bereavement – Dr Vanessa Pozzali

One of the first thoughts that come to our mind when thinking about bereavement is the funeral. You imagine several people dressed in black around a coffin.

It sounds like a banality, but the social and ritualistic aspect of sepulchre helps people cope with the stages of mourning.

During the pandemic, the ritualistic and social aspect of mourning was lost. It was not possible to perform funeral services (as in Italy) or the number of participants was reduced to a few intimates (as in the UK).

There has not (yet) been a collective ritual that symbolizes this loss, such as the sound of bells, a minute’s collective silence, a monument or something.

Attempts have been made to try to humanize the statistics proposed by the various states. For example, the BBC in England has launched an initiative to give a face and a name to the number of victims given by statistics every day. Coronavirus: Your tributes to those who have died.https://www.bbc.co.uk/news/uk-52676411

Socially we can see the psychological mechanisms that contributed to the denial of death. The simplification of death in statistical numbers, the repetition of the motto “everything will be fine”, denial of the pandemic, the prohibition to participate in funeral celebrations. They were acts due to the protection of public health, but they also had the function of denying the great suffering that (as a community and as individuals) we were not ready to face.

On the other hand, mourning is a natural and almost physiological event that every human being and every culture faces.

‘Phases’ have been identified concerning the processing of bereavement. The word ‘phases’ is in quotation marks because they are not rigidly successive phases: they can also be skipped or recrossed several times during mourning processing or can be included. They have been identified by Elisabeth Kübler-Ross, a Swiss-American psychiatrist, and studied by other professionals and psychotherapeutic orientations. For example, the same stages may concern the discovery of a disease that can lead to death (even just evocatively).

The five main steps are:

Denial.

During this stage, the person who experiences a loss is not able to cope with the reality and pain associated with it. When the denial is total the person acts as if nothing had happened. When it is partial you experience some moments when you act as if it had not happened (for example, we find ourselves calling that person as was usually done). This is a defence mechanism that serves to protect against great suffering that, at any given moment, we are unable to deal with.

In the case of death due to Covid-19 many people (especially in the first period) accompanied the loved one to the hospital, relatively in good health and death occurred within a few days, without being able to see the loved one again. This condition often prevents people from accessing the later stages of mourning, making processing a very difficult and even more painful path.

Anger

At this stage, the anger is violent and blind. In the case of religion and faith, a feeling of anger towards otherworldly deities can develop. The individual finds her\himself not praying or not attending places of worship. Anger can also erupt towards institutions, the care team (if bereavement is due to illness) or the person himself (‘Why did you leave!)’. Anger is an important and necessary feeling and helps people mobilize their inner resources and adaptability.

In the COVID-19 period, anger can be directed at those who complain about the restrictions or towards negationist people. There is a risk of embarking on a political battle driven by anger and of taking away one’s resources from the processing of mourning. It is important that you have sufficient energies to devote yourself (also) to yourself and your own path.

Trading

At this stage, the anger is attenuated. It is like you want to erase what happened. It is believed that doing a certain action (praying, doing good) can convince God\fate\others to erase what happened.

At this time due to the Covid-19, we try to negotiate with fate: ‘If I commit myself to respect the rules and helping the neighbourhood, then they will call me from the hospital to tell me that they have made a mistake before!’. The lack of a ritual that accompanies the death of the loved one can make us linger more strongly in the possibility of an uncharitable false hope.

Depression

This phase is accompanied by feelings of deep sadness, a sense of helplessness and inadequacy. These feelings are a normal and physiological reaction to the event of a loss. Some people report feelings of guilt if they find themselves laughing at a movie joke as if they have forgotten the deep sadness they feel. It is normal to be able to experience different moods throughout the day.

Due to the Covid-19, this period is characterized by isolation and safe distances. it is easier to let go of these deep feelings, especially when the social and relational network is missing. If this state becomes deeply disabling or nostalgia is so deep that you would like ‘to reach’ your loved one, it is important to talk to your doctor about it and ask for help as soon as possible, even now!

Acceptance

At this stage, a sense of awareness and acceptance of objective reality is experienced. Alternative ways of relating to the deceased are put in place. For example, some people go monthly to the cemetery to tell their progress. Other people find a way of internal dialogue with their loved ones. Some others share the memory\fact\story of the deceased. In this phase, we begin to redesign and redefine one’s goals and projects, without the loved one anymore.

The Covid-19 period is characterised by insecurity job and economic precariousness, it may be difficult to re-modulate one’s objectives and projects. It is important to look within yourself and be able to recognize your resources and resilience.

This description is just an indication of what might happen during this process. Everyone expresses a personal and peculiar experience with respect to their own life experiences and personal peculiarities.

Mourning is a life experience that profoundly changes those who live it. Mourning did not turn, it transforms. Pain, although greatly attenuated, accompanies people throughout their lives. This pain takes different and more manageable forms when we can accept the event, establish a new way of relationship with the deceased person and be able to return to remodelling projects and objectives.

This process usually does not require medical or psychological attention, but some factors can complicate these steps by requiring psychotherapeutic intervention to help with processing.

Many studies agree that in the mourning process there are some factors that can facilitate or complicate this experience.

Personological factors

Our attitude to life, our way of thinking and our acting can influence the path of mourning.

The intensity of affective bonding

The kind of relationship we have with the deceased person can aggravate or facilitate bereavement. The more intense the relationship, the more painful the bereavement. Sometimes when the relationship has been confrontational or ambivalent this can complicate the mourning process.

Manner of death

Depending on cultural influences, accompanying your loved one during a sudden illness or death can help or be unfavourable in mourning processing.

Socio-economic implications

Depending on social influences, the death of the loved one can aggravate economic position or social prestige or prevent those who remain from achieving important social objectives. This may or may not complicate the mourning process.

The pandemic has aggravated the process of mourning by adding the trauma of Covid-19. So much so that we can talk about post-traumatic stress syndrome. Symptoms can be: