Coping with COVID: Grief and loss

When natural disasters happen, it is normal for people to experience loss and grief. Many of us have felt some form of loss as a result of the COVID-19 pandemic, like the loss of a loved one, change in health, job loss, or even just the loss of our “normal” life. Any grief and loss we might be feeling is layered on top of all the other stress of a pandemic. It’s ok to not feel ok if you are grieving a loss, especially during a natural disaster like this one.

In this episode of our Coping with COVID podcast series, Kira Mauseth, PhD and Doug Dicharry, MD talk about how most people experience grief and loss, and provide strategies for families to cope as we make our way through the pandemic.

Grief can be complex

Everyone grieves differently, but there are some common experiences. You may have heard of the “stages of grief”: denial, anger, bargaining, depression, and acceptance. Many people experience these, but grief doesn’t always happen in stages or clear steps. Elements of grief don’t come in any specific order, and some might not show up at all.

Instead of clear-cut stages, feelings of grief usually come in waves. It is normal to feel an unexpected wave of grief when faced with a trigger like a memory, a photo, a special place, or even a smell. At the beginning, these waves might feel overwhelming, but over time they become smaller and less frequent.

Being able to accept loss and move on with life can take some time. That’s normal and ok. As you work towards acceptance, there are things you can do to actively cope and manage feelings of grief.

HEAL to cope with grief and loss

The HEAL model was designed to help people cope with loss and grief. The letters in HEAL stand for Honor the loss, Express emotion, Acknowledge obstacles, and Live. When grieving people practice HEAL, it can help them move forward in a healthy way.

Honor the loss

An important part of healing is to honor the person or experience, rather than avoiding the memories. Honor the loss by participating in rituals, ceremonies, or other events. Give yourself time to process — write in a journal, share stories, look at pictures, and reflect on memories.

Honoring a loss can look different during COVID-19 because of gathering restrictions and safety measures. We can adapt by planning small, outdoor or virtual gatherings, and delaying large in-person events until it’s safe to get together.

Express emotion

People experience a range of emotions during grief. These include fear, anxiety, depression, and anger. There are no wrong emotions. It’s normal to be feeling a lot, and it’s ok to express these feelings.

Children may not process or express their feelings the same way adults do. To help children cope with loss, it’s important to listen to their concerns and answer questions honestly. Give them the opportunity to express their emotions by sharing the facts in a developmentally appropriate way. It might feel like hiding bad news protects children from pain. However, when children don’t have all the information, they might imagine a situation to be worse than it is.

Acknowledge obstacles

Acknowledge the obstacles that slow down the healing process. Common obstacles that get in the way of acknowledging and accepting a loss are:

• Avoiding or denying the loss.
• Wishing things were different than they are.
• Wondering what could have caused a different outcome or prevented the loss.

Acknowledging these thoughts can help remove them and move towards healing.

Live

After a loss, sometimes all we can do is get through the day. Some days will feel harder than others. It’s normal for grieving to take time but be careful not to withdraw from life in the process. Focus on living life by engaging with loved ones and participating in everyday activities.

Support others

Many people are experiencing grief and loss right now, and physical distancing means more people may feel isolated while grieving. Even if you’re not sure what to say, it is important to support others and reach out to those who are grieving. Practice active listening to understand what others are going through instead of trying to problem-solve. Offer specific ways that you can support them, like dropping off a meal or calling to check in.

Everyone goes through grief and loss at some point and it’s never easy, especially during a pandemic. If feelings related to grief go on for a long time, it is important to get help. Talk to your health care provider if you are concerned about you or your family’s mental and behavioral health.

To find more resources for mental health during COVID-19, visit our mental and emotional wellbeing webpage or check out our Behavioral Health Toolbox for Families. If you need someone to talk to about stress due to COVID-19, call Washington Listens at 1–833–681–0211.

More information

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Information in this blog changes rapidly. Check the state’s COVID-19 website for up-to-date and reliable info at coronavirus.wa.gov.

Answers to your questions or concerns about COVID-19 in Washington state may be found at our website. You can also contact the Department of Health call center at 1–800–525–0127 and press # from 6 a.m. to 10 p.m. Monday — Friday, and 8 a.m. to 6 p.m. Saturday — Sunday. Language assistance is available.

Please note that this call center cannot access COVID-19 testing results. For testing inquiries or results, please contact your health care provider.

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.