Grief & Loss Handout Making sense of: Grief & Loss Grief is often associated with the loss of a loved one. The Covid-19 pandemic has dramatically altered everyone’s lives and whilst some have indeed lost loved ones to the virus, everyone in this extraordinary, never-before-experienced situation, will be experiencing various different types of loss. And will be involved in many different aspects of the grieving process at the same time. Before we look at the different aspects of grief and some different theoretical models that may help us understand the grief process a little more, it’s important to set a few ‘ground rules’. A few key messages that are helpful to hold on to as we talk about grief. Everyone experiences grief differently. It’s often said that each individual’s grief is as unique as their own fingerprint. It’s worth saying that again here. Each emotion we experience is valid, is coming from somewhere and serves a purpose. It’s important to not feel ashamed or critical about the emotions you may be feeling (of which ‘numbness’ is also a feeling – there’s a purpose to that too). Try not to place value judgments on your emotions – try not to label them as good or bad. Finally, it’s worth looking at the root of the word ‘emotion’ here – it is emovere – a Latin term meaning ‘to move out’. Emotions need motion. They need space to move. It is important to try to allow that to happen in some way as opposed to stifling or repressing the emotions and keeping them stuck. So what is grief? What are some definitions of it? One is that ‘Grief is the price we pay for love, a natural consequence of forming emotional bonds to people and objects’. It’s pretty simplistic but is a useful starting point. We form connections to a favourite pair of shoes, to a routine, to a pet, to a person. And when those things are taken away from us or we lose those things, we have an emotional response, a feeling of loss. ‘Grief is the normal response to loss, particularly to the loss of something or someone that has died, to which a bond or affection was formed’. The key word here and one that I hope is also held on to, is the word ‘normal’. What are people grieving at this time? There is a lot to be grieving right now with the outbreak of Covid-19. It’s particularly chilling to witness an entire way of life coming to a sudden, unexpected and horrible stop. Some of the losses people are experiencing include the loss of: Freedom A (somewhat) predictable future The ability to plan ahead Businesses Careers Social roles Routines Being able to walk past people on the street and feel safe Not having to think twice about holding onto a railing on the tube or a handle on a trolley in the supermarket Safety Plans for the future Normality Hope People dying (and the extra grief of not being able to be with loved ones, whether related to C19 or not). Identity – many of the things we have lost are those which give us a sense of who we are: our social roles (being a sister, a friend, an uncle), our routines, the foods we buy, the friend’s house we visit on a Tuesday evening. The current situation is unique in so many ways but something that particularly stands out is how many different types of loss – and therefore grief – are being experienced simultaneously. This can lead to a feeling of not being grounded, of being uprooted, of the very ground you have been used to unconsciously walking on for many years suddenly disappearing. This can lead to a feeling of being in freefall, of feeling discombobulated, of feeling fractured and fragmented. A further aspect of loss that is useful to understand is the concept of ‘secondary loss’ – someone may have lost an elderly parent which is incredibly painful before you even begin contemplating the intense pain at not being able to hold their hand as they died or to be at their funeral. The secondary losses are associated losses – you may have been a carer for your parent for many years, you would have been that person’s son or daughter, you may have bought the newspaper for your parent from the same shop for many years where you got to know and enjoyed seeing the shopkeeper. These secondary losses tend to unfold over time. There may be some you are acutely aware of immediately following a loss, and some may arise as the weeks, months, and years pass. Being aware that these secondary losses may arise can help us better understand what we may be grieving when we are caught off guard by a new feeling of loss or pain. A feeling often associated with secondary losses in particular is guilt – people compare the feeling of losing a loved one with the ‘selfish’ feeling of mourning some of the secondary losses such as missing the feeling of being needed as their carer. These secondary losses are a normal part of our grief and need to be given space to be processed. What are some of the common reactions to grief? Reponses to grief can be emotional (such as feelings of extreme sadness), behavioural (such as losing motivation to wake up in the mornings), or cognitive (how we think – frequently worrying about catching the coronavirus for instance). Some examples might be: sadness, longing, anger, despair, insomnia, fatigue, guilt, confusion, apathy, difficulty concentrating, numbness, fear, shame, helplessness, emptiness, loss of appetite, increased appetite, anxiety. What impacts our experience of grief? Grief is not unlike trauma in many ways and like trauma, there are different factors that have an impact on how we experience grief: what is being lost – if it’s a person, the depth of the relationship you had with that person; the age at which you’re experiencing the loss; your temperament and sensitivity; and previous experiences of grief, particularly those that are unresolved. Our current feeling of loss can catapult us back to other losses, things we perhaps haven’t grieved for in the past. This is known as archaic grief and is one of several types of grief that have been described over the years. Types of grief Normal grief: Is where people are feeling the emotions associated with grief but in a way which doesn’t interfere with their ability on with their lives, particularly in the long-term. Archaic grief: Unresolved grief from the past that is triggered by present day loss. Inhibited grief: When the griever avoids facing the reality of the loss and turns their attention to other things as a means to distract. Though thoughts and emotions are repressed, the body will often still attempt to ‘move the feelings out’. This can lead to exhaustion, recurring digestive issues, migraines and tension headaches, teeth grinding at night, and so on. Cumulative grief: Also known as ‘grief overload’. This occurs when one experiences a second loss (or a third, or a fourth) whilst still grieving the first. Anticipatory grief: the feelings of grief experienced when anticipating future loss or losses. In the current situation we know the world will not be the same yet we are unable to put our finger on what it will look like in the future and what else we will lose. Disenfranchised grief: When someone’s loss/grief is invalidated or made to feel insignificant because of culture or society. For example, when a relationship is seen as insignificant, such as the death of a pet, a person may stifle their grief; or when a stigmatised relationship breaks down, for instance a same sex relationship that might be seen as taboo or an extra-marital affair. Collective grief: The grief felt by a community, society, or nation as a result of a war, a natural disaster, a terrorist attack. Or a pandemic. Collective grief can often be pinned to one particular event: the events of 9/11, an earthquake, hurricane or tsunami, the death of a public figure such as Princess Diana, the fire at Grenfell Tower. What follows is often a collective outpouring of grief, a togetherness, and importantly, the ability to take part in the collective ritual of a funeral that provides the opportunity to get a sense of closure. Covid-19 is significantly different in that it is not connected to one singular event – it is ongoing with no end in sight and with losses that continue to be layered one on top of the other. Models of grief The models we cover help to provide a sense of scaffolding around the grieving process. Like all models, they are ideas and like all models, they don’t cover the complexity and depth of human feelings and emotions, but help in breaking down the process of grieving so that we understand it and can work through it. Theories that involve various stages can tempt us into thinking that there is a clear order to a complex (and often messy) process. It can be easy to be lulled into the idea of an emotional promised land of ‘recovery’, ‘closure’, and ‘moving on’. Though useful, they do not capture the complexity, diversity and unique quality of the grieving process from person to person. Kubler Ross and the Five Stages of Grief Perhaps one of the most well-known models of grief comes from Elizabeth Kubler Ross. Though there has been some criticism of the model as being a bit too neat and linear, it is a model that provides a useful breakdown of some of the different stages a person might go through in response to loss. Having a sense of the stages can help when we feel stuck in a particular stage. Ideally we would move through them in some way. Kubler Ross herself later acknowledged that steps can be missed or repeated and the process is a lot messier than she had initially envisaged. The stages – in relation to Covid-19 – are: Denial: “It’s a conspiracy!” or “It’s just a flu and will disappear”. Denial blocks the emotional pain of the loss and can be a healthy defence mechanism in some instances but the minimising that comes with denial, particularly when it becomes a long term coping mechanism, is obviously unhelpful. Anger: “But why can’t I go to the park anymore? My liberties are being robbed from me!”. Anger can be healthy and appropriate but it can also slide towards blaming and deflecting “This is all China’s fault. The Chinese should have contained this more”. Bargaining: This is where the denial starts to diminish and we slowly start to recognise reality… but we’re not quite ready to give up the illusion that we still have control. Examples are thoughts like: “I’ll be fine socialising with others as long as I wash my hands”. Depression: This stage happens when denial fully ends and what is really happening begins to land. There is often a sense of hopelessness in this stage, a feeling of being disempowered. “This pandemic is the new normal. I feel like I have to let go of my hopes and dreams”. Acceptance: This occurs when we are finally ready to acknowledge reality, accepting it as opposed to fighting it. This might be something like: “I can’t control the pandemic but I can do my bit by staying at home” Dual Process Model of Coping The Dual Process Model of Grief describes grief as a process of flipping between two contrasting modes of functioning. The words describing the two ways of being aren’t particularly helpful and they’re not important to remember but simply knowing that it’s possible to flip between the two, sometimes from day to day, sometimes from one minute to the next, is really useful to hold on to. The two modes are: Loss Orientation: where the griever engages in expressing the range of emotional responses associated with the loss. Restoration Orientation: where the griever engages with day to day coping and is required to focus on the many adjustments that the loss has led to, particularly when it comes to ongoing life demands. Worden’s Model: The tasks of grief Worden suggested that there are four tasks that must be gone through for the process of mourning to be completed and for some sense of equilibrium or balance to be re-established. Remember, like any model, this is just an idea or a theory. There are many grief theories and all are just trying to capture some sense of the process. If you do not feel like you have gone through them, don’t panic. Worden’s model – and the others – just provide a helpful breakdown of the kinds of stages you might be going through, and provide words for you to perhaps better understand your emotions and place yourself within your own grieving process a little better. What is helpful about Worden’s model, particularly the last stage, is the idea of finding meaning and purpose in our lives after the loss, no matter how long it takes to get there. In trauma theory, this is called post-traumatic growth and provides a useful opposite to the idea of post-traumatic stress. What can we do about the feelings of grief? First and foremost – be kind to yourself and give yourself space to feel and acknowledge whatever you are going through. Feelings of numbness or emptiness are still feelings – the important aspect here is the process of learning to turn your attention inwards in a compassionate and kind way, less about what you discover. The more you become accustomed to turning your attention inwards and realising that it’s safe to do so, the more you will be able to build a healthy relationship with your own internal, emotional world, which in turn will help guide you through whatever grieving processes you are going through. The emotional responses associated with grieving can take their toll on us. It is natural to be exhausted, to feel fatigued. Prioritise rest and relation, connect to others when you need to and be alone when you need to recharge. Feeling worn down is often a result of us being so activated and hyper-stimulated by news and all things corona on a daily basis. Again, allow yourself to recharge and try not to compare yourself to those people who are talking about how productive they’re being and how many new languages they’ve learnt in self-isolation. It’s difficult to hear that when you can barely get out of bed. Be kind to yourself. You are not alone in your pandemic-induced exhaustion.