With the COVID-19 Pandemic, It's a Good Time to Talk About Grief
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I’m writing this article to deepen the conversation about death and grief. This uncomfortable topic of human death in our American, Western culture where we deeply value human life. The thoughts and theories in this article are timeless and applicable to death from anything and under any circumstances outside of coronavirus; it speaks volumes to past, present and future losses.
Death is unfortunately all too relevant currently, as the whole world is at war with a common and uniting enemy: coronavirus, or COVID-19, a new-to humans virus that causes respiratory infection and can lead to serious or fatal health complications. I happen to live in the state of New York with the highest amount of cases and deaths reported each day in all of United States; one of the most affected countries in the world. At least for now; remember when we were so worried about China and Italy? Who knows how many more deaths there are to come, and at what rate? Individuals dying from COVID-19 come from all walks of life; indiscriminate of race, age, culture and geography. There is still much we do not know about the epidemiology, course and treatment of this virus. The way people are dying and the treatment of bodies and families have also been rather gruesome and inhumane; like straight from an Apocalyptic sc-fi/horror film; hospitals and nursing homes are overwhelmed with the amount of death that is occurring and no facility was prepared to handle this unprecedented amount all at once.
I will never forget the main lesson I learned from a Grief, Loss, and Bereavement course I took during my clinical social work program at NYU — the professor said if you remember anything from this class, let it be that you are to get comfortable with the topic of death. Comfortable talking and listening about it. Especially in the health field where clients are often in bereavement over a loved one or facing their own mortality (illness, suicidality, etc). This stayed with me, especially during moments where I have felt hopeless not being able to reverse events, as if that is the only way to help. But it is not. People typically don’t want to burden others with their intense emotions and feel like others can’t or don’t want to be involved. I have found the golden key to making someone feel like I can handle and contain their intense emotions while offering support and a nonjudgmental stance, which I’ve seen go a long way. So I am sitting here writing this piece, from my clinical and personal perspective, in hopes of passing that comfort along to readers and the general public.
News sources, politicians and civilians are reporting numbers on new deaths daily to eager civilians. It is safe to generalize that the public is becoming more and more desensitized as they proceed with their day and anticipate hearing the next update; human lives have been reduced to numbers. And this makes sense because psychologically, human beings become desensitized to almost any stimuli they are overexposed to repeatedly over time.
But this is not the case for those personally affected by a single death. These people can relationally be mothers, fathers, grandmothers, grandfathers, aunts, uncles, sons, daughters, friends, husbands, wives; some of the most meaningful relationships humans carry. And for them, life will never be the same. They will never watch the news the same way again. Their world has taken a shock and a pause. It is suddenly a gloomy, dark and unfair place. At least for now, they cannot keep up with the pace of others; their very personal and emotional grieving process has begun.
Swiss-American psychiatrist Elisabeth Kubler Ross described five stages of grief in her 1969 book “On Death and Dying.” They are denial, anger, depression, bargaining and acceptance. It is a misconception to believe one must grieve in the above respective order as the golden standard. In fact, such thinking can be harmful as someone may feel guilty or abnormal for not meeting this standard, creating secondary symptoms and more stress. I am here to share there is no one right way nor order to grieve. Grieving is an incredibly personal journey, one that a person has full rights to indulge in as their psyche naturally calls for throughout their entire life. The way someone grieves is also heavily influenced by their culture and religion, depending on their degree of affiliation. Regardless, our psychological and emotional systems will play out in unique and varying ways.
There is a wide range of normal in terms of how surviving loved ones and/or terminally ill people feel and behave following/towards a death. I will emphasize — very wide. Circumstances surrounding the death, the nature and quality of relationships will strongly impact the grieving process. Their intensity and their disconnect. People may develop their own idiosyncratic thought patterns and rituals in honor of that death or death-to-come. So long as it does not harm themselves or others, and appears simply eccentric or whimsy, then it can be regarded as healthy coping mechanisms the person developed in service of their ego, mood and overall functioning. At least that would be my assessment with a client in my therapy room and view it a desirable route.
In a death to COVID-19, a loved one may initially feel anger as their predominant feeling; blaming the person for not socially distancing enough, or for partaking in a social gathering where they may have gotten sick (if that’s the case); all which could have been prevented. And/or externalize the anger to the government for not providing accurate testing quick enough. This anger may mask deeper feelings that will be experienced through the remaining stages in any order following that. The anger may come and go throughout the rest of the loved ones life as they reflect on what happened and develop their own fixed narrative. Another loved one may start with depression marked by deep and intense sadness, shame, guilt and possibly hopelessness; feeling as though they didn’t spend enough time with the loved one, or do enough to help or save them. The loved one may feel angry with themselves; an internalization. Someone else may bargain intensely with a higher power or G-d; depending on their religious and cultural beliefs, experiencing survivor’s guilt. “Why them and not me?” Or more positively, interpret the death as a blessing in disguise, preserving faith that they will learn what the blessing is later. Each loved one will exhibit some hallmark thoughts and/or feelings (outstanding, predominating). The person in grief themselves are to be factored in, as they may come with their own pre-existing experiences, health and mental issues, and personality; which is the main differentiator among how and why everyone grieves differently.
To extend feelings to behaviors; the surviving loved one or someone facing their own mortality may show behavior changes that deviate from their usual presentation. They may become more angry, sarcastic or bitter in the content and tone of their articulations. They may also at times exhibit anger, rage and even violence.
Conversely, they may become more isolate and less social, focusing on solitary thought and activity. For someone facing their own mortality; they may need support. For the survived loved one, all aspects of their lives may become affected following a death; work, friendships, relationships, usual engagement in hobbies. While the aforementioned can still fall under the normal range, there are two area worth looking at; and those are the duration and intensity of negative impact and life interference.
In the DSM-V of mental health conditions, symptoms are one set of criteria required for a formal diagnosis to be made. Another set is to what degree that event has negatively affected other areas of your life such as work, relationships, hobbies? And how long has this been going on? How large is the deviation from your usual functioning and presentation? It is understandable to revert to a dark place for a time period and you may not seem nor feel like the same person. The DSM-V contains the formal diagnosis of -persistent complex bereavement disorder (PCBD) to address more complicated grief where symptoms surpass one year in duration. Symptoms can include deep depressed and anxious mood, obsessive thoughts/ruminations over what happened, persistent crying spells triggered by any stimuli reminding you of the loved one, and all this interfering with your life and ability to function. Individual or group therapy would be especially helpful at this point to process the trauma and loss.
Complicated precipitating factors tends to lead to such complicated grief; circumstances leading up to your loved one getting sick in the first place and the nature of your relationship affects the grieving process. Are you plagued with feelings of guilt? Survivor’s guilt? Do you feel you could’ve done more? Do you have regrets? Were you in a fight? Were there things left unsaid? Were there apologies not given? Accomplishments unacknowledged? Activities on a bucket list left undone? Leftover financial burden? Or a deep loss of personal support as you relied on this person for guidance and meaningful conversations… all great material for ruminations/obsessive thinking later. A person facing their own mortality may experience all the above, just with themselves.
I had a client who reported feeling guilty about not visiting her deceased grandfather’s grave at least once a week, a standard she set for herself. She made it about once a year, as it was far from her home. She carried this heavy narrative on her shoulder that because of this, she is not grieving “properly” or not being a “good granddaughter.” She felt like a “bad” person and this worsened her depression and PTSD. Her grief was complicated in the nature of their relationship and what he meant to her — she endured an abusive and traumatic childhood by her drug-addicted parents and her grandfather was the only stable and safe parental figure throughout her life.
I helped modify her fixed belief that “not visiting his gravesite is the one proper way to grieve and if I don’t I am a bad person.” I gave her permission for that to not be the ultimate truth and re-narrated that any time she thinks, speaks of and cries for him, or references his views before making life decisions, is as valuable as physically appearing at his gravesite. That was enough to honor his legacy her own way. She reported strong relief after this type of intervention.
Death, grief and loss of closed loved ones can stay with us throughout our entire lives. It can be viewed as a parallel process; while continuing to indulge in at least trying to live your best life, you keep deceased loved ones in your mind and heart. Their spirit may always walk with you, and that’s OK. Their spirit can influence your thought process and decisions and you can always honor legacies in that way. You are never alone in your grief, and you can do it your way.
Concerned about the coronavirus? Stay safe using tips from these articles:
- For Anyone Who Needs to Hear This: It’s OK to Just Exist Right Now
- Making the Most Out of Virtual Mental Health Appointments
- 10 Face Masks People With Chronic Illness Recommend
- 8 Soaps You Can Use to Help Prevent the Spread of Illness
- If I Get COVID-19 It Might Be Ableism – Not the Virus – That Kills Me
Getty image via Ponomariova_Maria