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Since losing her mother to covid-19 in April, Helen Stoba, who lives in Liverpool, UK, has been racked with guilt, anger and confusion. She struggles to focus and has nightmares. “No one truly understands how different the grieving process is at the moment,” she says.
Psychiatrists are observing similar emotions in others who have lost loved ones to covid-19 (see “Stories of loss,” below). They warn that the unique challenges of coming to terms with these deaths could lead to a rise in a condition known as prolonged grief disorder.
Grief tends to ease with time as people adapt to life without the deceased. But about 10 per cent of bereaved individuals develop prolonged grief disorder – severe, unrelenting grief that lasts for six months or more and makes it difficult to function.
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Previous research has found that people are more likely to develop the condition if a death is sudden and unexpected, they are experiencing other stressors or they lack social support.
More people are experiencing these risk factors during the pandemic, since the coronavirus often kills swiftly, many bereaved people have additional stressors, such as the loss of their job, and social structures are undermined. “Grieving people tend to appreciate a hug, which is impossible when we are required to adhere to physical distancing,” says psychologist Lauren Breen at Curtin University in Australia.
Many covid-19 deaths also come with extra challenges that could further increase the risk of prolonged grief disorder, says Joseph Goveas, a psychiatrist at the Medical College of Wisconsin. These include not being able to say goodbye in person, covid-19 specific restrictions on rituals like washing, kissing or viewing the body and limits on the number of people who can attend funerals. These may all derail the healing process, he says.
Goveas is also seeing high levels of guilt in patients who have lost loved ones to covid-19. “They feel like they didn’t do enough or they have survivor’s guilt and wonder why they were spared,” he says.
Guilt is an emotion that Stoba feels keenly, because she was not able to be with her mother when she died. “I am devastated that she was alone with no one but medical staff,” she says. Not being able to see her mother in the chapel of rest has also made it difficult to comprehend her death, she says. “Throughout her funeral, I kept asking if they were sure it was my mum in there,” she says.
It is too soon to know whether covid-19 will cause an epidemic of prolonged grief disorder, since it takes at least six months to diagnose, says psychologist Maarten Eisma at the University of Groningen in the Netherlands. But he thinks there is a high risk, since natural disasters tend to increase rates of the condition and covid-19 shares similar features, like causing large numbers of sudden deaths.
Fortunately, there are effective treatments. A talking therapy called complicated grief psychotherapy, for example, has been shown to reduce symptoms of the condition and to work better than antidepressants.
Stoba has found that talking to a bereavement counsellor and joining online support groups have helped. “Being aware of the risk of developing prolonged grief disorder and accessing timely treatment may aid in mitigating a silent epidemic from happening,” says Goveas.
Stories of loss
Lesley Branch from Essex, UK, lost her 67-year-old husband to covid-19 in April:
He rang me [from hospital] and I got to speak to him for under a minute. We were able to tell each other that we loved each other. I told him he would be OK and I would see him in a few days. His last words were, ‘I hope so and thank you’.
I woke at 4am to find a voicemail on my phone. It was the nurse looking after him. He died before they could ring me. I was in complete shock. I feel so sad and guilty that I didn’t get to say goodbye or hold his hand.
We were told only 10 for the service. No clothes to bury him in or anything placed in his coffin. Flowers were hard to get hold of as everywhere local was closed. The funeral wasn’t attended by anyone other than immediate family and we were seated apart.
Since his death, I find it hard to sleep. I have days where I get out of bed, sit in front of the TV though not really watching it, don’t wash or get dressed, and cry. The covid-19 situation has made it so hard. No one to comfort me and give me a hug or make me a drink. No shoulder to cry on. It’s not a natural way to grieve.
Evelyn Evershed from Bristol, UK, lost her 67-year-old husband, Richard, to covid-19 in April:
The ambulance came and he left in a wheelchair with the oxygen mask on, wrapped in a blanket. We never saw or spoke to him again. [After he went to hospital], they recommended that he should go on a ventilator straightaway and into an induced coma for five days. It was all so fast and almost unbelievable. I wasn’t even able to talk to Richard about this and I will never forgive myself for not asking to talk to him.
On Easter Monday, they told us that he would not be able to recover from such terrible damage to his lungs. It felt unreal – we were so removed from him at that point and it was totally out of our hands.
We were not allowed to see him or sit with his coffin in the funeral home. The funeral was pared down to 15 minutes and it was only my son and I who were there.
It’s like living a nightmare. The shock of what happened and the speed of his decline has been difficult to process. It was like he went on a plane and the plane crashed and that was it, we would never see him again.
On a positive note, counselling has been very helpful and I would definitely recommend it. Having a third party to talk to has been a bit of a life saver for me and I am continuing with this for the foreseeable future.
Laura Etherington from Sussex, UK, lost her 56-year-old mother to covid-19 in March:
The day before mum died, I tried calling her several times but she didn’t answer. I have no idea if she was sleeping or if she just couldn’t face saying goodbye to me. My dad was called to the hospital in the early hours of the next morning and was allowed 15 minutes to say goodbye.
The funeral director told us we would be able to see mum at the chapel of rest, but the day before [the funeral] they called and said due to government guidelines, mum had to be in a sealed coffin and therefore we couldn’t see her. I know not being able to see mum after her death is meaning my brain can’t process that she has really gone. I so wish lockdown had been earlier so that she might not have gotten it.
Pip Bensley from Southampton, UK, lost her 92-year-old father, Arthur, to suspected covid-19 in April:
Dad didn’t really take the virus seriously or understand the risks. He was still popping out to Sainsbury’s to buy things even though I had organised someone to drop fresh food off when he needed it. The last time I spoke to him on the phone I was really angry with him. I told him if he kept going out, he would get ill and would die in hospital on his own. That argument just haunts me as it was what happened.
Not being able to grieve together normally is awful. It feels so unreal. The funeral was the best we could do under the circumstances, but really, sitting there in masks just made it all feel so unreal. Our friends couldn’t be with us to support us. I feel so unbelievably lost.
Need a listening ear? Bereavement Trust Helpline, UK: 0800 435 455, Grief Resource Network, US, Griefline, Australia: 1300 845 745
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