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The Reckoning

Death, trauma, and grief in the time of COVID-19.

Adobe Stock
Source: Adobe Stock

Guest post by
Dorothy P. Holinger, Ph.D.

Recently, a patient described to me her intense grief during a virtual funeral for a friend’s grown-up child. She sobbed so much, she said, that she had to turn off the video function. In the diminished world of isolation, she had to suspend sharing her grief in person.

COVID-19 has spawned a new way of dying and a new grief. Coronavirus patients die isolated and alone, without family, and for the newly bereaved, grief is suspended and postponed. COVID-19 has changed death for the dying, grief for the survivors, and made trauma the price paid by many health care workers.

Disrupted Funeral Rituals

Funerary rites have long been used to prepare and care for the body after the death of a loved one. But no longer. COVID-19 has disrupted all of them: funeral, memorial, and mortuary services. In some states, so many patients were dying of the virus that the capacities of mortuaries and funeral homes were overwhelmed, and the bodies of the deceased had to be stored in refrigerated trucks.

Funerals and memorials are virtual—via Zoom—or drive-through, with people paying their respects talking into a screen, the way one orders fast food. The symbolic rituals of detachment for the bereaved—those physical ways of handling the deceased, and memorializing the person who has been lost—have been replaced by video streaming and drive-through funerals. The pandemic has hijacked what was customary and comforting to the bereaved.

COVID’s Medical Trauma

Nurses, doctors, and residents have had to endure the agonizing experience of seeing patients die alone. A critical care nurse was quoted in media reports as saying, “The hardest thing for me during these COVID times has been seeing patients die without the presence of family.”

Hospital care workers, helping dying patients say a FaceTime goodbye to their families on an iPad, are themselves isolated in protective gear, and later must deal with their own grief and trauma. Treating virus patients under these conditions has taken an emotional toll on all health caregivers. Many have experienced compassion or trauma fatigue, and exhaustion also known as “vicarious traumatization” (VT) that has been studied by Kay Saakvitne and her colleagues. Dr. Saakvitne defines VT as “a change in the helper’s inner experience as a result of empathic engagement with and responsibility for a traumatized person.” Many who experience VT feel diminished hope, sadness, grief, and helplessness against the onslaught of this killer.

Relatives of the dying are not spared trauma either. To be confined to lockdown and separated from one’s dying relative is devastating. And to imagine the painful suffering of a loved one, alone and dying, makes the loss all the more heart-wrenching, and traumatic for some. It edges COVID-19 grief with trauma, imagining the suffering of a dying relative, and etches that grief with regret, being deprived of a bedside presence and funeral services. There’s loss within the loss.

Reckoning with the Effects of COVID

Some COVID-19 health care workers and survivors can benefit from psychotherapy. Those patients already in therapy are experiencing how it has changed. No longer are sessions conducted in person but through Zoom or telephone. I talk with patients who have described feeling “flattened, boxed in, and lonely and angry” during the lockdown. Some have been afraid to go out, wary of leaving the safety of their home because of age or compromised health. Some have chafed at having to wear masks, “feeling like the whole country is a hospital with all the masks.”

One patient, whose sibling died of other causes, described “not feeling grief,” and still not feeling sad but numb several sessions later. She worried that she wasn’t grieving the way she should. We talked of how her grief, like that of many, is suspended and postponed until she can grieve in person with family and friends.

For those professionals carrying on through trauma, and those whose grief is suspended, it’s critical to acknowledge deep feelings. To reckon with their trauma and grief, and to join with others to honor the lost, are essential steps toward recovery. Shelving these issues while trying to avoid grief makes matters worse, causing it to be expressed in the body as physical symptoms or experienced as anxiety or depression. Or even, as reported by the news media, suicide, a choice an emergency doctor made because the onslaught of COVID-19 patient deaths was unrelenting.

What Will Our Changed World Look Like?

When the restrictions of the pandemic are lifted, when there’s a vaccine, when the bereaved can grieve physically with family and friends, what then? Nothing can replace being with a loved one when they are dying. And nothing can take the place of being at the funeral home with the deceased (or their ashes) for the last time, or going to the cemetery with family and friends when the loved one is buried. All that is gone. Those important times we could have spent with our dying loved ones in the hospital and during funeral services are lost forever, as are they.

Kiera Slye
Source: Kiera Slye

But there is something that is not lost: memories of our loved ones. When at last we can all be together physically—at the delayed memorial service, Mass or gathering of family and friends—there will be tears, hugs, hands held, and embraces. We’ll pick up our suspended grief that was postponed, and share memories of the deceased, reminiscing of times with them that we’ll cherish always, and begin a slow return to joy.

Adapted from The Anatomy of Grief (2020), by Dr. Dorothy P. Holinger. Visit her website for more information.


Dorothy P. Holinger, Ph.D., was an academic psychologist on the faculty of Harvard Medical School for over twenty-three years and has maintained a psychotherapy practice for twenty-five years. A graduate of Brown University with a degree in English, she earned her doctorate in psychology from the University of Michigan. With a National Research Service Award—a grant from the National Institutes of Health—she completed a postdoctoral fellowship in Biological and Social/Developmental Psychiatry in the Clinical Research Training Program at Harvard Medical School. Dr. Holinger has studied the human brain for thirty years with grants from the Montreal Neurological Institute and the National Institutes of Health. She is a member of Sigma Xi, the Scientific Research Honor Society, and the American Psychological Association, and is a fellow in the Association for Psychological Science. She has contributed papers to journals such as Brain Research, Archives of Neurology, Journal of Clinical Neurophysiology, and the American Journal of Psychiatry. In her book, The Anatomy of Grief (2020, Yale University Press), Dr. Holinger has drawn from brain science, psychology and literature to describe what happens to the brain, the heart, and the body of the bereaved. She lives in Brookline, Massachusetts, with her husband.

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