How to mourn when you can’t grieve

Iani de Kock - The rate and number of deaths has been staggering, completely overrunning our health care system and leaving overwhelmed and distraught medical staff, patients, and family alike in its wake. By any measure, the majority of COVID deaths are “bad deaths”, which include sudden, unexpected, or accidental deaths; deaths by violence; difficult-to-process, painful deaths; as well as deaths due to inadequate care or negligence. All of these conditions seem applicable to a COVID-death. Add the fact that people are not only losing one, but multiple loved ones, acquaintances, neighbours, and colleagues, and the bereavement overload on those left behind has swept over us like a suffocating tsunami of complicated grief.

Complicated grief refers to when an individual cannot process the loss of a loved one and move on with life. They remain stuck with an intense, prolonged yearning for their lost loved one, which can be completely immobilizing and bring about impairment. It frequently shows up as a freeze response and a deep melancholy and despair or hides under the guise of somatic reactions like panic attacks, aches and pains, stomach upsets, and headaches. We struggle to focus or concentrate and thus struggle to work. Our patience and emotions run thin, so our people skills suffer.

Our healthcare workers themselves are suffering from vicarious grief and trauma of having to see so many people die, often due to a live-or-die judgment call they had to make themselves. In their pain and blind anger, families blame healthcare staff and themselves for negligence, despite doctors and nurses working inhumane hours in understocked, understaffed, and ill-equipped conditions - beyond the point of fatigue or mental clarity. Our morgues are overflowing due to family members being unable to locate or collect the remains of their loved ones.

According to the classical bereavement model of Elisabeth Kübler-Ross, we have to navigate through various stages of loss, including denial, bargaining, anger, and depression, before one finally - over time - learns to live with the loss in the final stage of acceptance. Considering this model in the context of COVID-19 and the nature of “bad deaths” can help us understand why we are facing such a crushing wave of complex grief. Due to the highly infectious nature of COVID-19, our cultural and traditional rites of passage for death and burial have been overturned, and we are unable to mourn in ways conducive to proper processing, closure, and healing.

There is also such a sense of unfairness and injustice towards COVID deaths. We feel robbed by death, by medical staff, and - even at times - by God. We feel angry at ourselves for everything.

This anger turns into self-blame and bereavement guilt as we live with those final words unheard, old wounds unhealed, never-given apologies, goodbyes unsaid. Inexpressible anger without a clear target is often turned inwards, exacerbating our feelings of depression: the intense feelings of sadness and loss that nothing can fill the empty void with no motivation or joy.

Unable to grieve or move on and overwhelmed by loss and despair, many left behind are desperately attempting to cope in any way they can, generally trying to minimize and numb the pain with substances, being busy, or overworking. While these coping mechanisms may have worked in the past, numbing and avoidance strategies are no match for COVID-related grief with the sheer vastness of so many losses happening concurrently.

How do we, as a ravaged society, grieve when we cannot grieve? Firstly, complicated grief is lessened if there has been some form of preparation and closure before the death has even occurred. While society considers conversations about death and mortality to be morbid, or even bad luck (as if talking about it somehow summons it), these are vital conversations that ease the burden on both the person who is ill, as well as those who will be left behind.

Collectively, we need to get our affairs in order. Being able to make peace and offer our final goodbyes is vital to enabling the grieving process and reducing the guilt, shame, and anger that can follow. Often, in the Namibian context, we cannot rely on virtual technologies to keep in touch with our loved ones in isolation. Have those all-too-important difficult conversations with friends, family, and foes now and get closure before there can be none. Unsaid words weigh heavy and can be a burden for life.

Ensure you have your last will and testament set up so that the burden does not fall on those left behind. For those privileged enough, having a funeral plan can also really save your loved ones a lot of added anguish once we have passed, as they will not need to rush (as much) to make arrangements on top of their sorrow and loss.

Now that funerals are often delayed (sometimes by months), memorial services play a crucial role. Some creative and inclusive ways of hosting memorials that I have heard about lately include drive-by services and the return of letter-writing, with eulogies being written and serving as ways of expressing (and releasing) our grief. Increasingly, memorial services are being video-recorded and streamed, allowing loved ones across the globe to still attend in a sense.

Witnessing what the lives of our loved ones meant to others can be very meaningful and drive home the reality that they are indeed dearly departed. Without this deep realization, death remains an unreality, we remain in the stage of denial - unable to process adaptively and move on.

As mentioned earlier, unresolved matters with the deceased also perpetuate complex grief. A ritual substitute from Gestalt therapy, known as the unposted letter, can offer some closure and an opportunity to say what has not been said. Writing a letter to the deceased, and also writing a letter back to yourself (as if from the perspective of your loved one) can be a deeply healing and expressive form of grieving and finding meaning in the face of such an intense loss. These letters can then be burned or buried in a substitute funeral, which can further help us release and let go of our grief. Whatever means we can devise to grieve will do - the more personal, the better.

If we are to move beyond the denial and anger and pain in the aftermath of so much loss, we cannot simply go on with business as usual. Yes, the bills have to be paid, and the economy needs to keep churning.

Businesses and employers need their few healthy employees to carry the workload of all those who are no longer able to - even if the remaining few are drowning in grief. The paltry five days of compassionate leave we're legally entitled to, under normal circumstances, are nowhere near enough to allow for the time and space needed for adaptive grieving during trying times.

Still, if we do not create the time and the space to acknowledge and express our grief in adaptive ways, it does not simply go away. Grief manifests as physical, bodily complaints - like tension and disturbances in our sleep, appetite, and libidos. It also diminishes our psychological resilience and makes us vulnerable to the onset of burnout, anxiety, panic attacks, depression, trauma. These conditions are pervasive and can continue affecting and impairing our functioning for years after the passing of our loved ones and COVID-19. Doesn't it make sense to take the time and space to mourn, hurt, grieve, and heal - sooner rather than later? – [email protected], beingwellpsychology.com