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By now, many people across the country have lost someone to COVID-19 or know someone who has. The virus has killed more than 83,000 Americans and 292,000 people worldwide, and the toll is still rising. Mental health experts have been bracing for the collective impact of weathering so much loss, during a time when coming together is prohibited. According to one paper, published in March in the journal Applied Demography, the pandemic will give way to a “tsunami of grief.” We’re not prepared for it.
“America is about to experience an unprecedented loss of life,” wrote study author Emily Smith-Greenway, assistant professor of sociology at the University of Southern California. “It is important that the burden of bereavement, and its potential mental and physical health consequences, is factored into discussions of the public health challenge facing America and all nations.”
Grief, in the simplest terms, means deep sorrow or distress following a death or other form of loss. While grieving is a natural and normal response to personal tragedy, it can still have lasting health effects. For years, studies have linked the stress that accompanies grief to increased depression, cardiovascular disease and mortality risk. Now, grief specialists are sounding the alarm, emphasizing the importance of acknowledging our grief and taking it seriously.
“There’s nothing easy or neat about grief. Grief is a very organic, messy process,” says David Kessler, a leading grief expert and founder of the resource and support site Grief.com. “We want to simplify grief, to say ‘Oh, there’s five stages!’” He’s referring to the five stages of grief famously named by Swiss psychologist Elisabeth Kübler-Ross: denial, anger, bargaining, depression and acceptance. “The stages aren’t linear; they aren’t a map for grief and you’re done.” He should know. Along with Kübler-Ross, he co-wrote On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss.
Even under normal circumstances, mourning can be a painful, lonely process. Symptoms of grief include deep sadness, an inability to focus on anything apart from the loss, and difficulty accepting the death. (Complicated grief, a diagnosable condition, is defined as a grief response that lasts longer than six months and interferes with daily routines. The point at which “normal” grieving becomes a mental health disorder is a topic of debate among grief professionals.)
“Your home life has become your work life for many people. When are you on? When are you off? Grief needs dedicated time.”
Our current circumstances are anything but normal. Feelings of isolation that commonly accompany bereavement are compounded by stay-at-home orders, the absence of regular routines, and restricted access to familiar sources of emotional support, such as seeing friends and family in person.
Grief can also be a response to trauma, independent of personal loss. People are facing anxiety surrounding the virus, experiencing sorrow over being laid off or missing graduation, and stress-reading pandemic updates. By that definition, a lot of the country is experiencing some amount of grief.
“Those feelings of not being able to concentrate, and eating too much or not eating enough or sleeping too much or not sleeping enough, the overwhelming sadness — all that is what grief looks like,” says Kessler. “People have said to me, ‘I don’t know what’s going on, it’s 10 am and I’m exhausted.’ Well, we don’t realize the energy grief takes and how exhausting being in grief is.”
Shortly after the pandemic arrived in the US, Kessler started an online grief support group, as an alternative to in-person groups that could no longer meet. The first day, 1,000 people joined. Now, the group has over 12,000 members.
“Structure helps us grieve,” Kessler says. Having a regular time to meet, as well as a dedicated group of people to connect with. Especially now. “The boundaries are gone,” he adds. “Your home life has become your work life for many people. When are you on? When are you off? Grief needs dedicated time.”
We already had a mental health crisis in the US when the coronavirus arrived and upended our lives a few months ago. More than 50 percent of all Americans will experience a mental health illness at some point in their lifetime, according to the Centers for Disease Control and Prevention. One in 5 people will experience a mental illness in a given year. Inadequate access to care exacerbates the problem. More than half the counties in the US have no psychiatrists.
“There’s an emotional ‘bar tab’ that will come due … It’s going to be for decades that we see the ripple effects of this roll out.”
“There’s an emotional ‘bar tab’ that will come due,” says Megan Devine, psychotherapist and author of It’s OK That You’re Not OK: Meeting Grief and Loss in a Culture That Doesn’t Understand. Devine says that in less intense times, you’d typically experience one loss at a time. Now, there’s a saturation of loss. “It’s going to be for decades that we see the ripple effects of this roll out, and those are all mental health challenges that we will be seeing and responding to for a really long time to come, which is overwhelming and daunting, and it’s just the reality. There is so much loss happening right now and so much grief.”
During the pandemic, the CDC advises people to look for common signs of distress like difficulty concentrating, changes in appetite, anger or increased use of drugs or alcohol. The Substance Abuse and Mental Health Services Administration, a government agency, offers grief resources and coping guidance. A lot of the guidance boils down to common sense, such as talking to a friend or family member you trust, or general health advice, such as getting enough sleep and exercising.
Managing mental health while grieving is especially challenging right now. Among other things, people may be deprived of the coping mechanisms they relied on pre-coronavirus. Someone who, for example, used to go hiking when they felt down may no longer have that option. “This is about expanding your toolbox,” Devine says, and finding a new “mechanism for action,” as she calls it. “What other ways can you serve that need? It depends on where you live and how much economic stability you have, but even things like watching a nature show on PBS, or looking at photographs of a hike you took. Is it ideal? No. We are in emotional triage, we have to try some things.”
Following the death of a loved one, many people are holding Zoom memorials since they can’t get together in real life. Kessler thinks virtual memorials are a good idea, as is planning an in-person gathering for a later date, once it’s safe to do so. Maintaining formality and structure helps elevate an online gathering. “You actually have to do a virtual funeral with all the respect that a real one has,” he says. “It doesn’t work if everyone just clicks in and watches. Someone’s in a tank top, Aunt Martha is eating her dinner in a La-Z-Boy while you’re putting your loved one to rest. You have to dress up for it, you have to have someone running it [like] clergy. The funeral home will stream the casket, you can have music. You can’t make the virtual funeral like another Zoom call or it’s going to leave you feeling empty.”
Kessler suggests that people who are feeling lonely in their grief make a “direct ask” to a friend: Tell them you’re struggling and schedule a time to talk on the phone, rather than reaching out spontaneously with the risk of missing them.
When comforting a grieving loved one, Devine encourages people to resist the temptation to problem-solve. “Don’t jump in with ‘solutions,’” she cautions. “‘It’s not that bad’ or ‘Have you tried broccoli?’ These things have the net effect of silencing someone’s pain.”
“When we judge our grief and judge our feelings, we don’t feel any of them, and that takes even more energy.”
In his work, Kessler has noticed a unique and often destructive phenomenon, a byproduct of the self-help movement, which he calls “feelings on feelings.” This involves judging or commenting on our own feelings as we’re having them. “We’re sad, but we shouldn’t be sad, because no one’s died. Or our grandparents died, but they had a long life, or I’m angry, but I shouldn’t be angry. We have all these feelings that are half-felt,” he says. “And I tell people: Stay in the first generation of emotions. The key to grief is if you’re angry, be angry; if you’re sad, be sad. But when we judge our grief and judge our feelings, we don’t feel any of them, and that takes even more energy.”
Kessler, with permission from Kübler-Ross’s family, recently added a sixth stage of grief: meaning, which he hopes could serve as a powerful tool for moving forward. Finding meaning, as Kessler defines it, involves seeking out the good in a tragic situation. This isn’t the same thing as finding a “silver lining.” You’re looking for indications of good coexisting with tragedy.
As an example, he talks about a patient he worked with who survived the Las Vegas shooting. He told her to look for the good. Amid the horror of her memories, she recalled seeing people get a man into a wheelchair and out of the line of fire to safety.
“Some of us are going to come out fine,” Kessler says, when it comes to surviving the pandemic. “Some of us are going to come out with post-traumatic stress. I want to help people to come out of this with post-traumatic growth. The horror doesn’t go away, the [fact that] people died doesn’t go away. It takes time and it takes recognizing the good.”