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Covid Trauma

Each time l travel to central London, l have to remind myself that we are still in the middle of a pandemic. The streets, shops, and restaurants are forever buzzing with life.  But aren’t we suppose to be taking some safety precautions, to minimise the risk of contamination, and spreading the virus? We are! Not that long ago, the trains were halted.  l couldn’t travel to central London as freely as I do now. People were locked in their homes, and we were only allowed a short window to leave our homes to exercise-stretching.  These days, people no longer wear masks; the mention of social distancing is responded to as if you are speaking a foreign language. But that was our reality then; keeping a minimum of 2-meter distance, and disinfect, disinfect, disinfect. No one seem to care anymore, yet we were still in the middle of a pandemic. It’s as if we have suddenly forgotten just how tragic the last few years have been. Is this our defence against confronting the reality?  Our way of dealing with the trauma; some sort of amnesia or splitting (Klein, 1946)- pretend it never happened and it no longer matters. When it really does.

Covid is still here, and it’s here to stay. People are still dying due to some Covid related illnesses. The Gov.UK website reports that there have been 531 Covid related deaths in the UK in the last 7 days.  What made the past few years hugely significant in our history is the tragedy and trauma secondary to the mass deaths we had due to Covid. Some people lost their loved ones, while every other person knows someone who lost their loved one to Covid. Trauma is vicarious. An experience can still be traumatic, even if it did not happen to you directly. Some people had Covid and suffered immensely, both physically, and psychologically. It left them completely debilitated; at times with long Covid. Even if one never had Covid, or had a mild version of it, living with the threat of impending death is indeed traumatic.  As with any trauma response, we go into survival mode-fight, flight or freeze (De-Kolk, 2010). Which we are still in-individually and collectively. It is important that we continue exploring what the pandemic means to us as a society, and heal from this trauma, not just individually but collectively. Discussing Covid related loss and grief is a necessary part of our processing and working though this trauma.

Death, Loss, and Grief and Traumatic Grief

Our life cycle begins with birth, and ends with death. Each stage of life from baby-latency- adolescent- adult- old age- involves loss of the older version of who we were, and grieving for that loss. Death, loss, and grief are natural parts of life, both physical and psychic death. However, when death arrives suddenly and unexpectedly, the overlap of the traumatic experience, and the grief of the loss can be overwhelming psychologically.  This may result is some people getting “stuck” in the trauma and avoiding the feelings of grief and loss. Grief is a natural reaction to loss. We grieve because we love; if we did not love the person we lost, we won’t grieve at all. That is why grief is a painful process we need to lean into, that involves a range of feelings before we can come to a place of acceptance, relinquish the loss, and bargaining whatever we can take away from that lost relationship. We need closure.

Elisabeth Kübler-Ross (1969) was the first person to develop an epistemic theory of grief identifying the different stages of grief. Her ideas were informed by her work with dying patients and relatives, observing how they responded to loss, and grieved for the loss of their loved ones. Kubler-Ross (1969) hypothesised that people who grieve go through different stages of grieving which are denial, anger, bargaining, depression, and acceptance. These stages are not linear, and people will oscillate between them at different stages of their grieving process. Some people will go through the grieving process much easier and swifter than others; we do not grieve in the same fashion. When death is sudden and unexpected, shock is a preceding stage, which we experience as part of our grieving process. The shock itself is a response to what feels like an emotional violence.

The relationship we had with the lost person has a big part to play in how we grieve, along with how we have coped with other losses in life. The way we grieve for the loss of a loved one through death, and the loss of a relationship (break up) is no different in any way as it involves going through all the different stages identified. There is a lot of emotional labour involved.  We always talk about the first heart break, when you broke up with your first love-perhaps in your teens. It is one of the most painful experiences in life, and a defining one. Why? Because it involves a lot of emotional labour. It also becomes a process that sets a template of how we deal with other losses in life.

Covid Losses

Many people lost their loved ones to Covid. Most of these losses were very sudden and dramatic in how everything unfolded. You hear stories of someone who woke up fully fit, developed a cough, took a Covid positive test, placed in intensive care unit, intubated, and dead by the end of the day. As dramatic as it sounds, these are consistent themes and stories we have all heard, repeatedly. Many people who lost their loved ones in such a sudden and abrupt manner have experienced traumatic grief. Others continue to experience traumatic grief. The fact that in many cases death was sudden, and there was a restricted way of mourning the death of loved ones-not being able to bid farewell and not able to attend funerals, makes the grieving process complex. This goes against how we deal with loss and grief as humans and complicates grief. Its an emotional blow.

Sudden death by suicide, accidents and other unexpected deaths, can also lead to traumatic grief. We will concentrate on Covid losses this time.

Traumatic Grief

Not every sudden or catastrophic loss results in traumatic grief. Grief is personal, and we all experience it differently. According to Phillips (2021), some people experience uncomplicated bereavement, while others may show signs of both trauma and grief. They might avoid talking about the person they lost altogether, or they might become fixated on the way their loved one died.  Because of the trauma embedded within the grief, it can be challenging to differentiate between posttraumatic stress disorder (PTSD), grief and traumatic grief. “PTSD is about fear, and grief is about loss. Freud would have termed this melancholia- Freud, (1917). What makes a loss traumatic is not only the way the person died but also the meaning attached to the death. Freud (1917) differentiated normal mourning from pathological mourning, which he called melancholia. What’s different about melancholia is that there is no trauma embedded in the loss, it’s simply a process where the grieving process gets stuck and there is a narcissistic fixation with the lost object (person). The loss itself in the end becomes all about the person who is grieving, not necessarily the lost person. With traumatic grief, there is trauma, and one gets stuck in the trauma before they are able to grieve.

Social and cultural factors (such as personality, spirituality and race/ethnicity) affect how we all approach loss and mourning. In some cultures, there are certain rituals in the grieving process, and these are often done collectively. Grief is a process we cannot go through alone, we need others to bear witness, share the feelings, and talk about the loss-what it means to us.  Being able to share the experience is very important as it enables us to process and heal. In most western cultures, grief is a very personal experience where people tend to go though it in isolation.  This is often in the background of depression (unprocessed grief) and anger issues- (unprocessed grief). Normal grief involves a working through all the different stages to a place where we can get closure. Without this closure, we get stuck in the grief and we are unable move past it, no matter the length of time.

People who are experiencing traumatic grief experience these symptoms:

• Nightmares related to the lost loved one/s or about dying
• Anxiety about the possibility of losing other loved ones
• Guilt and self-blame "I” statements frequently “I should have done more to help them"
• Physical pains, have trouble sleeping
• Distressing thoughts or dreams
• Hyperarousal or anhedonia/numbness
• Loss of appetite
• Trouble sleeping (which can resemble signs of depression)
• Difficulty focusing (which can look like a sign of attention-deficit disorder)
• Preoccupation with the deceased at times in an obsessive manner
• Experiencing localised pain in the same area as the deceased
• Extreme longing for the person
• Hearing the voice of the person who died or “seeing” the person
• Being drawn to places and things associated with the deceased
• Experiencing disbelief or anger about the death
• Thinking it is unfair to live when this person died (suicidality)
• Having difficulty caring about or trusting others

How can we heal from traumatic grief?

Many people came to therapy with complex grief symptoms, and traumatic grief. If grief is not worked through, and remains unresolved, it can have a long-lasting impact on one’s mental health and relationships.

People experiencing traumatic grief are operating in survival mode. Like with any trauma treatment, its important that we create safety, so they can start to feel grounded, and engage with their grief feelings.

Therapy helps people with traumatic grief to emotionally regulate.

Therapy helps create new meanings-“its not my fault and l accept this happened”

Therapy helps processing the feelings- sit with the anguish with the therapist being fully present with the client

If conflict existed in the relationship with the person who died, people may need to work through challenges that they had or feelings of guilt or shame that can be present following the loss

Therapy enables us to develop a narrative around the loss which is a significant part of healing

Therapy enables us to consolidate the contradictory feelings we may hold towards the person we lost. Its not easy to grieve for someone we may have held a grudge against or someone who may have hurt us.

Apart from individual therapy, support groups can give you the holding space to process. Grief is not an experience we go through in isolation. Healing comes from sharing your story and allowing someone to hold you through the vulnerable experience.

References

Der Kolk, B.A.(2014), The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. Viking

Freud, S. (1917). Mourning and melancholia, London.

Klein, M. (1946). Notes on Some Schizoid Mechanisms. International Journal of Psychoanalysis, 27, 99-110.

Kübler-Ross, E. (1969). On Death and Dying. New York, The Macmillan Company.

Phillips, L. (2021) Untangling trauma and grief after loss. APA: Counselling Association.