The uncertainty and unpredictability that are part and parcel of Covid-19 days, can place us under unusual stress which, over time can produce many of the same trauma symptoms as we see when treating PTSD. But in this case, we’re not talking about a one-time event with a clear beginning, middle and end. Rather the length and duration here are unclear and the finish line is constantly in motion. We hear conflicting information and don’t know who to trust. We worry about what our future and the future of those we love might hold. This kind of daily atmosphere, can lead to a kind of “anticipatory grief”. Pre-trauma stress writes Stacy Colino in US News and World Report, a “is a phenomenon you won’t find in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-V). The symptoms are similar to post-traumatic stress disorder (including grief, sadness, worry, disturbing intrusive thoughts, sleep troubles and nightmares, and avoiding situations or activities that are reminiscent of the stressful event) but in this case, they stem from anticipatory anxiety about an event that may occur in the future.”
The feelings or symptoms we’re describing here, like anxiety, shock, disturbing thoughts and mood shifts can, if they remain unacknowledged or unattended to, morph into PTSD. Taking the time to work through the feelings that this period is bringing forth in us as they happen, can go a long way to acting as a preventative to later problems and life complications.
We are not at war. There are moments where there simply is no time and no spare energy to do anything but survive. But this is not one of them. We can during the COVID-19 period, prioritize our mental health and take time, each day to lean into our inner world and see what’s there. Whether we do that through meditation, long walks or face-timing with friends is less important than that we do it. We are not in this alone, in fact people are pulling together at unprecedented rates to cut through red tape and develop everything from anti-body tests to vaccinations. We need to cut through the emotional and psychological “red tape” of pre-trauma symptoms that might be keeping us immobilized. Symptoms that are causing us undue anxiety or depression or that are leading us to act out in abusive or neglectful ways. Symptoms that are making us want to eat, drink or drug our way back to calm rather than adopt the healthy habits that will not only bring calm, but give us the life skills to carry forward that will enable us to change and grow. We need to feel our feelings as we have them, so we can heal them, in the here and now. We can have mini healings now, and avoid the need for maxi healings later.
Past, Present and Future Pain
So what are some of the broad brush categories of pain that might be a part of COVID-19 grief?
Past, When Pain from the Past, Gets Triggered: COVID-19 can trigger what we call disenfranchised losses and then pain from yesterday gets mixed up with today and we get confused and overwhelmed. Just knowing this is liberating. It allows us to use what gets triggered through these anxiety-provoking days, as fodder for growth rather than for further pain. In spite of all of the good help and therapy we might get, life and relationships themselves are still our greatest trigger, it is feelings of closeness and intimacy that bring up all that we have experienced in our past in our close, intimate relationships. The confinement, the feeling of being “trapped” that’s part of this period of time, can trigger old, attachment pain that we can normally avoid in our busy, routine filled days. This can be a receipt for personal and relationship problems or for relationship growth.
Present, The Very Real Stress of Today: There is plenty of anxiety to go around right here, right now that can take it’s toll on our peace of mind. It can make us feel anxious and wistful for when life felt more normal. The uncertainty, the conflicting reports as to what to do and the very real threat that there is a virus that can potentially be deadly, can be a terrifying thought. And it is terror that kicks in our fight flight, freeze. Many people feel immobilized by the threat that is out there and are too overwhelmed by their weird daily mix of fear and dread to be able to think clearly enough to make plans to stay safe and exercise good, self-care. They are unable to mobilize their inner and outer resources whether meditation, walks in nature or conversations with friends, to sustain themselves on the inside so that they can make their personal world, the world they do have control over, feel nurturing and safe.
Future, What Does this Mean for My Future?: And then there is the very significant anxiety about what the future will hold, what’s next? When will this be over and what will over look like? Is my world changing and what does that mean for me? Parents can feel this kind of worry on behalf of their children, “will they fall behind at school, will missing major life events wound them permanently, do they yearn for their friends, their life?” Or we can feel it on our own behalf, “when will I have my life back? And what will my life look like?
The Many Faces of Grief
So what are ways that grief might be manifesting, how does hidden or unprocessed grief, disguise itself?
Anticipatory grief: With anticipatory grief, we feel grief in anticipation of what could happen. This is particularly relevant in this COVID-19 crisis because of our fear of becoming sick, the uncertainty about when life will return to normal, and what that normal might look like. We feel the loss of what was, of our normal routines, and we worry about what is to come.
Age correspondence reaction: For parents, when your child hits the age of a time in your life when you were wounded or traumatized, your unconscious pain from that time in your life may get triggered by the stage of life that your child is in now. If you do not make the connection between your past and your present (if you do not know it’s old relational or situational pain getting triggered by a new relationship), you will tend to make your pain from the past about your present. You, the parent, may go to one extreme or the other. You may experience extra worry and anxiety “for your child”, you may want to over-protect your child because the child in you felt under-protected or unsafe. Or you may want to distance from your child, because the child in you wants to go numb, doesn’t want to touch or feel that old wound. This phenomenon can also happen between an older to a younger sibling or any close relationship.
Parental Inner Child Grief: I am naming and adding this category because I see so much of it in my practice. This happens to mothers and fathers who don’t want to repeat the past but don’t fully understand how to identify and validate the grief of the child who lives inside of them. They are giving what they never got and when they give, they feel a kind of pain because the need in their child acts as a “reminder” or a trigger for the pain of their own, unmet childhood yearning and need. Parents need to attend to the wounds of their inner child so that they can gain some relief and healing, so that they can stop feeling like they are giving from and empty well. And so that they can avoid confusing the pain of their inner child with the child they have, making their unresolved grief somehow about their child, “projecting it” onto them.
Complicated grief/mourning: Complicated grief is the kind of grief that doesn’t seem to resolve itself over time and becomes prolonged or chronic. This can occur due to the nature of the loss being sudden, violent, or hidden (e.g. prison or addiction), where we are ambivalent about the loss and don’t really mourn it to begin with. It can occur when we lose someone who is alcohol or drug addicted or abusive, though we still love that person, we may have wished them out of our lives or resented them deeply. Some warning signs of this kind of complex mourning could include self-medication, sexual acting out, self-harming behaviors, chronic and disabling feelings of guilt, worthlessness, suicidal thoughts, violence, or radical lifestyle changes. The age correspondence reaction and inner child grief, may be seen as forms of complicated mourning.
Inhibited grief: When a person does not let their grief show, whether it’s because they want to keep it private or because they have hidden it even from themselves, their grief becomes inhibited. When someone cannot allow themselves to grieve, their body will do their crying for them. They may have physical symptoms like muscle stiffness, back pain, migraines, or illnesses that are directly connected to deep, emotional stress. Or they may act out or self-medicate to manage physiological symptoms or anxiety.
Cumulative grief: Cumulative grief occurs when losses accumulate because they occur on top of each other. This may happen if the COVID-19 crisis continues to disrupt people’s lives.
Collective grief: This a form of grief felt by a group. It might be racial, class-related, the death of a public figure, or the result of a natural disaster. Certainly, our world right now is experiencing a form of collective grief. It is important that we come together and “hold” each other through this time. The Italians singing out of their windows, the Greeks doing the Zorba dance on their rooftops, and the 12-Step community and other support communities moving online are all wonderful vehicles for sharing concerns so that the grief doesn’t pile up get acted out in destructive ways. When we find the support, we need to transform our grief into personal growth, we become more resilient.
Normal grief tends to run its own course and lessen over time, although the time as well as the intensity may vary from person to person and also according to the timing, nature, and intensity of the loss itself.
What We Can Learn: Moving Towards Post Traumatic Growth
Post-traumatic growth (PTG), a phrase coined by Drs. Richard Tedeschi and Lawrence Calhoun—editors of the Handbook of Post Traumatic Growth—refers to a profound, life-altering response to adversity that changes us on the inside as we actively summon the kinds of qualities like fortitude, forgiveness, gratitude, and strength that enable us to not only survive tough circumstances but also thrive. (Dayton, Neuropsychodrama)
Adopting practices of self-care and mindfulness can help us to not only keep a bad situation from getting worse, they can teach us the skills of self-care that will last a lifetime because we internalized them when we needed them most, when we really understood their importance to our own, mental health. Deep breathing, guided relaxation and meditation can change the way that we respond to stress. Through these practices, the amygdala, our fear center, down-regulates and sends fewer panic-type messages out to the body and mind, and our thinking mind gets stronger and is better able to hold and understand the emotions we’re experiencing, all of which leads to an enhanced ability to self-regulate. We’re getting neurons to fire and wire together in the direction that is more conducive to happy living and calm interactions.
So there is much we can do in these COVID-19 days to self-protect in healthy rather than unhealthy ways. This workbook, Maintaining Emotional Sobriety During COVID-19 is meant to help you in this process of inner healing. Through it, you can “see” what’s getting triggered inside of you, as a window into your inner world, a way to get to know yourself, your coping styles and your manner of being in intimate relationships. You can learn. You can grow from adversity by meeting it with openness, humility and grace.