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Bioethics Forum Essay

Unresolved Grief is Eating Away at Us

The start of a new year is a time for reflection. In most ways, 2023 was a return to normal. Schools were fully back in person; hybrid work was old hat; travel rebounded; and people ate in restaurants and went out to the movies and plays.  One could be forgiven for thinking that the greatest pandemic of our lifetime had not even happened. Yet, I see people easily agitated and stressed, and nerves frayed. These behaviors show up in social interactions, on the road, and on social media. I think in our desire to regain a sense of normalcy we have not grieved properly for the losses and hardships of the past four years.

Grief is “the anguish experienced after significant loss, usually the death of a beloved person,” according to the American Psychological Association. It can present in response to any event that disrupts or challenges our sense of normalcy or ourselves.  Natural disasters, wars, and pandemics involve collective grief, loss experienced by a group, and traumatic grief is a response to loss that takes place under horrific and unpredictable circumstances. Grief is typically followed by a period of mourning. Avoiding this stage can lead to complicated grief, a disorder characterized by long-lasting, painful emotions and difficulty recovering from the loss.  I think our collective, traumatic, and unresolved grief is seeping out in unhelpful and unhealthy ways. If we do not tend to it, it could affect us for years to come.

Elizabeth Kubler-Ross is famous for identifying five stages of grief: denial, anger, bargaining, depression, and acceptance. These stages don’t necessarily happen in this order, and I think as a society we are stuck in the anger stage. We experienced denial in the beginning of the pandemic and definitely depression during lockdown and beyond as mental health issues remain at higher levels than pre-pandemic. There may well have been lots of bargaining going on too, e.g. “If I don’t go to this social gathering, I can go to the next one safely.”  We have lost so much. We lost the world as we knew it. We lost a sense of predictability in life and some degree of optimism about the future. We lost loved ones and colleagues; children lost educational, social, and emotional development. Many Americans lost trust in our leaders and experts.

Early in the pandemic, there was attention to those lost. The news media tracked the Covid deaths daily. Now, these deaths rarely make the news.

What we have lost needs to be acknowledged to process our grief and move toward acceptance, a process that will be uncomfortable, if not painful, for a while. There are many ways this can happen. Nationally, we could identify a day of remembrance for the over 1 million lives lost to the pandemic in the United States alone. States and local communities could join in and add their own services. The only such service we’ve had was attended by President Joe Biden on the eve of his inauguration in January 2021

Churches, synagogues, and mosques could hold special services for their members annually helping to personalize the mourning within that community. It would also be worthwhile for individual institutions and employers to acknowledge their losses, recognizing the individuals who were known to them and who are missed. The health care profession, of course, was hit particularly hard.

Beyond acknowledging our losses, schools and parents need to help children understand their emotions and process them. Local communities, perhaps through the libraries or other civic and nonprofit organizations, could offer times and places for their members to share their experiences over the past few years. Ignoring what we have lost isn’t working. Waiting for the anger and frustration to dissipate isn’t wise. Only when we face our losses and the toll they have taken and grieve can we truly move on.

Katherine Wasson, PhD, MPH, HEC-C, is a professor in the Neiswanger Institute for Bioethics at Loyola University Chicago. 

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  1. Thank you for this important recognition. The lack of resolution is compounded by the reality that we are still in a massive health crisis, despite the end of the public health emergency declaration and related policies that helped to mitigate transmission. Today, and every day for weeks, over a million people in the US will get COVID in what is likely the second largest surge of the pandemic, creating waves of illness and related harms and leaving 20,000 Americans a day newly affected or more deeply affected by Long COVID, a frequently disabling condition. And COVID is now the 4th leading cause of death and adults, stripping our generations of elders and leaving holes in our social fabric. How much more does this unresolved grief fester when we acknowledge neither the harms of the first years of Covid, nor the continuing harms of an unabated crisis?

    1. Thank you, Jay, for your comment. These are indeed important facts and many people are so focused on moving on that they have not been acknowledged. The impact of this unresolved grief is somewhat unknown as we have not experienced this type of collective grief from a traumatic experience in the US in our lifetime. I suspect that some of us have grieved on a more personal level, depending on our experience with specific losses during Covid, and some people process grief bette than others. However, if we ignore the large scale impact of the pandemic and ongoing impact of Covid we may stay stuck in this stage of grieving for a long time. What do you think?

  2. Thank you, Dr. Wasson, for bringing this forward. As a hospital chaplain who lives in a small town and rural area, I witness a hesitance for people to talk about these losses due to COVID, given the current strong political feelings some have about this whole issue. If a person shares that they lost a loved one to COVID even though the person had been vaccinated, there is the risk of hearing an angry diatribe about vaccines, etc., versus just the caring and support that is needed. Some people feel betrayed that their loved one died, even though vaccinated; some people feel angry that hospital staff providers refused to utilize a treatment that was not evidence-based, and blame them for their loved one dying; nurses and providers were threatened and cursed for simply following best known treatment procedures at the time, and some experienced burn-out in the process; and some people grieve and may feel responsible for their loved one’s death to COVID, because they could not persuade them to get vaccinated or take precautions.
    In general, talking about COVID at all can trigger harsh discussions, and possibly reveal political leanings that could literally endanger a person living in certain communities. Those folks certainly have a hard time receiving the support for their mourning process. And you identified many other losses incurred by a wide range of people who were either for or against the vaccine, and the choices made by leadership in addressing the crisis.
    You have stirred my thinking about this and given me ideas for my hospital staff and community, toward honoring those who died, supporting those who mourn, and making it a bit easier to focus on the common thread of grief and loss — the human aspect in all this — regardless of political beliefs.
    Thank you.

    1. Thank you, Aime, for posting your thoughts. You highlight some of the many layers of the pandemic experience that contribute to the barriers to talking about these losses. I hope you will be able to find ways to honor those lost and the many losses we all have felt beyond the death of a loved one. Somehow our society needs to acknowledge our pain, the sources of which are not the same for everyone, before we can begin to move forward.

  3. Excellent article addressing an all to common issue: grief. Elizabeth Kubler-Ross’ contribution to the field was stages that dying people experience, NOT grieving people.

  4. Thanks, Katie for a very insightful piece. In particular, it’s great that you point out that we’re grieving losses such as “. . . a sense of predictability in life and some degree of optimism about the future.” I am particularly concerned about these losses in the younger generations of Americans. Many of the millennials already had lived through the devasting effects of the Great Recession on their prospects and just as they were starting to see broad-based opportunity again, it seemed that the world melted down under the burden of COVID. For members of Gen Z, this massive unpredictability may now seem a feature rather than a bug of the universe. I am not sure what happens to a society when its young people’s worldviews have been so impacted by large scale trauma, in some cases, repeated trauma. But you suggestion of facing the grieving process seems a good start.

  5. I have noticed that the reports of the current shortage of nurses and doctors fail to mention the estimated 88,000 to 188,000 healthcare workers who died from COVID, (NIH estimate). The inability to recognize this loss contributes to the inability to grieve. We are no longer cognizant of those we have lost, out of mind for those who did not lose a loved one, buried in the psyche unnamed.

  6. I have profound grief for two things (besides people): 1) The lack of community/solidarity in how we responded to the pandemic; there was too much attention to and honoring of individual “freedoms.” 2) Perpetuated and exacerbated inequities for minority and underserved populations. We have known about inequities for so long, yet nothing seems to change.

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