Grieving in pandemic: Stages &virtual comfort | Economic Times

513 days since the first Covid case was detected in India. 456 days since the first day of the lockdown. And 390,691 deaths (at the time of publishing). That is almost over 30 deaths every hour - if you were to ignore the reports of both cases and deaths being under-reported. It has been a year of reading such numbers, seeing them in headlines and in papers splashed with gut-wrenching photos of bodies lining up to be cremated. Of social media timelines flooded with desperate cries for oxygen, hospital beds, medicines, and often strangers appearing out of nowhere to provide that slightest glimmer of hope. But despite the coming together of citizens to battle the virus as the healthcare system crumbled, countless of these people — mothers, fathers, husbands, wives, children, best friends — returned home without their loved ones.Death was omnipresent. And such were the times that even a final hug wasn’t possible.The horrifying second wave seems to be receding, but will the grief it is leaving behind ever completely disappear? Or will it remain a burden for an entire generation to carry?As friends and family members go back to an empty room, an empty chair at the dining table, a phone contact that will never ring, a social media account that met its untimely end, how will they cope? How does one process this loss, especially when the only way to share the pain is virtual?How do we even identify what we are feeling when every emotion is entangled with another equally fierce one?In literal terms, grief means immense sadness, but Dr Ambrish Dharmadhikari, Head (Psychiatrist), Mpower – The Foundation & Program Coordinator, The Mpower Hub, says, “The psychological understanding of grief is wide and encapsulates several emotions.”Echoing this sentiment is Dr Alok V Kulkarni, Senior Consultant Psychiatrist at Manas Institute of Mental Health, Hubli, who describes bereavement as “the complex set of reactions that occur with the death of a loved one.”“Studies have shown that the experience of grief has several universal constructs, such as feelings of numbness and disbelief, yearning, angry protest, and ‘searching’ behaviours representing separation distress,” Dr Kulkarni explains, before adding that grief proceeds in a non-linear fashion through many emotions or “stages”. 83771807Grief — In StagesNothing prepares you for death. Nothing prepares you for the loss and the stabbing pain you will feel at a loved one’s absence. And when faced with it, it often feels like nothing will make it go away. But grief comes, and goes, in stages. Dr Dharmadhikari quotes the Kübler-Ross model of processing grief in five stages: denial, anger, bargain, depression and acceptance. This theory was developed by the late Swiss-American psychiatrist Elisabeth Kübler-Ross, a pioneer in near-death studies, who first discussed these stages in her book ‘On Death and Dying’. However, Dr Dharmadhikari says that while earlier it was believed that we go through these stages in a particular order to reach acceptance, further research has indicated that one can go through the various stages in any order. 83772048“Loss is very personal in nature. It is contingent on personal meaning and attachment, and leaves a large vacuum in the grieving person's life. Everyone reacts differently to loss and finds one's own pathway to resolve grief,” Dr Dharmadhikari adds. Explaining these different stages, Dr Kulkarni says often, the first response to loss is denial. We simply refuse to believe that the person is not with us anymore. “Transient symptoms such as a sense of the deceased’s ongoing presence, seeing the face of the loved one lost, hearing their voice, or at times even feeling their touch are common in people who are grieving,” says Dr Kulkarni, adding that yearning for a loved one is a hallmark of grief reaction, and it may take around a year to settle. But this denial often changes into anger. We constantly raise the unanswerable question, “Why me?”, and the result is misdirected feelings of irritability, impatience and restlessness.This is followed by bargaining. Dr Kulkarni explains that at this stage, one’s mind is occupied with endless questions such as “Could I have rushed him to the hospital earlier? If only I had done something else, maybe I could have prevented this loss.”There is a stage of depression before one finally heads to acceptance. At this point, it is important to note any signs that may indicate that the grieving person is slipping into an acute clinical depression.“Grief can precipitate clinical depression in genetically vulnerable persons who may be predisposed to develop clinical depression. Normal grief reactions generally last 4-6 months, and any continuation beyond this ‘acute’ period should signal the possibility of a pathological response. Grief becomes chronic in 10-15 per cent of people, and is characterised by unremitting distress, prolonged duration of symptoms, and failure to adapt to new life roles. Sadness accompanying grief comes in waves, and when it abates, feelings of joy and the ability for humour often manifest; in contrast, the ‘down’ state of clinical depression offers no respite,” Dr Kulkarni says.But all of this is followed by a progressive acceptance of the death of the loved one. The last stage comprises continuing to find meaning once we have come to accept the loss. And it is this stage that offers hope for those left behind in this devastating tsunami of loss. It is in knowing this that we find strength when we call that friend or family member, sharing their grief from the other end of a phone line, and trying to make words suffice in place of the comfort of a hug — such are the times we live in. 83771787Talk Your Heart OutAmong the many things that the pandemic snatched from us was also our right to mourn the loss of a loved one in-person.How do you console the cousin who lost a parent but couldn’t make it for a final farewell? What do you say to a friend when you find out she lost her husband of two years? Or to the cousin who recovered and came back from the hospital but her child didn’t?How do you be there for them at a time when a simple hug has become a luxury many crave?Can a virtual world ever suffice? How do you make a call or send a text to a person in pain when you know all they need is a shoulder to cry on?Also Read: In memoriam: Tech unites people in pandemic grief as virtual prayer meets and Zoom calls mourn loss of loved ones“Nothing can replace human touch and companionship,” says Dr Dharmadhikari. But we have to adapt to the given times, and thus it is imperative that we try to connect, even virtually, more often. Dr Kulkarni also emphasises on the need for friends, family members and relatives to be pillars of support during these trying times. “Telling the bereaved person how to grieve, that they should ‘forget about the past’, and that ‘time heals all’ is generally perceived as being unhelpful. Talking to a bereaved person needs compassion, patience and empathy,” he adds.While it may seem like there are no right words to say to a person who is grieving, Dr Dharmadhikari suggests remembering that it's not words but the presence, empathy and support that make the difference. “Words are merely one tool to express. If people are totally naive to the situation, they can simply express empathy by acknowledging the distress, and offer any help if needed,” he advises. It is also imperative to recognise any signs that may indicate the need for professional help. This can come in the form of preventive counselling, cognitive behavioural therapy, interpersonal therapy or web-based virtual psychotherapeutic interventions. These virtual meets, phone calls and support can help one get as close to closure as possible. At the end of the day, as we continue to fight this tough fight, we need to recognise that the pandemic is leaving behind immeasurable suffering, and the only way out is to culturally evolve and adopt appropriate models of support for people who are grieving. And maybe ask ourselves: “Will we ever be the same when we come out of this pandemic? Or will we all be a little bit more broken?” Or, maybe, having grieved together, we’ll simply be more compassionate and humane, and remember that it was being there for each other that got us through this.