Coping with COVID: Grief and loss
By: Washington State Department Of Health
Tags: Grief And Loss, Coronavirus, Coping, Public Health, Covid 19

Transcript

Welcome to a Washington State Department of Health podcast on coping with the impacts of the COVID-19 pandemic. And now your hosts for the show, disaster psychologist, Kira Mauseth, and child and adolescent psychiatrist, Doug Dicharry.

- Hi, welcome to our show today, I’m Kira Mauseth.

- And I’m Doug Dicharry. Today we’re discussing how to cope with grief and loss.

- Yeah, this is an important topic that’s really come up a lot for folks in the context of COVID as a disaster and as a pandemic because you know, most of us have had some experience of loss as a result of this, even if it’s not the loss of a loved one or the direct loss of a friend or a family member. So there’s lots of ways that people can experience grief and loss in this disillusionment phase. And there’s lots of different sort of versions of loss that folks have gone through in the last several months. So it’s important to realize that going through these experiences and whatever kind of loss that it is that you might have had in the last several months, that’s layered on top of the additional stress and the rest of the conditions of COVID that we’re dealing with in addition to that.

- Right, and as you mentioned Kira, there’s so many different ways that we can experience grief and loss. Obviously, we feel it when someone in our lives passes away, but it can also happen with a change in our health, change in our economic status, a job loss, for example, and it can last for a long time, maybe permanently, and we feel it when our goals or our future plans are interrupted or when we’ve lost opportunities.

- Yeah, and there’s certainly been several of those this year, hasn’t there?

- Sure.

- Lots of hits that people have taken from this experience. The grief process, you know, it’s sort of complicated, but there are some experiences that are fairly common. It can be different for everyone, but what we’re going to talk about today are sort of, sort of the underpinnings and the normal processes that are common to most folks and what’s normal, and that there’s a reason for it. And there was also some things that we can do to sort of actively cope and manage the grief and the distress that we’re experiencing that are going to help sort of navigate this entire situation a little bit better.

- So one thing to keep in mind, and this is very common, is that grief comes in waves typically, so it could be a memory, it could be a photo, a particular room, even a smell can trigger waves of grief unexpectedly. And this is completely natural and normal. And typically what happens is that over time, those waves become smaller and less frequent, but they can be pretty overwhelming early on in the process.

- I agree, that’s a really good point, especially about the smell. Smell is a really strong trigger of memory. And so you can walk into a room or smell something cooking and it can instantly remind you of a situation or a person or something like that in your life. So, yeah, really good point for sure.

- Right, so we have those classic kind of signs of grief and loss, like denial and anger, a period of bargaining, depression, acceptance. But they don’t necessarily come in that order, or they don’t necessarily all show up. It may be for some people, they get stuck in kind of an anger phase, or it may be, can lead into more of a depression. And if it’s something that’s extended, something that goes for a long period, it would be important to seek help for that. Hopefully you can, someone who’s going through this can get to the point of acceptance and move on with their lives. There may always be kind of a tinge there of grief, but it’s an opportunity to move on and grow.

- Yeah, that’s exactly right. And, you know, you may have heard along with those five stages, sort of the stages of grief, you may have heard something about like a year of mourning, and a year is traditionally a range of time that we consider simply because, it’s simply sort of for the fact that once you go through an anniversary of things, it takes a year to get through a birthday or the holiday season or the the markers that occur every year on an annual basis, and when you go through all of those experiences once under the new circumstances of the grief and loss, that allows you to help process it a little bit. So in addition to those five stages that we have sort of heard of historically, and we might be familiar with the concept of about a year, I mean that’s just a range, it’s different for everybody, but going through all of those anniversary milestones is a big step for people too.

- Right, right.

- So in order to help cope with grief and loss, one of the models that I like to share with people is something called the HEAL model. And that’s just the letters H-E-A-L that can help us sort of navigate the different pieces that go with coping with grief and loss. The HEAL model is something actually that was developed working in Haiti because the experience of grief and loss certainly was not limited to the loss of people there, but also homes and livelihoods that so many folks were experiencing. And I know that that applies to our situation here in COVID as well for many, many people. So it’s an acronym, just the four letters for the word heal, H-E-A-L, and the first one there, the letter H stands for honor the loss. So, you know, that takes a different sort of view in COVID based on what we’re able to do with our get togethers and with our participation in certain rituals and ceremonies. But it is really important to continue to do that in whatever way that you’re able to, given, you know, the current guidelines at the time. And not avoiding memories, to recollect and to recall and sort of process and allow yourself to either honor the person if it’s the loss of a person, or honor the experience that you’ve been through. And, you know, maybe it’s the loss of a job or a piece of identity, but allow yourself to have some time and give yourself some time to sort of process and think about whatever that experience is and reflect on some of those memories.

- Right, and I would add that it’s as important and in some cases, even more important, when it comes to children to follow these principles. So the other, the E in there, is to express emotion, and keep in mind that there really are no wrong emotions. People will experience the whole gamut of emotion from fear to anxiety to depression to anger, that there are no wrong emotions. It is what it is. Being angry is very common, for example, when many people experience grief. They may be angry with the person that they’ve lost, they may feel guilty about feeling angry, but it’s entirely normal. In the case of the loss of a loved one, it’s not uncommon to feel angry toward that person or to feel angry, for example, if they’re spiritual toward God or a higher power, and it’s okay. I mean, that’s part of the phase of working through this.

- Yeah, you know, Doug, I’ve heard some things from my other colleagues who are also pediatric folks, I’m wondering if you can comment on this but I’ve heard them say things like, you know if you give a child bad news about a loss whether it’s a person or maybe the family has to move or something, oftentimes young kids will say, okay, thanks, can I go play now? And they don’t actually kind of process it and express the emotion that you would expect. Is that normal for kids?

- It is, it is, and depending on their developmental stage and their level, you have to kind of listen or you do have to listen carefully to what their concerns are, because they may not absorb it fully depending on how old they are, for example, but give them time, listen to their questions and answer. The main thing is to be honest with them.

- We’ve dealt with that a lot, and I think a lot of adults have the impression at least that by not giving kids the full information that they’re protecting them from something, and it’s been my experience at least that kids by and large will imagine something worse, and if you don’t give them all the information. So that’s part of honoring the loss and expressing the emotions, is giving them that information in a developmentally appropriate way, not hiding things or lying to them.

- Exactly.

- Yeah. Another thing that sort of is another step in this process is the A in the HEAL model which is acknowledging the obstacles. And most of us get stuck with very typical and common obstacles that prevent us from moving forward and getting to a place of acceptance with loss. And that includes things like avoiding or denying it, wishing it was different or wondering what could have caused a different outcome. And when our brain gets stuck on the “but if this had happened then” — the “if thens” — “if I had just or if we had just, or if so and so had just, then it would be different,” but the thing that you know is sort of a mantra that’s worth repeating, I believe in your own head is that, “but it did, but it did happen.” And kind of grounding yourself in that, even though that’s really difficult, acknowledging the things that are blocking you, is an important step.

- And the L is for live, and this is so important that some days after a loss, all you can do is make it through the day, and over time, it becomes more important to focus on life and active living. You really have to be careful not to get in a rut, not to become withdrawn, but to continue to engage and connect and learn and participate. Get with friends, get with family, continue growing in your life.

- Some days that’s certainly going to feel harder than others, for sure.

- Right.

- It’s worth keeping in mind how important that is. Other things that are sort of special considerations for where we are in the context of COVID is the necessity of kind of adapting creatively to do these things that we’ve been recommending, honoring the loss, reminiscing well, distancing, participating, to the extent that you can, whether that’s a virtual service or very small scale sort of a memorial, planning things for later, planning bigger things for later down the road. Let other people help you. And then another tip is, if you really don’t know what to say or how to help someone else through a loss, but just to engage in active listening. We’ve talked previously about how important and how helpful active listening can be. And that’s just listening to someone else express their concerns and talk about what they’re going through for the express purpose of understanding and caring — not to problem-solve for them, not to try and fix something, but just to listen. It’s not something we do very easily, but it’s really helpful in the case of grief and loss.

- Right, and it’s so important because often people may feel isolated because so many people around them are in the situation where they don’t know what to say so they don’t approach the person who’s grieving, but it is important to make that contact and to listen actively. And as people go through stages of grief, there are specific things that you can do and one thing to keep in mind. Instead of asking for example, “let me know if there’s anything I can do,” someone in that situation may not actually be able to think clearly about what they need. So instead of asking what you can do, offer specific suggestions — “would you like me to drop a meal off this evening?” Or “I can text you or give you a call tomorrow,” or “let’s go take a walk,” or as we said, just practice active listening, just check in. There are things that you can do specifically to support someone who’s going through stages of grief and the more specific you can be, the more helpful it is, but that active listening piece is really probably the most important, to let them know that that you’re there.

- Yeah, I agree. Absolutely. So, yeah, we’ve touched on several strategies that can help you cope with grief and loss during this time and giving you some resources hopefully that can help. There are lots of hotlines available, smartphone apps, and other things that you can find. There’s a website that we would recommend, coronavirus.wa.gov/wellbeing. That’s one option.

- And there’s also Washington Listens to talk through issues you’re dealing with and connect with resources in your area. And that number is 1–833–681–0211. That’s 1–833–681–0211. And as always if you’re concerned about mental or behavioral health for yourself or those of your children, if you’re really having difficulty getting things under control, be sure to talk to your healthcare provider.

- Yeah, that’s always a great recommendation if you’re concerned. That’s it for our show today, thanks for joining us, and we’ll see you next time for the Department of Health behavioral health podcast on coping with COVID.

- So long for now.