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Grief During Quarantine: Losing A Loved One During A Time Of Crisis

Hashil Al Hatmi

By Hashil Al Hatmi

Hashil Al Hatmi previously worked at the Sultan Qaboos University Hospital under the Behaviour Medicine Department and is now establishing psychological services at the Royal Hospital. His main interest is in Health Psychology and Behaviour Change both on a patient level and a public level. He thoroughly enjoys assisting his colleagues and other professionals in improving their resilience and emotional wellbeing.

Losing a loved one or someone very close and dear to you can feel like the sky has gone dark or that your heart has shattered into pieces. The sudden shock of a loss can be devastating and overwhelming. One, therefore, develops a heavy heart. Time tends to slow down and you ruminate for hours, days, possibly months, struggling to bring yourself back to normal. Sleep becomes a battle every night. Your appetite has either skyrocketed or dropped significantly. Perceiving the world and everything around you as dark and hollow. The issue is not moving forward but it’s how, as the pain is so severe that you feel numb from head to toe, finding it extremely difficult to take a step forward.

What is Grief?

Grief is the response to loss, particularly to the loss of someone or something that has died, to which a bond or affection was formed. According to Help Guide, people experiencing grief may experience different kinds of unhelpful and unexpected emotions, from shock or anger to disbelief, guilt, and profound sadness. Grief can also disrupt physical health, such as sleep difficulties, as well as cognitive problems like thinking straight and memory loss1. Bereavement, on the other hand, is the period following a deep loss, similar to a mourning period. Grief has three phases, acute grief, integrated grief and prolonged grief. Acute grief is experienced shortly after a loss. Integrated grief is “the permanent response after adaptation to the loss, in which satisfaction in ongoing life is renewed”2. Prolonged grief or complicated grief is painful emotions are so long-lasting and severe that you have trouble recovering from the loss and resuming your own life.3. This is when a person is starting to experience symptoms of anxiety and depression and is need of psychosocial support. People with complicated grief struggle to accept reality and may find it difficult to engage in their daily activities.

What may be the benefits of grief counselling?4

  • You will be able to focus on you again
  • You can go at your own pace
  • You can make your own choices
Stages of Grief

There are five stages of grief; denial, anger, bargaining, depression, and acceptance. These stages were first developed by a psychiatrist Dr Elizabeth Kübler-Ross which are part of a framework that helps people to learn to live with a lost loved-one5. The first stage is denial, which helps us allows us to reduce the overwhelming pain of loss. Processing the reality of our loss is like switching to a survival mode for emotional agony. The goal is denial is not to pretend that the loss does not exist, rather it attempts to slow the process and gradually understand what is happening. The second stage is anger, which is very common and normal for people to feel after losing a loved one. Experiencing a loss and processing that information not only takes time but can be extremely discomforting. Anger is usually the first emotion expressed during a loss and can leave a person feeling isolated and perceived as unapproachable by others during those moments when they can benefit from comfort, social support, and reassurance. The third stage is bargaining, which can be considered a defence mechanism when losing a loved one to the point that a person is willing to do almost anything to alleviate or minimize the pain. Some common bargaining promises include “I’ll never get angry again if you can stop him/her from dying or leaving me”. The fourth stage is depression, commonly perceived as the resulting condition during and after grief. The world in front of you seems to fall apart as you are dipped into a pool of sorrow or walking into a hollow forest filled with complete darkness. The reality of the loss truly kicks in and one, therefore, spends most of his or her time either ruminating or at times, questioning their existence, i.e., suicidal ideation. You may find yourself find ourselves retreating, being less sociable, and reaching out less to others about what we are going through. Finally, the fifth stage is acceptance, where you no longer resists the reality of the loss. Sadness and regret may still be partially present, but the prior stages will have reduced when a person reaches the acceptance stage6.

Grief and Depression during the COVID-19 Pandemic

Since the outbreak of the coronavirus, humanity is experiencing a new reality marked by grief and loss7. Many events, gatherings and travel arrangements have been cancelled and forced people from all around the planet to process this grief both individually and collectively in staying isolated at home, working remotely, studying online, and taking all necessary precautions to remain healthy and far as possible from being at risk of being positive for coronavirus. From the major concerns is the duration of the pandemic and lockdown, will our lives go back to normal? A question that is repeatedly asked by billions. Loss of a loved is just one part of the grief, for many people who have not lost someone in the midst of the pandemic still experience a form of grief that will change the course of history. Loss of jobs, loss of opportunities in business and entrepreneurship, loss of real estate, and financial bankruptcy are widespread. As the number of COVID cases rises, so do cases of the world’s mental wellbeing. It is expected that mental health conditions will rise significantly. Approximately 45 per cent of adults in the US have reported that their mental health has been affected by the coronavirus which has led to excessive stress and worry8.

One of the most common mental and emotional disorders is depression. According to WHO9, more than 264 million people of all ages suffer from depression. It is considered to be the 4th leading cause to disability and approximately 60 per cent of people with depression and other mood disorders (dysthymia and bipolar disorder) are at risk of committing suicide10. In a study by Pappa and colleagues (2020)11 they found that mood and sleep disturbances were from the most prevalent mental health conditions during the outbreak of COVID-19. Authors emphasised the need for mitigating mental health risk and providing interventions for psychological wellbeing. Moreover, mental health professionals from all around the world have an immense duty like physicians and nurses in the forefront as mental illness and emotional disturbances are trending as the days pass by.

Coping with Grief during the COVID-19 Pandemic

There numerous ways of coping from grief. Many sources emphasise speaking to someone, whether it be a family member, support group and most importantly with a professional in mental health. Amy Greene, the Director of the Center for Spiritual Care at Cleveland Clinic mentioned 13 tips to cope with grief12:

  1. Accept some loneliness. Loneliness is completely normal, but it is important not to get too isolated. Reach out to people and support groups who are comfortable with grief — who can let you move through the process at your own pace.
  2. Choose good company. Look for friends, old and new, who know how grief feels and who can let you be “alone but not alone” when you just need company and who won’t place any further burdens or expectations on you.
  3. Be gentle with yourself. Try not to judge yourself for not “doing better” or “keeping it together.” It will get easier over time to feel like your normal self.
  4. Get extra rest. Physical and emotional exhaustion is common. You will need more rest than usual.
  5. Embrace all emotions. Realize that feelings come whether we like it or not. All we can do is let them move through, like waves in the ocean or clouds in the sky. It is neither weak nor abnormal to feel these waves. There are many approaches under the category of “mindfulness” that can help with emotional self-regulation. It’s also important to know when to seek professional help.
  6. Set a regular sleep schedule. Make it a goal to go to bed and awaken at the same time each day. Give yourself a good amount of time to rest, but be on guard for sleeping too much as a way to avoid the hard work of grieving.
  7. Move your body. Get up and walk or move around, preferably outside, at least a little each day.
  8. Talk to your doctor. Tell your primary care doctor you are bereaved so he or she can help you keep an on eye on healthy habits.
  9. Keep structure in your day. This means groom and dress, even if you are not leaving the house. Also, eat small, regular meals, even if you are not hungry.
  10. Set goals. Set small, reachable, short-term goals so that you don’t get overwhelmed.
  11. Make a list of daily activities. This can help while you are grieving because forgetfulness is common.
  12. Be cautious. Do not make any major decisions or changes in home or work right after you are bereaved.
  13. Take care of your inner needs. Find time, whether through a spiritual practice or a creative outlet, to connect to things that give you inspiration and help you maintain your sense of meaning and purpose. You could keep a journal, write a song, poem or letter to your loved one.

 

 

References

  1. Smith, M. (2019). Coping with Grief and Loss. Retrieved 3 May, 2020, from https://www.helpguide.org/articles/grief/coping-with-grief-and-loss.htm
  2. Shear, M.K, Ghesquiere, A & Glickman, K. (2013). Bereavement and Complicated Grief. Curr Psychiatry Rep, 15(11), 851-2175.
  3. Mayo Clinic. (2020). Complicated Grief. Retrieved 8 May, 2020, from https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374
  4. Thomas, J. (2020). Benefits Of Grief Counseling. Retrieved 9 May, 2020, from https://www.betterhelp.com/advice/grief/benefits-of-grief-counseling/
  5. Kessler, D. (2020). The Five Stages of Grief. Retrieved 9 May, 2020, from https://grief.com/the-five-stages-of-grief/
  6. Clarke, J. (2020). The Five Stages of Grief. Retrieved 10 May, 2020, from https://www.verywellmind.com/five-stages-of-grief-4175361
  7. Cherry, K. (2020). Understanding Grief in the Age of the COVID-19 Pandemic. Retrieved 20 May, 2020, from https://www.verywellmind.com/understanding-grief-in-the-age-of-the-covid-19-pandemic-4801931
  8. Panchal, N. (2020). The Implications of COVID-19 for Mental Health and Substance Use. Retrieved 20 May, 2020, from https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
  9. World Health Organization (WHO). (2020). Depression. Retrieved 23 May, 2020, from https://www.who.int/news-room/fact-sheets/detail/depression
  10. US Department of Health & Human Services. (2014). Does depression increase the risk for suicide?. Retrieved 23 May, 2020, from https://www.hhs.gov/answers/mental-health-and-substance-abuse/does-depression-increase-risk-of-suicide/index.html
  11. Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V.G., Papoutsi, E., Katsaounou, P., Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis, Brain, Behavior, and Immunity (2020)
  12. Greene, A. (2018). Grief: What’s Normal, What’s Not – and 13 Tips to Get Through It. Retrieved 26 May, 2020, from https://health.clevelandclinic.org/grief-whats-normal-whats-not-and-13-tips-to-get-through-it/