COVID-19 and the Grief Process
By Keith Carlson via Multibriefs
Thursday, March 26, 2020
The COVID-19 pandemic is encircling our planet and the entire human family is facing great distress. The deadly impact of the coronavirus can be felt throughout every economy in the world, as well as in villages, rural communities, cities, and suburbs the world over. From shortages of essential supplies to the demise of thousands of small businesses, the ripple effects of this pandemic are beyond imagination.
Amidst the social isolation and the wide array of emotions elicited in most every individual, one concept stands out: the grieving process.
The Stages of Grief
In the early 1970s, Dr. Elisabeth Kubler-Ross was a pioneer in popularizing concepts regarding death and dying. During this period, Dr. Ross realized that grieving did not only apply to the dying process, but also to any situation causing an individual intense emotion. From the failing of a business to the selling of a beloved family home, grief can manifest at any time and play itself out based on the individual’s capacity to move through that experience.
The five stages of grief are often misconstrued as linear, whereas we now understand that an individual may cycle in and out of them at any rate or frequency. Popularized in the media, even television shows such as “The Simpsons” have utilized this process, albeit in simplified forms that may be misleading. Having said that, such manifestations of Dr. Kubler-Ross’s work demonstrate the pervasiveness and relative acceptance of her theory.
The five stages as identified by Dr. Kubler-Ross are:
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Regarding the erroneous notion that these stages are discrete in their evolution from one to the next, the Elisabeth Kubler-Ross Foundation website states:
“…the so-called ‘stage theory’ that you will read in this book is openly described and discussed as a heuristic device. In other words, these stages are merely a set of categories artificially isolated and separately described so that the author can discuss each of these experiences more clearly and simply. The careful reader will note Kübler-Ross’s own repeated warnings that many of these ‘stages’ overlap, occur together, or even that some reactions are missed altogether. To emphasize this conditional way of taking about stages, the word ‘stages’ was even put in inverted commas to emphasize their tentative nature in the only diagrammatic representation of these ideas in the book.”
COVID-19 and Grief
In the context of COVID-19, the above-mentioned concept of overlapping stages could not be more salient than it is today. From hospitals and clinics to private homes and online communities, grief is everywhere.
As humans, we are caught in a tragic circumstance that fundamentally challenges our preconceived notions of safety; the ability of government to act judiciously on our behalf; our fellow citizens’ ability to be kind and cooperative; and the healthcare systems’ capacity to handle the mounting human toll.
Denial
A healthy denial can have its place and viewing extraordinary situations with a skeptical eye can be useful in telling fact from fiction, as well as judicious action from overreaction. However, many individuals — and perhaps entire communities, governments, or nations — can become mired in denial in the quintessential metaphors of the ostrich hiding its head in the sand or the toddler hiding under the covers in hopes that not seeing the monster will prevent the monster from seeing the child.
Recent individual or collective denial has indeed sadly led to much suffering and death around the world, and denial can work in tandem with other stages of grieving, including anger and depression. Overcoming denial of the current reality could not be important; our lives literally depend on it.
Anger
At this time in history, anger can serve a purpose by galvanizing us into political and social action; spur us to protect the interests and health of our families and loved ones; and help us to process deep emotion. However, anger can team up with denial and cause individuals or groups to rely on meanness and selfish irresponsibility.
The angry nurses who confront a nurse manager whose denial of COVID’s seriousness could lead to unnecessary illness are channeling their anger in constructive ways; but what happens when anger leads to destructive looting of stores, violence, or hate crimes?
Bargaining
Bargaining in the midst of this pandemic is natural. This process often occurs in a form such as, “If only I _________, then _______ would occur.” Such thoughts and feelings are natural, yet bargaining may or may not lead to constructive action.
If one gets stuck in bargaining, it may very well occur in the presence of anger or denial, as well as depression; moving out of this stage is an important step towards acceptance.
Depression
Sadness in these unprecedented moments in our collective history is completely understandable, and one can only imagine how many human beings cycle through depressive feelings multiple times per day.
With such loss, suffering, tragedy, and illness constantly the subject of both news reports and conversation, we can feel anything from passing sadness to absolute terror-induced immobility powered by fear and fed by depression.
Depression is natural and expected in such times, yet if such feelings lead to thoughts of violence against self or others; lapses in hygiene and sanitation in the interest of safety; loss of relationships; decreased productivity or loss of work opportunities; or all manner or repercussions, then diagnosis and treatment with medication and/or talk therapy may be warranted.
Acceptance
Some may perceive acceptance as giving up, yet it is far from such. In fact, acceptance simply means that the individual has realized — if only for a brief moment — that there are things within and outside of our control.
In this stage, we realize that we must accept both the reality of the situation (the opposite of denial); feel our fear and depression and then force ourselves to move into more positive feeling states; and also accept that others are cycling through the stages of grief in their own way, in the context of their personal capacity, and in their own time. Acceptance isn’t static, but an ongoing tending to of our movement towards healing and balance.
The Continuum of Grief
The grieving process in the age of COVID-19 is a continuum that we may all experience for years to come, even when the virus is ultimately defeated to the extent that life can return to some semblance of normalcy.
Many deaths have already occurred and many more are sure to come, along with untold amounts of suffering on every level imaginable. Grieving takes time, and we all need to do it in our own way.
Take care of yourself and others, be kind, allow your feelings to move through you, and do your best to seek support if you seem stuck in a stage of grieving that feels destructive or unproductive. This situation will eventually be over and we will be forever changed.
Consider how your grieving can be a useful tool in processing emotion and moving in the direction of more powerful introspection, self-understanding, and increased compassion for the self and others. You deserve to be happy and healthy, and the stages of grieving can provide a useful framework for your own personal healing.
Keith Carlson, RN, BSN, NC-BC, has been a nurse since 1996. He is the blogger behind the award-winning blog, Digital Doorway, a widely read freelance nurse writer, and motivational/keynote speaker. Keith is the host of The Nurse Keith Show, a popular nursing career podcast. Under the auspices of Nurse Keith Coaching, Keith's passion is helping nurses and healthcare professionals create ultimate satisfaction in both their personal and professional lives.
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