Bengaluru: The Covid pandemic, especially the second wave, has brought an unprecedented surge of grief — grief of an alien kind.
For around a month starting late April, the daily Covid death toll hovered between 3,000 and 4,000, climbing even higher on some days. The death from disease was just a part of it — adding to the trauma were reports of people dying for want of medical attention, as well as access to medical oxygen.
There were stories of multiple members of a family dying, of children orphaned by Covid. There was a sense of communal heartbreak as some individual stories emerged from this sea of grief to haunt distant strangers.
There was the pregnant dentist who followed all precautions but seemingly caught the virus from someone at home, then, gasping for breath, recorded a video in her final days to warn people against taking Covid-19 lightly. There was the young mother on non-invasive ventilator support who was seen, while awaiting an ICU bed in hospital, enjoying a peppy Bollywood number about loving life, days before she died.
There was the eight-months pregnant government school teacher who reportedly caught the virus while out on duty for panchayat elections in Uttar Pradesh. And the journalist who “live-tweeted” his own death.
Away from the visuals and stories flooding the media, conventional and social, there was the personal loss. Few perhaps have been left untouched by personal grief amid the havoc wreaked by Covid — many lost their parents, their children, their spouses, their uncles and aunts, their friends and colleagues, neighbours, or just somebody they used to know, someone they once shared a laugh with.
This grief came with its own baggage — loneliness.
The nature of the pandemic is such that death was stripped of its usual rituals. Bodies of Covid patients are wrapped in a body bag to cut transmission risk, so all one can do is take a quick last glance before the final farewell. There can be no last touch or hug.
Restrictions on attendance, and the government’s advisory against large gatherings, have deprived many of the chance to be a part of funerals. There have been cases where funerals have been conducted in the absence of any family member at all because each of them had Covid and couldn’t conduct the ritual themselves.
For the same reasons, the memorial meetings that follow a death — where families and friends come together, say a prayer, seek catharsis in shared pain — have been missing too. In short, the meaning of grief has changed.
“With the second wave, what I noticed was a lot of helplessness, confusion, trauma, and anxiety,” said psychologist Ruchita Chandrashekhar, whose work has involved trauma therapy. “This wave, it seemed like either people had it themselves or someone in their homes did, so it hit closer and closer to home. The intersection of not having resources and the heightened fear around reading so much about death became contributing factors to how people’s mental health was impacted.”
There’s “a lot of confusion and unprocessed anger”, Chandrashekhar added. “Anger at the virus, anger at the system, lack of resources, and even just at death as a concept. We know how to understand loss from conventional health causes like heart attacks or accidents, but there is rage at people having died because they didn’t have oxygen. We are processing loss differently.”
Dr Prabha Chandra, former head of psychiatry at NIMHANS, Bengaluru, said she was particularly worried about the impact on children, who find themselves holed up at home.
“While there will be a collective sense of loss, the meaning of that loss is going to be different for different people,” she added. “My worry is for adolescents and children who had losses because normally young people spend time in each other’s company and that helps manage their emotions better.”
Unresolved grief
As people around the country — and the world — tried to come to terms with the wave of fatalities, pop culture stepped up with comforting words. In the series WandaVision, the robotic Vision says, “What is grief, if not love persevering?”
Many found comfort in the words, and they frequently popped up on social media.
Grief can manifest in many ways, including in a visible impact on physical health, especially immunity.
American psychologist George Bonanno says resilience is the most common and natural reaction to grief. He claims normally unhealthy behaviours can be helpful during times of stress — something he calls “coping ugly”.
After the 9/11 attacks in 2001 and the SARS epidemic in Hong Kong in 2003, Bonanno’s work in bereavement led him to propose four behaviours or paths that people may adopt to process grief. He called these the ‘Four Trajectories of Grief’.
First is resilience, when an individual is able “to maintain relatively stable, healthy levels of psychological and physical functioning”. Recovery is when a person undergoes extreme stress and PTSD for some time, maybe a few months, but is then able to bounce back. Chronic dysfunction occurs in those who are unable to function for several years. Delayed grief is when a person experiences distress symptoms only much later.
Reaction to grief is also classified by the Kübler-Ross model, which proposes that everyone faced with this emotion goes through five stages — denial, anger, bargaining, depression, acceptance. While widely accepted, the model also has its critics, including Bonanno.
Speaking about coming to terms with a loved one’s death, Dr Chandra said “people always do better when there is a buffer or support system in place”.
“Even those who had devastating losses in the first wave but had ample support in the second managed to cope comparatively better this time.”
Having a support system, Chandra said, doesn’t mean just therapy or counselling, but also systems in place that help a person through their stressors and trouble spots.
“It’s the feeling that somebody can look after you in an emotionally and physically safe environment,” she added. “When emotional and physical safety are no longer at the forefront of our minds, we can do other things.”
A lot of managing mental health just comes down to survival, said Chandrashekhar. “If someone lost a loved one, there has been grief pertaining to paperwork, or managing assets or belongings. The days will keep passing, and it comes down to taking care of loved ones and seeking control in different ways, because loss has been outside of one’s control — whether it be the virus or the black fungus or the lack of oxygen.”
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Coping with grief
Around the world, people have been trying to find ways to deal with the overwhelming sense of loss wrought by Covid.
A virtual bereavement festival in the UK last year attracted thousands of people. Aimed at “exploring the unique shape of grief during the Covid-19 pandemic”, it offered a grief school with modules on grieving, delayed grief, and traumatic loss.
China held a national day of mourning Covid-19 victims last year. Then there are hyperlocal community events, including even Clubhouse rooms, where people gather to talk about their loved ones, their mental health, and to mourn.
There are also a number of ongoing studies that are looking into Covid as a mass bereavement event.
Coping with grief of this scale and building resilience, say experts, first requires acknowledging the tragedy.
“We need to not turn a blind eye to how many people have died and acknowledge the failures that have taken place to be able to process the anger and grief,” said Dr Soumitra Pathare, director of the Centre for Mental Health Law and Policy.
With no systemic mechanisms in place for providing large-scale mental-health support at a society level, experts caution that consequences could be devastating for decades to come.
Providing an outlet to public grief and building systems that support those who have been affected by the pandemic is crucial to rebuild and survive as a healthy society, they say.
Pathare cited the example of events like the Partition of India or the Palestine conflict as those marked by intertwined grief and trauma. The large number of collective deaths shape a generation of people who then go on to write laws and formulate policies, often influenced by anger and unresolved grief, he said.
On the other hand, he added, is the case of apartheid in South Africa, where grief was addressed publicly in a structured manner through the Truth and Reconciliation Commission (TRC), a restorative justice body that heard statements from victims and held public hearings for perpetrators over several years.
Experts say the need of the hour is an institutional response to the loss or grief leadership, a concept that is gaining widespread recognition, especially among workers in the social sector, where exposure to death is a part of life and resilience is often at a higher risk of vulnerability.
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Grief leadership
Amid the pandemic, a group that is at perhaps the highest risk of suffering from grief and PTSD are healthcare workers, who have had to make difficult decisions in the face of lack of resources, for example, prioritising a patient with better scope of survival. Experts say grief leadership is an initiative that particularly needs to take this group into account.
“Healthcare workers are trained to save lives, and this time they’ve been forced to make tough choices in the face of zero guidelines,” said Dr Pathare, Director of the Centre for Mental health Law and Policy. “When Italy came out with triage guidelines early in the pandemic, it had immense value because healthcare personnel didn’t carry the guilt of their choices. And this feeling stays with people for a long time.”
The specific need for grief leadership, however, is complicated by the fact that there is already a dearth of mental health resources in India.
“The 2015-2016 mental health survey showed that, in India, around 150 million people need mental health intervention,” said Pathare. “And only 30 million have access.”
As awareness of the impending and ongoing mental health crisis deepens, experts hope that resources become scalable, as does care.
“There needs to be more thought put into public health and safety,” said Chandra. “Grief is a process by which we find our new identity in the world without a person, while keeping them within us.”
“We know that unresolved grief without closure has a huge impact on an individual,” added Pathare. “It impacts our everyday behaviour. What is also concerning is what this would do at a societal level.”
(Edited by Sunanda Ranjan)
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