By the Rev. Matthew Rhodes
There is no greater loss than the loss of a loved one, and even in the best of times, the grief can feel overwhelming.
Rituals like funerals, shivas and life celebrations can often help ease the pain and allow those left behind to begin healing.
But because of the COVID-19 pandemic, many people have been forced to change the way they say goodbye, complicating the grieving process, though making it no less important.
In the absence of rituals surrounding the dying – such as visiting the bedside, viewing the body and having a funeral – how does someone grieve? How does a spouse or a child or a friend grieve someone’s absence without having been present?
These unclear and uncertain experiences that many people are grappling with right now are referred to as ambiguous losses.
Coined by the researcher and educator Pauline Boss, Ph.D., the term ambiguous loss is defined as when the emotional and physical realities don’t align.
A loved one may be physically gone, but it still feels as though they are emotionally present because one has not had a way to “observe” their death.
For instance, when a loved one in the military goes missing and inevitably dies, but the loved one still feels them as emotionally present even as they are physically absent.
A patient with dementia, for example, is physically present but the loved one feels their emotional absence.
Thus, the idea being that when an otherwise healthy enough person leaves home to go to the hospital, declines rapidly, and the loved one doesn’t get to see them throughout the process, it creates something like ambiguous loss.
Grief is a normal response to loss and is marked by a range of feelings, including:
• Emotional numbness, shock, disbelief or denial.
• Anxiety over being separated from the loved one.
• Distress that leads to crying; sighing; having dreams, illusions and hallucinations of the deceased; and looking for places or things that were shared with the loved one.
• Periods of sadness, loss of sleep, loss of appetite, extreme tiredness, guilt and loss of interest in life.
These feelings, compounded by ambiguous loss, can make the grieving process more difficult.
Not to mention, with physical distancing measures and restrictions on gatherings in place to help prevent the spread of COVID-19, people are being left to grieve apart at a time when they need to be together the most.
While it may be too soon to say how grieving in isolation will affect people long-term, studies have shown that lack of social support increases the chance of having problems coping with a loss and could lead to complicated grief.
As defined by the National Institutes of Health, complicated grief is characterized by:
• Minimal grief reaction. A grief pattern in which the person has no, or only a few, signs of distress or problems that occur with other types of grief.
• Chronic grief. A grief pattern in which the symptoms of common grief last for a much longer time than usual. These symptoms are lot like ones that occur with major depression, anxiety, or post-traumatic stress.
Five Things to Say
In his book The Four Things That Matter Most, palliative care physician Ira Byock, MD, writes that most dying people – and their loved ones – typically want to hear four things from each other.
• Please forgive me.
• I forgive you.
• Thank you.
• I love you.
And the fifth, though not explicitly in Byock’s book: Goodbye.
Though these conversations cannot be held at the bedside at the moment and are impossible when someone dies suddenly, they can still be had in some form that provides a sense of closure.
A letter, for instance, can help address any thoughts or feelings that were left unresolved or unsaid. Some people may benefit from playing out the conversation they would have had with their loved one and contemplating the deceased’s responses. Others may enjoy talking with other people who were also close to their loved one.
Additionally, though no substitute for in-person interactions, online gatherings and live-streamed services can provide an outlet for people to share stories and memories of the deceased and offer comfort for those left behind.
For people struggling with grief, online counseling is available.
There is no question that the effects of the COVID-19 pandemic have been disorienting for almost everyone. Few people have their regular routines any more, and the traditions and rituals that help mark life’s triumphs and its losses, have been suspended.
This has made the grieving process more difficult, but in time, as tears turn into laughter, people will heal, move forward and find peace.
As the effects of COVID-19 are felt throughout Central Jersey, Penn Medicine Princeton Health remains committed to providing high-quality, comprehensive care to the community 24/7.
If you are debilitated by grief, whether from the loss of a loved one or the multiple losses felt by healthcare workers during the pandemic, Princeton House Behavioral Health may be able to help. To learn more, visit www.princetonhouse.org or call 888-437-1610.
The Rev. Matthew Rhodes is the director of Religious Ministries at Penn Medicine Princeton Health.