Infectious Diseases

Confronting Love’s Unwillingness to let go: Coping with Grief under Coronavirus

Posted on 11 April 2020

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Opinion: How do we help close ones cope with grief during the COVID-19 pandemic?

Denying one last goodbye forever.
Image by Jilla Dastmalchi, via BBC

We make jokes about why we should have Zoom dates, marriages or graduation, since our lectures and work meetings are all online. But when we are saying goodbye to one we love during the unfolding pandemic, this might not even be a choice. Live streaming a Zoom funeral might just be the most depressing thing, being unable to hold the hands of your loved ones and send them on their last journey. Some would even consider this lucky. Corpses of patients with COVID-19 are considered a biohazard, and with the NHS and other healthcare systems completely overwhelmed, some family members simply get a text from the hospital and get told the body will be cremated and sent back in a box. Undoubtedly, in times like this, many are left feeling depressed, lonely and helpless. The West is far from alone, Chang Kai, a famous director from Hubei died in Wuhan on February 14th. The virus took along with him his father, mother and older sister all self-quarantined in their home because there were no hospital beds, being survived with his only son in London. 

It is very difficult knowing what to say to them. Losing a loved one is hard enough, losing multiple in a pandemic without hope or support is catastrophic. I don’t think anyone can prepare for this, and it is understandable that so many of them have rendered themselves hopeless. Humans as a civilization have always had a conflicted approach to death. We find it necessary, so we learn how to find meaning in life, and shun those who seek immortality as cursed. But the grief and pain that we get from this eventuality is unimaginable. People often don’t know what to do in situations like this, and it’s hard to say anything apart from asking them how they feel and feeling sorry for them. People just tend to avoid this topic, or just shy from saying anything that tackles this. We are similarly hopeless to realize what we can say to them and what we can do. This is too, understandable, we don’t know what to say, and we’re worried that we’ll say something that triggers a negative emotion, and perhaps the easiest way is to simply avoid it. A typical avoidance safety mechanism. 

Social Anxiety – Image via Instagram

Perhaps we could take a page from studies in social anxiety. People who are afraid of social connection have safety behaviours where they prevent eye contact with others, speak more quietly, and talk less to others. Some think that (unconsciously) perhaps these behaviours could help them be judged less by others, where in fact these exact social behaviours might be what other people are judging them for (*experimental support: see McManus et al. 2009; Hirsch et al. 2003).

In the same way, we shouldn’t avoid the conversation when we see a friend who is grieving, and we certainly shouldn’t be afraid of confronting death. They need someone to talk to, and someone to support them through this. When we avoid talking to them about death and their grief, perhaps we would be harming them more than we are helping.

Grief and bereavement is natural, there is nothing wrong by feeling as such. What we can do is to give them support, not by beating around the bush, but reminding them they are not alone. Remind them that there are many others around them and who love them, who will support them throughout their lives, from grieving to happiness. No one is truly alone. Of course, no way of grieving is absolute, and each person will have a different way dealing with it, but providing support and talking to those who grieve can be simple – ‘I’m here for you, what do you need’?. Speak from your heart, be honest, don’t give some religious bullshit on how you’re praying that god helps you. Help them take one step at the time, like every intervention, recovery takes time. Some might even find it helpful, if we gradually help them return to normality. Don’t push them and think that this is no big deal. Maybe some would benefit from giving them some personal space, some time to think on their own, but make sure whatever you do, always make sure you are there when they need you. A little heart and care goes a long way. 

“As I draw my last feeble breaths, I say to my family, my friends, and my son in faraway London: All my life, I was a filial son, a responsible father, a loving husband, and an honest person! Farewell to those I love and to those who loved me!”

Famed Chinese film director Chang Kai’s message from his death bed to the world, sourced from Caixin

Chang Kai writes in classical Chinese “As I draw my last feeble breaths, I say to my family, my friends, and my son in faraway London: All my life, I was a filial son, a responsible father, a loving husband, and an honest person! Farewell to those I love and to those who loved me!” He will be remembered, as are the many who we’ve lost to the virus. Their families and loved ones aren’t alone, there has never been a time where humanity has been more united, to come together in times of a crisis and support one another. 

Chinese whistleblower and doctor Li Wen Liang, sourced from HKFP

We will remember our fallen. And so will we remember the roots of our grieving and sadness. The deaths of whistleblower Li Wen Liang and many others who have repeatedly warned us about the virus, and the responses that many authorities gave, by blatantly ignoring the threats about COVID-19 in order to ‘preserve the economy or social order’ should forever be etched in our memory. These are the people we should blame, those who are hiding behind masks, surgical equipment and pushing medical personnel to the front lines without any protection, ventilators or hope are the people who are responsible. It’s time to change this. We shouldn’t and we shall not forget this painful lesson. Like how Hong Kong and other East Asian countries such as South Korea learnt in the aftermath of SARS and MERS, after we grieve, we’ll need to make sure never again, will this happen.


References

Home quarantine policy in Wuhan, the story of Director Caixin: https://asia.nikkei.com/Spotlight/Caixin/1-family-4-deaths-The-danger-of-Wuhan-s-home-quarantine-policy

Hong Kong Free Press' article on Li WenLiang: https://hongkongfp.com/2020/03/19/coronavirus-wuhan-police-inappropriately-punished-whistleblower-doctor-li-wenliang-chinese-govt-probe-concludes/

Italy and COVID-19: https://www.bbc.com/news/health-52031539

*Description of the two social anxiety experiments: McManus et al. (2009) on safety behaviours and social anxiety https://www.ncbi.nlm.nih.gov/pubmed/19081225 Hirsch et al. (2003) on self images https://www.ncbi.nlm.nih.gov/pubmed/12880646

These fit with Clark and Wells' (1995) Social Anxiety Disorder model, showing that doing safety behaviour actually increased anxiety, with more self-focused attention. This was because they believed if they didn't do the safety behaviours, they believed that the fears were more noticeable, ironically those who did safety behaviours were rated as more nervous by observers than those who didn't. This suggests that the increased self-focused attention led to the generation of safety behaviours (such as rehearsing what they want to say) and vice versa (McManus et al., 2009).

Hirsch et al. (2003) used negative images as an example where patients with social phobia held two conversations, one with a negative image in mind, and the other a neutral control, where both conditions were counterbalanced in participants. An independent assessor (who didn't know which condition was which) found the behaviour of participant as more anxious and less positive in the negative images condition. Also, when participant's own ratings were compared with assessor, they had a greater belief that their symptoms were more visible, they performed worse overall socially, and believed their anxiety was more visible in the negative image condition. This suggests that the anxiety actually affects the self-focused attention in return and vice versa.

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