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Bereavement During Covid-19


“There is no end to grief that’s how I know there is no end to love” – note left by Bono at the site of the Bastille Day attack where 84 people died in Nice in 2016.

A headline caught my eye on Euronews from mid-last month: “Covid-19 death numbers top 2 million”. That is two million people: two million people who were dear or known to someone else; the numbers have names. The impact of those two million deaths could affect 10 or 20 million acquaintances or loved ones. All are suffering from grief and some form of mourning.

What is grief?

In The Grief Recovery Method, a grief support blog, Russell Friedman’s article “The Best Grief Definition You Will Find” quotes “Grief is the normal and natural emotional reaction to loss or change of any kind. Of itself, grief is neither a pathological condition, nor a personality disorder.”

“Grieving is like breathing,” states Arizona therapist Dr Shatavia Alexander Thomas: you have to do it. You have to go through it, or you will cause yourself harm.

According to Paul Maciejewski, once standard mourning patterns are known, those with abnormal patterns can be identified and adequately treated. Misapplication or misunderstanding of grief and mourning can be harmful if it leads bereaved individuals to feel that they are not coping appropriately. So then, what is normal within the context of mourning?

How we deal with grieving

Elizabeth Kubler Ross described the five stages of how people cope with illness and dying: denial, anger, bargaining, depression, and acceptance – stages that, one should note, are not linear or follow a predictable progression.

Although some regard it as outdated, I find that it still explains the different emotions people experience and, as such, gives some framework of normality and structure to their grieving process. 

Maciejewski et al. did some research on these stages. They found that acceptance often comes first and where there is disbelief and non-acceptance, that the process is aggravated. He also found no difference in mourning’s positive or negative outcomes in terms of age, race, sex, or basic education.

They also found that individuals with higher education seemed to have more positive progression levels through the post-loss process. “Yearning” is more prevalent than depression, which tended to peak around six months post-loss and usually does not occur earlier than two months.

Acceptance increases steadily to the 24-month post-loss mark. The duration criterion, which could indicate prolonged grief disorder (typically after the 24 months mark), is more prevalent when the death was sudden or traumatic. It is well known that age-inappropriate deaths (children and young adults) are usually more challenging to process.

George Bonanno, a Clinical Psychology professor at Columbia University, and a pioneering researcher in bereavement and trauma believes the ability to rebound remains the norm throughout adult life. He found psychological resilience to be at the core of human grief and trauma reactions. People’s resilience, even when facing extreme stressors or losses, contradicts the stages of grief model.

Bonanno states that many resilient individuals show no grief. He describes resilience as “the ability of adults in otherwise normal circumstances, who are exposed to an isolated and potentially highly disruptive event, such as the death of a close relation or a violent or life-threatening situation, to maintain relatively stable, healthy levels of psychological and physical functioning” as well as “the capacity for generative experiences and positive emotions.”

According to Martin Seligman, how human beings react to extreme adversity is normally distributed. On one end are the people who fall apart into PTSD, depression, and even suicide. Most people are in the middle, at first reacting with depression and anxiety symptoms, but within a month or so are (by physical and psychological measures) back where they were before the trauma. That is resilience.

On the other end are people who show post-traumatic growth. They, too, first experience depression and anxiety, often exhibiting full-blown PTSD. However, within a year, they are better off than they were before the trauma. These are the people of whom Friedrich Nietzche said, “that which does not kill us makes us stronger.”

I have found that mourning is not a linear process. It is not on a continuum. It seems to resemble the rings of a tree better than a straight line. Grief and trauma are often layered. You are the sum of everything that has ever happened to you, and new experiences can trigger old wounds. 

Aggravating factors brought about by a prolonged pandemic, and the fallouts around that have never been present to the extent that it is currently. The list is long: it includes the changes that have been made to end-of-life services and processes, palliative care, and funeral arrangements.

Also concerning is that self-isolation might have to happen due to cultural or funeral rituals such as washing, dressing, kissing, and holding the deceased’s body. The loss of future celebrations, loss of certainty, and anticipated loss – the fear that someone else may be lost – all contribute as well.

Techniques which can facilitate emotional healing

  • Self-care is pivotal: if you are physically unable to function, you will not manage any responsibilities whatsoever. Self-care includes avoiding stimulants like alcohol and caffeine, eating small meals regularly, hydrating, practicing good breathing techniques, journaling, exercising, talking to someone, sleeping for seven hours, and meditating. 
  • According to Martin Seligman, the building blocks for resilience and growth are positive emotion, engagement, relationships, meaning, and accomplishment (PERMA). Build resilience by connecting with others, learn a new skill, which might give you confidence, give to others (charity feels good!), be mindful, make lists, plan something positive for the future. 
  • Focus by using time management techniques such as the Pomodoro, cut tasks into smaller units, and take breaks.

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