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I am working on a presentation that ties in the topic of general grief and mourning with grieving during a pandemic. In researching the specific pieces on complicated grief resulting from a pandemic, I came across this article from the Atlantic magazine, “We’re Not Ready for This Kind of Grief: The coronavirus pandemic will leave lasting emotional scars (warning – Atlantic only allows up to 5 free reads a month).” This article was written in April, in the midst of the peak period of COVID-19 in the US.

To begin with, for those of us on the medical front lines, we can well imagine that the grief we are experiencing is similar to wartime grief. As the author offers:

According to my mother, there are two unique forms of grief that everyone touched by war understands. There’s the grief associated with the loss of human life—through bombings and brutal combat, and through the disease that runs rampant when health care and all other social services are halted. Then there’s the grief associated with the loss of a life as we once knew it: loss of country, loss of employment, loss of identity as a “prewar person,” and the subsequent need to start over. The two run along together like two dark snakes intertwined.

We are experiencing little that was like it was before. We are pained, traumatized, exposed to death and exposed to other losses simultaneously. We are overwhelmed by the pain this creates, even when we don’t recognize we are in pain.

All of this damage is occurring while people are still dying from other causes, too—and when grieving people are being discouraged from even going outside, much less seeking solace from their loved ones. Making matters worse, the current crisis has put enormous stress on the healing professions that, in normal times, help families deal with loss and bereavement. Our society is ill-prepared for the kind of grief the coronavirus is visiting upon so many people during so short a span.

Death and loss is occurring all around us. It effects everyone and harms those trained to be the healers and ones who help others. We are all in this together and continue to be. While the grief surrounding a pandemic are not fully comparable, some of the following points from previous mass casualty grief studies can offer perspective and what to look out for.

Research on grief after large-scale casualties is scant, but the literature suggests that suffering personal losses can be particularly harmful when experienced in times of broader social stress. A 2015 study found that children who lost a loved one during a mass-trauma event such as a natural disaster, a terrorist attack, or a war are likely to suffer long-term psychological trouble. Studies of service members and veterans who served during 9/11 found a high prevalence of what is sometimes called complicated grief—a type of bereavement that is unusually severe and long-lasting. These service members and veterans showed worse symptoms of post-traumatic stress disorder and had a higher number of lifetime suicide attempts.

A study of survivors of the Rwandan genocide found that what the researcher called “unprocessed mourning”—in part the result of the halting of traditional mourning rituals during the war—contributed to lingering mental-health woes. Two years after the 2004 Indian Ocean tsunami, chronic grief was found in almost half the survivors, and was strongly associated with losing a spouse or being female. And a systematic review of Ebola survivors found high levels of psychological distress, including prolonged grief, which was compounded by the stigma placed both on survivors and their families as they attempted to return to work.

As is clear, there is an increased likelihood of complicated grief because of the increased stressors or because of “unprocessed mourning.” I wonder if the moving of mourning rituals to Zoom changes some of this sense of unprocessed mourning.

For those in healthcare, pandemics can be a particular challenge. Normally, we all have tools and methods for coping with death and know when we have reached our emotional limits. But these are not normal times and for many, there is no time for a break (or at least we don’t perceive we have time for a break. Furthermore,

Before the coronavirus, the ethos of humanism—of listening closely to patients’ concerns and fears and tending to their needs—had never been stronger in the medical profession. The pandemic returns doctors to a time when compartmentalizing a patient’s suffering—and one’s own—is an emotional survival tool. “We’re asked to be as dispassionate as the disease itself,” Daniel Lakoff, an emergency-room doctor in New York City, recently told me. “We don’t touch the patient in many cases, we use telemedicine, we give oxygen, and we watch and wait. And we often feel powerless.”

How we render care for others has changed for all medical disciplines. In chaplaincy, so much work has become remote or at the very least, with PPE, we have created increased perceived distance between us and the people we care for. We are all in pain and grieving.

Finally,

Claire bidwell smith, a counselor in Charleston, South Carolina, who has written three books on grief, told me that these recent weeks have been the busiest of her decade-long career. (She offers her services online.) She raises the possibility that grief may play out differently during this pandemic from how most people typically experience it. Usually grief feels very personal, Smith says, because the rest of the world proceeds normally while the bereaved feels numb and alone. That dynamic may change because much of the world has now ground to a halt. Grief may be delayed, she said, but a shared catharsis may lie ahead. “I think there will be a massive collective mourning when we’ve emerged from this, for us as a culture,” Smith said. “While what’s happening is heartbreaking, and we haven’t been able to ritualize or memorialize. We will come back to this.”

We have only begun to grieve, if that. We are feeling the pain of all the losses but have we processed them yet. Do we recognize the long and hard road ahead of us? This article offers us a chance to reflect and contemplate were we are currently and understand the challenges that still lay ahead.

For some other resources I found in researching online, see:

Grief During the COVID-19 Pandemic: Considerations for
Palliative Care Providers

Coping with Grief and Loss – Mourning the Changes since COVID-19

Therapeutic Response to Trauma and Loss
in the COVID-19 Pandemic

Grief Following Patient Deaths During COVID-19
Tips for Healthcare Workers in Managing Grief

Ambiguous Loss:
Grief in the Time of COVID-19