The constant barrage of media headlines about COVID-19 deaths serve as triggers for fear and justification for perpetuating lockdowns, mask wearing, social distancing and, ultimately, increased tracking and tracing; never mind that the total mortality rate in 2020 is normal and on par with other non-pandemic years.1,2
Whatâ€™s not normal, though, is the way people are dying in 2020. No matter the cause, people who enter hospitals are forced to go alone, leaving their family members behind, sometimes for the last time. Unable to comfort and be near loved ones in their final moments, the pain for survivors continues long after their loved onesâ€™ deaths, as the rituals of mourning are also interrupted and experienced, again, largely in isolation.
Traditionally, Americans mark losses by gathering together to share their grief with others, holding vigils, giving hugs and reminiscing about better times. â€œBy contrast, in bedside farewells via FaceTime, drive-by burials as under-attended as Jay Gatsbyâ€™s, and digital funerals on Zoom,â€� a STAT news article noted, â€œweâ€™ve been forced to mourn the victims of the novel coronavirus in a numbing new way: more or less alone.â€�3
Worldwide Rise in Prolonged Grief Disorder Expected
Prolonged grief disorder (PGD) was added to the 11th edition of the International Classification of Diseases in 2018.4 It describes a persistent and pervasive longing for the deceased person, or a preoccupation with them, that persists for more than six months. The longing is accompanied by intense emotional pain, such as sadness, guilt or anger, as well as:
- Difficulty accepting the death
- Feeling youâ€™ve lost a part of yourself
- Emotional numbness
- Difficulty engaging in social or other activities
Such feelings are normal during bereavement, and the push to â€œmedicalizeâ€� grief is controversial. In this case, the distinction that moves â€œnormal bereavementâ€� into the category of a mental health problem is that the intense grief continues for a long period of time and also causes disturbances in your ability to function socially and professionally.5
Disruptions to traditional grief rituals, including the ability to say goodbye and viewing and burial of the body, are known to increase symptoms of prolonged grief disorder.
Cases also rise when physical social support is absent â€” something that is being made out as the new normal during the pandemic. Writing in the journal Psychiatry Research, researchers from the Netherlands suggested, â€œ[I]n the development and aftermath of the COVID-19 pandemic, we anticipate that, worldwide, PGD will become a major public health concern.â€�6
Further, â€œdue to government policy targeting the pandemic, the same potential risk factors could also increase grief severity of people whose family members died through other causes than COVID-19.â€�7
Psychiatric Pandemic Looming
The loss of a loved one is one of the most difficult events in a personâ€™s life. Being forced to go through the loss and grieving process in social isolation and without the comfort of long-held bereavement rituals is a â€œrecipe for a psychiatric pandemic,â€� according to experts from the Iran University of Medical Sciences.8
Theyâ€™re among many sounding an alarm that COVID-19 social distancing and quarantine polices are increasing the likelihood of PGD, making an already difficult life event even harder to process. They stated:9
â€œMillions of people around the world have experienced the loss of a loved one due to the Coronavirus Disease 2019 (COVID-19) pandemic.
Given the restrictive lockdown regulations and stay-at-home orders, most of these individuals did not get a chance to say goodbye to their loved ones, properly to have a funeral/ceremony for their loss or to bury them. As a result, millions of individuals have not experienced a regular grief cycle that enables individuals to rapidly adjust to the situation and recover themselves.â€�
Humans are social creatures, but government policies are demanding that people â€œshow their loveâ€� by staying away from others, which is contrary to human nature and human need, especially during times of crisis.
Thereâ€™s nothing â€œnormalâ€� about holding up a sign outside a hospital window while a loved one lies dying inside, but this is a scenario that happens daily during the pandemic. One man recounted the details to STAT News of losing his 83-year-old father during the pandemic; his father spent three weeks in the hospital, alone:10
â€œEventually, his fatherâ€™s nurses disconnected the elder Smithâ€™s oxygen just long enough for him to be propped up near a window, where he could see the family standing on a small knoll outside the hospital, holding signs saying, â€˜We Love You,â€™ and â€˜Fight As Hard as You Can.â€™ He died two days later.â€�
Pandemic Restrictions Affect All Stages of Grief
Itâ€™s often said that there are five stages of grief â€” denial, anger, bargaining, depression and acceptance. You may or may not experience every one of them, and people vary widely in their experiences of each. Some people skip several stages, may experience them in a different order or may revert back to stages that have already been â€œcompleted.â€�
Whatâ€™s apparent, however, is that lockdowns, social distancing and other pandemic requirements are interfering with every one of these stages, making it nearly impossible for people to work through their intense feelings:11
- Denial â€” Accompanying the body of the deceased helps loved ones to move past denial of their death, while taking away this step allows denial to linger.
- Anger â€” Feelings of anger are intensified when loved ones are unable to accompany the patient during the last days of their life. The inability to hold a ceremony can also intensify feelings of anger and guilt.
- Bargaining â€” Family members may blame themselves for their loved oneâ€™s death and run over scenarios they feel they could have done differently to protect them. â€œThis can cause negative thoughts and emotions, which complicates this period,â€� the Iran University of Medical Sciences researchers explained.12
- Depression â€” Government-imposed lack of social support and inability to hold conventional funeral ceremonies can intensify depression.
- Acceptance â€” Under normal circumstances, most people take six weeks to several months to accept the loss, but this, too, will take longer without social support.
Experts are predicting that these profound disruptions are going to lead to a wave of unresolved bereavement, depression and even post-traumatic stress disorder (PTSD) as humans are robbed of their ability to participate in age-old bereavement rituals.13
Grief Reactions More Severe During the Pandemic
In the first empirical comparison of grief before the COVID-19 pandemic and during it, researchers questioned 1,600 bereaved adults, including those who had experienced a loss before the pandemic and those who suffered a loss during the pandemic, within the last five months.
Those who lost a loved one during the pandemic experienced more severe grief compared to those who experienced a loss before it, which suggests the loss was more difficult during the pandemic. The results suggested the pandemic â€œhas a small but robust negative effect on psychological adjustment after non-COVID-19-related deaths during the pandemic.”14
Different types of grief are also likely, including anticipatory grief, as loved ones are forced to watch an intensifying medical situation for their loved one from afar. Disenfranchised grief, which is grief unacknowledged by society or social norms, is also likely, especially in the absence of rituals like funerals.15
Again, researchers urged palliative care professionals, grief counselors and policy makers to prepare for heightened levels of grief in people bereaved during the pandemic.16
Losses in Many Areas of Life Lead to â€˜Bereavement Overloadâ€™
During the pandemic, individuals may be faced with mounting losses in addition to losing a loved one. Loss of freedom is among them, as lockdowns become a new way of life for many. This triggers secondary losses of relationships, recreation and social support.
Whatâ€™s more, Yusen Zhai and Xue Du from Pennsylvania State University argued that such multiple losses will prove to be detrimental to mental and physical health, putting civilians and first responders â€œin peril of bereavement overload:â€�17
â€œSocial distancing minimizes emotional and physical intimacy, which results in dissolution of intimate relationships involving partners, family, and friends. Moreover, over 16 million U.S. population filed for unemployment within three weeks in March 2020 during the pandemic.
Job loss, as a primary loss, brings losses of financial security, independence, healthcare, and sense of future â€¦ Civilians experience losses of relationship, freedom, and employment within a constricted time period.â€�
Already, Americansâ€™ mental health is suffering, and those with existing mental health conditions may not come out unscathed. In a survey of U.S. young adults, those with a mental health diagnosis were far more likely to be struggling mentally during the pandemic than those without a diagnosis â€” by more than sixfold for depression and four- to sixfold for anxiety and PTSD.18
Higher levels of COVID-19-related worry and grief, poorer sleep, and poorer reported health-related quality of life were also noted among people with a suspected or reported mental health condition. Itâ€™s also likely that the pandemic is pushing people on the brink of mental illness over the edge. The Psychiatry Research study reported:19
â€œThe high rates of mental health symptoms above the clinical threshold found among those with no pre-existing diagnosis was striking with one out of five of these young adults scoring in the clinical range for depression (18.3%) and anxiety (20.4%), and one out of eight reporting clinical levels of PTSD (13.8%).â€�
EFT for Grieving and Holiday Stress
If youâ€™re struggling with grief, itâ€™s important to seek out activities and people that will help lift your spirits. Now is not the time to isolate yourself but to embrace human contact and emotional support. Itâ€™s unfortunate that â€œpandemic shamingâ€� has become a U.S. pastime, and people may be vilified for seeking to spend time with their loved ones, even when their mental health is at stake.20
There is reason to believe that the COVID-19 pandemic is the â€œgreatest hoax ever perpetrated on an unsuspecting public,â€� according to Dr. Roger Hodkinson, one of Canadaâ€™s top pathologists and an expert in virology, yet people are being told to stay away from their families, during what could turn out to be the last days or weeks of their time together.
Itâ€™s not humans who are to blame for desiring essential connections with others, but the impossible mandates being placed upon them that are making such connections seem criminal. That being said, if youâ€™re alone with your grief, you can most certainly record your thoughts in a journal, as both talking and journaling can help you work through intense feelings.
In the video above, Julie Schiffman demonstrates how to use the Emotional Freedom Techniques (EFT) for grief. EFT is an energy psychology method designed to help you process emotions and reprogram your body’s reactions related to them. Even if you have never used EFT before, take a few minutes to learn the technique and then use it whenever grief surfaces.
Because feelings of grief and loss tend to be intensified during the holidays, Iâ€™ve also included the video below on tapping for holiday stress. During this particularly challenging time for grieving, be gentle with yourself and your feelings, and be open to experiencing them fully â€” a necessary prerequisite to healing.
My Personal Deep Grieving Resolution
I lost both of my parents unexpectedly a few years ago within a year of each other. My mom was six years younger than my dad, but she passed away first quite unexpectedly of natural causes. It was the most profound grief experience I have ever gone through and allows me to better understand the pain that many of you have or still continue to struggle with.
These unnecessary COVID restrictions only contribute to the grief as you are unable to socialize with other family members and friends, which certainly helps when you need someone to lean on. I am very grateful they both passed before this dystopian nightmare we are currently cruising through, as I would have had loads more of forgiveness to go through.
Anyway, what I found to be an incredibly valuable resource was the book â€œLetting Go: The Pathway of Surrenderâ€� by Dr. David Hawkins. Hawkins was one of the most brilliant medical minds of our time and I regret never having had the opportunity to interview him. The book was published in 2014 and it was the last one he wrote before he passed.
He provides simple explanations and approaches to be with the pain, which ultimately catalyzes its release. I was miserable, grief stricken and depressed for two weeks prior to reading it but the pain quickly resolved after applying his techniques. If any of you are struggling with grief I highly recommend this book.