Pandemic grief

The intensity of grief usually reflects how close the griever was to the deceased person. (Julia Galuzinskaya/Dreamstime/TNS)

Few of us get through life without experiencing grief, but, as a culture, we don't do a great job of talking about it.

The United States is what Annapolis, Maryland, psychologist Sherry Cormier calls "grief illiterate."

As a result, you might be surprised the first time you lose someone dear to you by how intense and unruly the emotions are, by how they ebb and flow, by how long they can leave you feeling heavy, scattered, edgy or vulnerable to untimely tears, by how sorrow and happiness can co-exist.

WHAT IS GRIEF LIKE?

This varies with the griever and the nature of the relationship. The intensity of grief usually reflects how close the griever was to the deceased person. It can also be affected by whether the death was sudden or violent.

Dina Goldstein Silverman, a psychologist at Cooper University Hospital, said bereaved people can have a long list of powerful symptoms: sadness, anger, irritability, tearfulness, reduced concentration, lack of appetite and poor sleep. Casey Bien-Aimé, spiritual care coordinator at Lankenau Medical Center, said many describe a heaviness, a dull pain. "It's like love that doesn't know where to go," she said.

Contrary to popular belief, grief is not a linear process, Cormier said. The stages you've heard about were meant to describe the experiences of dying people, not their survivors.

Grief comes in waves, some big and stormy, others much calmer. It may worsen at holidays or important family milestones. A favorite food or perfume can trigger it. "Grief moves and changes in a person over many years," said Carmela McDowell, bereavement coordinator for the Jefferson Home Care Hospice Program.

The bereaved are both grieving their loss and moving toward a new future, said Ashley Herr, education and community outreach director for the Center for Loss and Bereavement in Skippack. She thinks of a Venn diagram where people oscillate between the "loss-oriented side and the restoration side."

WHAT MAKES LOSS SO HARD?

Obviously, it hurts to lose people we love and who loved us, but we may also have lost an important role, such as being a wife, husband or parent. A death may force the grieving person to take on new, unfamiliar responsibilities, and it can have serious financial consequences. "We do need to remember that grief is not just about a death," said Cormier, who wrote Sweet Sorrow: Finding Enduring Wholeness After Loss and Grief.

For many, the death of an important person in their life shakes their world view, the future they imagined for themselves. Herr calls it the loss of the "assumptive world."

Many struggle with the "year of firsts," the first Thanksgiving without grandma, the first Father's Day without Dad. They assume things will then be fine. "The day after the anniversary of that first year, the feelings are still there," Herr said.

Grief often makes people feel off-balance and helpless. Loneliness is common. "I've never talked with a grief survivor that hasn't said to me, 'I feel so alone,'" Cormier said. COVID-19 isolation has only made that worse.

The intensity of emotion is frightening. "I think we all feel competent when we feel in control," McDowell said, "and grief takes away that sense of competence and control."

AM I DOING THIS RIGHT?

"There's no right way to do this stuff," Herr said.

People grieve in different ways and at different speeds, and that's OK. Herr described two grieving styles. For intuitive grievers, there's a "feeling to be felt." They want to connect with their emotions and talk about them. Instrumental grievers see a "problem to be solved." They may want to create a memorial fund or throw themselves into work. "Most people are a kind of a mixture of the two," she said.

You will set yourself back if you try to fight the uncomfortable emotions. "We have all these emotions for a reason," Bien-Aimé said. "They have a purpose, and they are meant to be experienced instead of pushing them down until they grow and become uncontrollable."

She recommends the book Healing Through Dark Emotions. "Grief expressed," she said, "can help us connect and heal."

Kathy Shear, an expert on prolonged or complicated grief at Columbia University, said people tend to want grief to move fast, to control it. "They don't know what to expect, and it's hard to let it just be what it is," she said. "The more you try to control it, the more it controls you."

Cormier agrees that you can't shove grief under the rug. "The way to work with grief is through it, not around it," she said.

HOW CAN I FEEL CLOSURE?

You can't. You don't get over the death of a loved one, experts said. If you're healthy, you integrate the loss and the good and bad memories into who you are now.

WHAT CAN I DO TO GRIEVE IN A HEALTHY WAY?

– Be kind to yourself. Get enough sleep. Meditate or do yoga. Light a candle. Write in a journal. Talk to a friend. 

– Exercise is healing. Cormier recommends movement that helps you feel connected to the earth such as walking or tai chi. "It helps you reestablish your sense of equilibrium," she said. 

– Participate in rituals that are important to you. Therapists said many families are now having delayed memorial services. Think about how you can honor your loved one. 

– You can also join a support group. People usually aren't ready for groups until three or four months after the death. You may prefer individual counseling. "It gets to be all about you, your story, 100% of the time at your convenience," McDowell said. 

– Give your friends a break if they don't do exactly what you'd like. McDowell said she knows a woman who realized she hadn't been enough support for a friend after she lost someone herself. "I've called her and apologized," the woman said. "I had no idea." 

– Don't expect everyone to be good at everything, Cormier said. One friend may be a good listener, another a good doer and a third a good distractor. 

– Also, you don't have to grieve all the time. Watch something funny. Go out. Work. After her husband died, Cormier said a friend who had lost a child told her, "Remember grief is so powerful you must take breaks from it."

HOW CAN I HELP MY GRIEVING FRIEND?

– The pandemic has made this harder, but you can still drop off food and call or text. People need support for months, not just the week after the death. 

– If you're not sure what would help your friend, ask. If you're uncomfortable, say so. 

– Sometimes it's helpful just to hang out. Sherman Lee, a psychologist who studies negative emotions at Christopher Newport University, said all you need to do is care, listen and be present for your grieving friend. "It's not a time to talk about your problems," he said. 

Cormier offers a list of common sayings that don't help: Everything happens for a reason. This is God's will. You're strong, you'll be able to get over this.

What people want, she said, is acknowledgement and validation. For example: "I see that your mother died of COVID. I'm really sorry. I would like to bring over dinner. Tell me when it's convenient."

HOW DO I KNOW IF MY FRIEND OR I NEED MORE HELP?

"We never stop grieving, but grief should look different generally after six months," Bien-Aimé said.

By then, most grieving people are returning to normal work and social routines. If someone is still really struggling, experts begin to think about complicated grief, or what is now called prolonged grief disorder.

Trouble signs, which could call for more family support or counseling, are increased alcohol or drug use, suicidal thoughts, a lot of anger, isolating on purpose, feeling overwhelmed, either avoiding reminders of their loved one or obsessing about them, numbness, intense sorrow or failure to accept the death.

"It's almost like grief inhabits them and becomes their whole identity," Cormier said.

There's a popular belief that people struggle more after someone with whom they've had a troubled relationship dies. But Shear has found that many with prolonged grief have "lost someone who is kind of their soulmate, someone really important and rewarding in their life."

She developed a 16-session treatment program for prolonged grief, that focuses on adapting to loss. It does not directly address grief itself, because Shear believes that "grief is a natural response. ... We don't expect it to go away. We just expect it to stop interfering with the person's life."

The program uses a variety of psychological techniques to help patients see promise in the future, strengthen relationships, narrate the story of the death, live with reminders, connect with memories, and develop an ongoing sense of connection with the deceased.

"People we love really do exist within ourselves," Shear said.

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