On Sunday, June 14, as the country was beginning to emerge from 15 months of seclusion and isolation, the Naomi Ruth Cohen Institute (NRCI) convened its 19th annual conference via Zoom to talk about grief, stress, and the COVID-19 crisis.
The NRCI is ideally suited to take on this work. Founded by Marilyn and Larry Cohen after losing their daughter to suicide in 2000, the institute has, over the last two decades, focused on educating others about the unique challenges of living with mental illness and bringing people together in a safe welcoming environment.
Michael Kocet, Ph.D., professor and chair of the Counselor Education Department at The Chicago School, moderated the panel. The panelists included Serena Wadhwa, Psy.D., psychotherapist and professor at Governors State University; Jillian Blueford, Ph.D., faculty member at the University of Denver and chair of the Grief Competencies Task Force for the American Counseling Association; David Fireman, executive director of the Center for Grief Recovery and Therapeutic Services in Chicago; and Michael Catania, an early COVID-19 sufferer who spent 15 days on a ventilator last March.
Several key themes emerged, which we explore below.
Grief and stress are very formidable presences in our lives
The panel agreed that grief and stress can easily overwhelm an individual’s daily existence. Fireman described grief as a “barely survivable human experience” that shakes “our assumptive world.” We expect our lives to go on as they are and then, in an instant, our world may be shattered by loss. Comparing grief to snowflakes, Dr. Kocet said, “No one grieves the same way, including during the pandemic. Grief creates an ‘unknown-ness,’ and people struggle because they can’t name it.”
Dr. Wadhwa provided an overview of both acute and chronic stress and their effects on the body. Acute stress is short term, the body can recover quickly, for example when you can’t find your car keys. Your stress level maybe high, but it dissipates as soon as you find your keys. Chronic stress is long term, and often the individual does not have the opportunity to fully recover. This cycle can last up to six months. Stressors generate responses, including physical (stress response) and mental (cognitive functioning) that can lead to mental exhaustion, emotional isolation, and disconnection.
Grief is best understood in contrast to common misconceptions and misperceptions about it
To demonstrate how stigmatized grief can be in our society, Dr. Kocet shared and debunked several myths about grief. The first is that all losses are the same. In reality, while all grief is valid, all losses are not the same. A second commonly held belief is that grief always declines over time in a steadily decreasing fashion. The fact is that even clinical experts in the field cannot predict how any one person will respond to loss. Another common belief is that it is best to put painful thoughts and emotions out of your mind, when, in reality, in order to grieve, it’s essential that we feel the pain. The last myth: expressing intense feelings is the same as losing control; in fact, the opposite is true. It is important that we be in touch with our emotions.
Grief and stress do not affect all communities equally
One of the most striking revelations from the height of the pandemic was that all communities were not affected equally. Poor communities of color bore the brunt for a series of reasons, most significantly because of the disparity in health care in America and the fact that essential workers were disproportionately people of color, placing them on the front lines of the crisis.
Fireman said that “the pandemic germinated along the stress lines in our society that existed before.” Dr. Blueford agreed: “And then you add COVID on top of all of this. You have loss after loss after loss. The pandemic has reinforced existing systems. It has highlighted racial and ethnic disparities in numbers of cases, death, and vaccinations.” Grief and loss are universal, but some communities are hit harder than others.
Some of these communities are better able to process grief due to their family structures and affiliation with neighborhood churches. Dr. Blueford pointed out that we learn from families and that community systemic factors influence our grief responses and understandings. However, these systems often were overwhelmed by the scale of the crisis, with people fearing not only illness and death but also loss of employment and with that the potential loss of health insurance and financial security.
While it is natural to want to push grief aside, doing so can cause physical, psychological, and spiritual harm
Fireman said people seem to feel grief is “un-American.” The cultural expectation is that you put your sense of loss behind you and go on as you did before. Dr. Blueford agreed, saying, “You can get a clear picture of how our society respects grief by the amount of bereavement leave companies offer.” She explained that society creates norms, and those norms can create limitations that can disenfranchise grief and the griever.
And yet, while society’s expectations might dictate a short grieving process, we cannot control how we process grief. As Fireman says, “Grief happens upon you. It’s bigger than you. There’s a humility you must surrender to. It’s a bow-down and a carve out, and it comes tremendously forceful arrival. To stiffen, to resist, to fight is to hurt yourself. Experience loss as an attack on the self and become fortified, lose touch with vulnerability at our peril.”
If people were experiencing grief and loss before the pandemic, those symptoms may be exacerbated by the crisis
Dr. Wadhwa said, “Remember we’re experience something that hasn’t happened before.” Many people have been so preoccupied with muddling through day by day that they fail to grasp the enormity of the tragedy. Dr. Kocet added, “Everyone has experienced some form of grief, loss, depression, stress, and anxiety as a result of the pandemic—some directly, some indirectly.”
The scale of death alone is overwhelming—600,000 in the U.S. and millions more around the world, those who were gravely ill but survived only to come down with debilitating long-haul symptoms, and the loss of livelihood and human interaction.
Dr. Kocet referenced a paper by Yusen Zhai and Xue Du, two professors at Penn State University, who documented aspects of grief during the pandemic, including primary and secondary loss (not just the loved one but what is also lost because of their absence); anticipatory grief (for the gravely ill); stigmatized grief (for those who contracted COVID-19 and feel as though it’s their fault); and “bereavement overload” for those so cannot process the magnitude of the loss.
Fireman said that the grieving we are undergoing now is similar in many ways, but in some ways different from before COVID-19. He urged therapists experiencing a new level of grief in this moment to be optimally responsive to the bereaved and to practice “empathic immersion.”
Overcoming grief and stress requires patience, self-care, supportive professionals, and time
Though grief makes different demands upon each of us, the members of the panel were united in their conviction that both the clinician and the individual experiencing grief must work actively of overcome what Fireman likens to a tsunami. In looking toward recovery, he discussed the open and the closed narrative. The closed narrative is “fixed and intractable,” whereas the open narrative is “flexible and does not foreclose future possibilities. It is open to dreams, open to texture. We want to move from closed to open. Imagine reconstructing life to contain courage, boldness, and eagerness,” he explains.
Dr. Wadhwa agreed that an important aspect of grief and stress management is self-care. One of her strategies to cope with stress is contained in the acronym BASICS: Breakfast, Attitude, Steps, Inventory, Cognitive, Sleep. She also recommended keeping a log or journal to discern patterns and track behaviors that will ideally lead toward self-compassion, regulation, support, and coping skills, saying, “We don’t always have skills to cope. We need to ask ourselves, ‘What skills will I need to help recover’?”
A view from the ICU
Michael Catania was the last speaker of the day, and his personal experience struck at the heart of the conference’s prevailing theme. Catania is a retired Chicago Public School teacher who contracted COVID-19 in early March of 2020 back when “no one knew what it was or what was happening.” He has no idea how he contracted the virus, but at the time he felt guilty, as if it were his fault that he got sick, maybe because he was overweight or had underlying risk factors. Such is the nature of stigmatized grief. When is emergency room physician, Dr. Halleh Akbarnia, told him he was going to be intubated, Catania wasn’t happy about the idea but put his trust in her hands. He was on a ventilator for 15 days.
His family was told that he might not survive and were left to wonder each time the phone rang, “Is this the call?” Ultimately, Dr. Akbarnia tended to Catania throughout his illness and with his permission, she published an account of this experience, which went viral. Catania was grateful he was able to educate others about the cost of contracting the disease. Catania’s COVID-19 story came full circle when Dr. Akbarnia administered his second dose of the vaccine.
What to take away
A conference on stress and grief during a pandemic necessarily leads its participants to reflect on their own experiences with stress and grief, especially those related to the pandemic. We are all in this moment, and we are all experiencing loss. Grieving is a burden none of us wished for but one we must face collectively because that is how the healing begins.
To learn more about the Naomi Ruth Cohen Institute, visit its website. To learn more about The Chicago School, fill out the form below.