, "because I know that other people are under stress, and that they're all feeling what I'm feeling," he says.

Do extra…

Marquet describes a common scenario for a submarine crew: You're out at sea, and the initial plan is for 30 days, but then you get word that you've been extended to 45 days or more. "The first thing that happens is all fresh food gets eaten," says Marquet. "So now you're on cans." If a crew keeps getting extended, they start running out of cans. That leads to rationing and calorie reduction. Now you have a tired, hungry, young, overwhelmingly male crew. "The next thing that happens is you bump into somebody and things get tense," says Marquet.

So how do you avoid a brawling crew?… "Do extra," he says. "Compensate by working harder." Working harder in this instance means two things:

One, "you've got to trust in the other and assume good intent." Even if they annoy you or do something you disagree with, know that they're doing their best. And two, whenever you feel like you're going to snap, "take a breath and say, 'well, what's his experience?'" By even pausing to consider how the other person is feeling - whether that's your fellow crew member or your spouse - you can alleviate any blow-ups.

Think, then do…

On the Santa Fe, Marquet implemented an approach he called "deliberate action." Basically, it meant thinking before you act, which seems obvious until you take a look at the world around you and realize how rare it actually is. In a stressful situation, when people often fall back on instinct, deliberate action is indispensable.

"What you want to do," Marquet says, "is think of your life in terms of a series of think/do think/do, think/do. It's the absence of the 'think' in the think/do sequence that gets people in trouble."

Find a quieter part of the world…

As many of us know all too well, when you're trying to balance work and childcare, while also maintaining some semblance of a relationship with your partner-all under the strain of confinement-sleep is a low priority. That's a mistake in self-quarantine, and in submarines. "We would go out there and do these operations that would put the people on a high level of stress for four, five, six, seven, eight, nine, 10 days in a row, where you're getting four or five hours of sleep," says Marquet. "And I'd see guys nipping at each other, and then one of the officers kind of mouths off to me in an unusual way. And I'd say, you know, I think we need to hit pause and take the submarine literally out of a hot zone and into a quieter part of the world so that we can just sleep. Sleep for a day and then we'll go back and reengage."

Eliminate binary voting…

Say all week long you've been looking forward to getting pizza. But when Friday arrives, your equally exhausted partner suggests Thai. You put it to a vote. Who wants pizza, who wants Thai?

Wrong. Marquet developed another technique while serving called "fist-to-five." Instead of a "binary vote" - either this or that - he had crewmembers not only vote but indicate how strongly they felt about their vote by holding up the corresponding number of fingers.

"The reason that you want to go that way," he says, "is because it lets people signal in a more nuanced way." With a binary vote, you might have two votes for Thai and two for pizza - and thus, open war- but the Thai voters might be sort of into Thai, where the pizza voters are really into pizza. In that situation, you're eating pizza. Just tip your delivery guy lavishly, please.

Give all of your attention or none of it…

"One thing I was thinking of that has to do with kids is - I call it the 100-zero rule," Marquet says. "We apply it to adults, but you can apply it to kids. Either give somebody 100% of your attention or zero." The thinking is: If you're half paying attention to someone - a kid, a partner - while doing something else, you are failing at paying attention to them and at whatever else you were trying to do. "And because they know that you're not giving them your attention, then they want more. It becomes self-defeating."

Let it go…

It's not just a song every housebound parent of young children will be hearing a dozen times a day for the foreseeable future until they beg for death. I asked Marquet how sailors handled downtime - specifically how they kept their minds from drifting over to the peril all around them, like most people tend to do with the news today. "First," he says, "there's remarkably little downtime. None really for most of the crew. A few minutes here and there." And when they do have downtime, they keep their minds busy. "Read. Work on a college course. Watch movies. And games! Cribbage is a big submarine game."

Apart from that, he says, the way to keep ambient stress at bay-both deep underwater and in times of plague-is simple. "Focus on what you can control. Washing hands. Connecting. Following rules to stay apart. Not touching your face," he says, "It's about circle of control."