Making Room for Grief During COVID-19

(Part 2 of a 3-part series)

T.S. Elliot begins his epic poem “The Waste Land” with the line “April is the cruelest month.” And indeed, it is shaping up to be just that.

In my last blog, I wrote about how Elisabeth Kübler-Ross’ five stages of grief provide a useful outline for our emotional experiences during the COVID-19 pandemic. Our first responses, marked initially by denial and then anxiety-driven anger and bargaining, have for some, now given way to depression. Perhaps not clinical depression, but we certainly find ourselves in the grips of grief and sorrow.

The breadth of this event has left no one untouched, but not all those who are touched have been impacted equally. This leads to a disorienting sense of separation while, at the same time, a singularity brought about by a unifying event. For some, their losses have been a series of disappointments—weddings canceled, trips scuttled, perhaps the challenges of trying to work from home while also homeschooling their children. Many have lost jobs and businesses.

Part 1 in the series: Navigating the Emotions of a Pandemic

For others, the losses have been profound. As of the time of this writing, there more than 981,000 cases worldwide, with 226,000 in the United States. More than 5600 people have died in the US and more than 51,000 across the globe, and as we are constantly reminded, “this is only just beginning.”

The losses have taken many forms. The world has been stripped of its familiarity and its safety. We feel unable to control what comes next. While some are fortunate enough to be able to shift our jobs to work remotely, there is a loss of the routine of going to work each day and the myriad of small interactions—saying hello to the person across the hall, the few minutes of banter before the staff meeting—that bring texture and pleasure to our days.

The simple joys of social life—seeing a family member, meeting a friend for coffee, exchanging a laugh and a hug—have been reduced to phone calls and boxes on a teleconference screen. But these losses pale when compared to those who have watched a loved one succumb to this illness, navigate the chaos of an overtaxed hospital, and die alone on a ventilator (or worse, to not be able to get a ventilator when one is needed).

Part 3 in the series: The Search for Acceptance and Meaning in COVID-19

The feeling of loss is palpable right now, even if we don’t know anyone who has been sickened or died. We are suffering the loss of our ordinary lives, and we didn’t even know how much we loved these lives and how much we were taking them for granted, until they were gone. There is lassitude in the air and there is deep sorrow. Meanwhile, spring announces itself with a riot of flowers and glorious cloudscapes.

The poet Mark Nepo captured this sentiment in his poem “Adrift”:

“Everything is beautiful and I am so sad.
This is how the heart makes a duet of
wonder and grief. The light spraying
through the lace of the fern is as delicate
as the fibers of memory forming their web
around the knot in my throat. The breeze
makes the birds move from branch to branch
as this ache makes me look for those I’ve lost
in the next room, in the next song, in the laugh
of the next stranger. In the very center, under
it all, what we have that no one can take
away and all that we’ve lost face each other.
It is there that I’m adrift, feeling punctured
by a holiness that exists inside everything.
I am so sad and everything is beautiful.”

My teacher Francis Weller has taught me that grief is an appropriate response to loss, but that losing the things we love is not the only reason for grief. We are experiencing grief for other things too, including the things which we had hoped for but did not get. There is also the grief of feeling alone and not being seen and witnessed by a supportive community. And there is the ancestral grief that we carry and the collective grief of the world. All of these places of grief are alive right now.

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We do not grieve that which we do not care about. But sometimes it is only when the quotidian has been taken from us do we realize how much we loved our ordinary life before the loss. When it is gone, we wish we had praised it more. We wish we could savor that which we once took for granted.

Navigating Our Grief

How do we navigate our grief? We must first find a place to sit with that which is broken. This is going to be a slow and difficult journey. How can we fortify ourselves for the long night ahead? Below I offer some pragmatic notions that may help to build a vessel to hold our grief. These are not meant to be prescriptive. This is not a list of more things to do when stuck at home. They will not all be useful or useful for everyone, but perhaps they are of use to some, as they have been for me.

• Rituals. The routine rituals of our life create a container for our emotional and spiritual experiences. For many of us, our routines created the structure that supported the rest of our internal lives. With that stripped away, we are called to create new rituals. After many years of good intention, I’m finally meditating most days. It could be taking the same walk around the neighborhood each afternoon, or a bath with a couple of candles at the end of the day.

• Meditation. Meditating allows us to notice what we are feeling and thinking without having to act. Meditation need not be elaborate or extensive to be helpful. Some people find meditation easier with guidance, and apps such as Headspace and 10% Happier are offering free subscriptions to health care workers at this time.

• Routines. Keep a routine. While I can go to Zoom meetings in my pajamas, the loss of routine has disrupted the momentum of my day. I feel better when I get showered and dressed each morning, even if I’m not leaving the house.

• Movement. Move the body. For many, our exercise routines have been disrupted by the shelter-in-place orders. I can no longer swim my laps at the YMCA. Some of my favorite beaches are closed. It’s easy to become sedentary, but our bodies need movement. Most of us can still go for (socially distanced) walks, or do yoga or pushups in our living rooms. The “soft animal of your body” wants to move. Let it.

• Get outside. My body craves fresh air, sunlight, and movement. My kid teases me that I’m like a Golden Retriever that needs to go for walks. It’s true. Fortunately, even with the need to shelter at home, I can still get outside and take advantage of some of the open spaces that exist where I live. Make a point of building outside time into each day, even if it’s just reading a book in the back yard or on a balcony.

• Intention and action. Before bed each night, choose one thing you will do the next day that you feel that you need to get done, that will leave you feeling like you accomplished something useful. This could be a simple as folding the laundry. Also, choose one thing that you will do that morning that is pleasurable, such a calling a friend or taking a walk. Then, when you wake up, do those things first. Allow them to create a momentum for your day.

• Balance inside and outside attention. Curiously, with our usual outlet for outside attention (other people) removed from us by our need to shelter in place, many people have turned to the internet, the news, and social media for contact with others. While this has many benefits, it’s also easy to become pulled into a world in which we are constantly checking our email, Facebook, and the news to see what has happened next. This action, especially when it becomes compulsive, takes our attention away from our inner world and leaves us anxious. Be sure to carve some time out of the day where you are not available and spend that time in whatever reflective practice that works for you, be it meditation, listening to music, or walking.

• Appreciate beauty. I’ve long been a photographer, but often only found beauty in things that were new to me or grand in scale. Since the COVID-19 shutdowns, I’ve slowed down enough to notice beauty in the small things around me. Some friends and I have taken to social media to share the beauty we have found around us in the form of music, words, and images. Beauty salves my soul in a way that nothing else can.

• Stay socially distant but emotionally connected. The sudden loss of our day-to-day, in-person connections has highlighted how important other people are in our lives. Make a point of reaching out to others and prioritizing conversation, even if it’s over the phone or on video chat. I really miss hugs from my friends, but a smiling face on the other end of the screen is a reasonable substitute for the time being.

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• Find opportunities for gratitude. There is much loss and sorrow in the world. Each day, we are reminded of the fragility of life. While fear of loss is an understandable response, we also have the opportunity for noticing, for appreciating, and for savoring. The grief we are feeling is a form of praise that reminds us of how important that which we are without has been to us.

• Show compassion and patience. Make compassion for and patience with others a practice. Being cooped up with our loved ones can quickly get irritating. The habits of our household, once easily ignored, become a proverbial rock in our shoe. When we find frustration rising, take a breath or two, remember we’re all stuck in this together, and maybe find another part of the house to go to, or take that walk that you said you were going to take today. It’s worth remembering that we’re all trying to get through this as best as we can.

• Practice self-compassion. No one is self-quarantining perfectly, and that is fine. Lists like these can feel dictatorial and burdensome, fuel for that self-critical part of ourselves to say, “See, other people are making good use of this time, why can’t I?” I welcome you to take what works for you from this list, whenever you feel the need, and to leave the rest behind, without guilt. Let’s go easy on ourselves and each other. These are difficult times that call on us to sustain ourselves and each other for the long road ahead.

• Learn from others who have gone through this before. While media has been a helpful escape of late and there is great value in an amusing distraction (I recently saw a meme about reaching the end of Netflix), there is also the opportunity to learn from the wisdom of others who have faced similar circumstances. John Keats spent 10 days quarantined in the Bay of Naples during a typhus epidemic. Albert Camus’ The Plague and Viktor Frankl’s Man’s Search for Meaning have been helpful companions for me in recent weeks.

• Consider death. The ever-present, ubiquitous subtext of this entire pandemic is that we, or someone close to us, could die. Consider this reality as difficult as it may be. It’s worth making sure your advance directive for health care and your will or estate are in order. Talk to your loved ones about your preferences. Practical considerations aside, it’s worth meditating on the impermanence of life in the quiet moments of our day. While I first balked at this thought, the more I have practiced it, the less frightening, and sometimes, dare I say, comforting, it has become.

We are called to make space for our grief, in whatever form that takes. There will be times when we want none of this, when our hearts are heavy with all that we have lost, and times that the suggestions on this list just feel like another opportunity for failure. There are times when we will want to weep and times when we will want to sit and stare plaintively out the window. If that is what your soul is asking for in that moment, allow it that, too.

T.S. Elliot ended his poem with the haunting line “These fragments I have shored against my ruins.” This time will undoubtedly leave us both brokenhearted and greater of spirit. There is room for it all if we can allow it.

Andrew Penn, RN, MS, NP, CNS, APRN-BC was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. He has completed extensive training in Psychedelic Assisted Psychotherapy at the California Institute for Integral Studies and recently published a book chapter on this modality in The Casebook of Positive Psychiatry, published by American Psychiatric Association Press. Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing, where he teaches psychopharmacology, and is an Attending Nurse Practitioner at the San Francisco Veterans Administration. He has expertise in psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. As a steering committee member for Psych Congress, he has been invited to present internationally on improving medication adherence, cannabis pharmacology, psychedelic assisted psychotherapy, grief psychotherapy, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice.