Understanding Grief in the Shadow of COVID-19
New research identifies key determinants of bereavement intensity.
Posted May 10, 2022 | Reviewed by Hara Estroff Marano
The pandemic has been a time of terrible loss, with ongoing death, illness, and feelings of vulnerability as variants mutate and spread. The grief— individual, family, collective—has yet to be reckoned.
As of this writing, an estimated 6.25 million people have died globally (CDC), nearly 1 million in the U.S. alone. According to sociologists (Verdery et al., 2022; who calculated a “bereavement multiplier” for the pandemic) for every death due to COVID, statistically speaking, nine people will be affected by that loss through social connection. This means that at this time, the number of COVID grief-stricken people is more than 56.5 million.
How people respond to loss depends on a number of factors. Trauma is experienced more negatively when events are of human, versus natural, origin. When human beings cause or contribute to tragedy, it is experienced as more damaging because of the possibility of moral transgression and attributions of blame and preventability. Loss is part of the natural order of things, but when human beings tip the scale, it does not feel right because they could have chosen otherwise.
While the pandemic is thought to have a natural origin–conspiracy theories notwithstanding–the human element is present in terms of its start through unsafe practices in wet markets and wave after wave of transmission arguably caused by the refusal of some to follow public health recommendations. Notably, subscribing to COVID conspiracy theories has been associated with higher-risk behavior during the pandemic.
Estimating the Inestimable
Given the unfathomable scope of loss, understanding the nature of grief related to COVID is vitally important both now and for a future when there is more emotional room to breathe. Conducting research published in the journal Death Studies (2022), Lee, Neimeyer, Mancini and Breen recruited 209 U.S. residents who had experienced a COVID-related death. Based on prior bereavement research, they measured1 factors likely to contribute to grief intensity: 1) the relationship to the deceased (e.g. family, friend, acquaintance, coworker); 2) the presence of “unfinished business,” including not being able to live together the expected future (“unfulfilled wishes”) and experiencing loss with outstanding issues in the relationship (“unresolved conflict”); and 3) the impact of the three self-blaming emotions—guilt, regret, and shame.
Across the study, more than 82 percent of participants reported experiencing severe, dysfunctional grief. More than half of participants reported at least one experience among unfinished business, guilt, shame, or regret. More than 35 percent reported all four. More than 50 percent reported experiencing moderate to high levels of grief-related distress around each of the four factors, the highest being unfinished business, affecting more than 60 percent.
Most notably, after factoring out demographic factors (age, ethnicity, duration since the loss) and type of relationships, a strong effect emerged: More than 39 percent of grief intensity was a function of unfinished business, the impact stemming mainly from unresolved conflict. In contrast, self-blaming emotions accounted for 2.9 percent of grief intensity, and demographic factors and self-blaming emotions together accounted for 9.8 percent.
Unfulfilled wishes, unresolved conflict, and grief intensity were greater in close relationships. The type of relationship was important for unresolved conflict, with lower levels among those who lost a friend or acquaintance than among those who lost a family member, intimate partner, or close friend. Likewise, grief intensity was lower with more distant relationships.
Sadly and not surprisingly, COVID has left so many with intense grief, in this study most strongly correlated with unresolved relationship problems. Sudden, unexpected loss; quarantine measures preventing the spending of time with loved ones before they departed; an overwhelmed healthcare system; and limited preparedness with massive collective trauma add horror and helplessness to an already grim experience. Unresolved conflict was, by a large margin, the most significant factor in determining COVID-related grief intensity, reflecting a profound interruption of the mourning process.
Grief severity was less strongly but significantly correlated with the closeness of the relationship and the presence of self-blaming emotions, predominantly shame and regret; notably, while present, guilt was not found to be a significant contributor to grief intensity in this study. Perhaps guilt has been blunted during the pandemic because quarantine and hospital policies took choice away from people wanting to visit those who were ill. It's hard to feel guilty about something over which we have no control, although we may be more likely to feel helpless and vulnerable.
In this study, the duration of grief was not associated with grief intensity: Whether the loss was a month prior or a year earlier was not statistically significant. The authors note it is important to track whether grief will, as it sometimes does, fade over time. With the pandemic, it will be important to look at whether people are able to grieve differently once the pandemic shifts into a new normal, potentially blunting the triggering effect of continuing waves.
Grief work often hinges on relationship with the deceased. In his seminal paper, Mourning and Melancholia (1917), Sigmund Freud discussed when grief leads to healthy mourning and when it spirals into a melancholic state—when the mourner's sense of self is problematically intertwined with the "lost object". Freud wrote, “In mourning it is the world which has become poor and empty; in melancholia it is the ego itself."
Contemporary models of grief respect that we maintain and develop an attachment with loved ones over the years after they are gone. Rather than expecting people to get “closure” and “move on”, successful bereavement means that our relationships with lost loved ones evolve and become a part of who we are, as opposed to impeding development. Reconstruction occurs through adaptive grieving:
“[A]daptive grieving can be understood as reaffirming or reconstructing a world of meaning that has been challenged by loss, with obstacles to the integration of the experience arising in the form of impediments to (a) restorative retelling of the event story of the death, particularly when it was tragic or traumatic in nature; (b) restorative revision of the mourners’ self-narratives, when they struggle with their post-loss identity, and (c) restorative realignment of the continuing bond with the deceased, when grievers require reconstruction of a secure attachment to the loved one or resolution of unfinished business.”
1. Measures included demographics, questions regarding presence or absence of guilt, regret and same, and rating scales: the Unfinished Business in Bereavement Scale Unfulfilled Wishes (e.g. “I didn’t get a chance to say I love you one last time”) and Unresolved Conflict (e.g. “I never got closure on some important issue or conflict in our relationships) and the Pandemic Grief Scale estimating grief intensity (e.g. “I wished to die in order to be with the deceased”).
Ashton M. Verdery, Emily Smith-Greenaway, Rachel Margolis and Jonathan Daw (2020). Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States, Proceedings of the National Academy of Sciences, Vol. 117, No. 30, pp 17695-17701, DOI: 10.1073/pnas.2007476117, https://www.pnas.org/doi/abs/10.1073/pnas.2007476117
Sherman A. Lee, Robert A. Neimeyer, Vincent O. Mancini & Lauren J. Breen
(2022): Unfinished business and self-blaming emotions among those bereaved by a COVID-19
death, Death Studies, DOI: 10.1080/07481187.2022.2067640, https://doi.org/10.1080/07481187.2022.2067640
Freud S. (1917). Mourning and Melancholia. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIV (1914-1916): On the History of the Psycho-Analytic Movement, Papers on Metapsychology and Other Works, p. 237-58.
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