Managing anxiety and mourning during COVID-19

What repercussions can a global state of emergency have on people's mental health?

This is without a doubt an unprecedented situation, and as such, all the news are bringing forth experiences of uncertainty and, therefore, tension. Having never experienced anything like this, we feel we have no control over the situation, and so we are not able to contain and elaborate our fears and worries, and reassure ourselves. 

Furthermore, not knowing when all this will end is even more alarming, so we don't really know how to manage the resources we have available over time. We have to resist, but for how long?

The fact that everyone's health is at stake then has a strong impact on our way of seeing ourselves, as usually, most people take care of their health only when they don't feel well. For the rest of the time, we move like machines, immersed in our many commitments, with little consideration of the fragility of the human being. This is the aspect that increases the sense of unreality that we perceive of this situation because these things were seen only in the movies! Therefore, we find ourselves thinking in a way that we have never had before, and that scares us because it makes us feel that we are not really untouchable and indestructible as we used to believe.

And it's not an easy thing to accept. In addition, the fact that this problem is everywhere makes us feel a little trapped because it prevents us from implementing our most primordial defence strategy, which is that of escape.

Where can I run this time to save myself?

Getting to grips with these experiences is difficult for anyone, especially for those who are used to moving around the world frequently. And here is how important it is to take care of yourself and your moods, even for those who are not very practical. But I guarantee you that the effort of paying attention to yourself and your emotions, and doing things that make you feel good will repay you both in the present and in the future, avoiding the development of annoying symptoms. 

How can forced isolation undermine the emotional state of the individual and what strategies can we adopt to deal with the onset of states of anxiety or malaise?

Unfortunately, studies on forced isolation are not encouraging because they show an association between the duration of isolation and the levels of distress (understood as the negative stress that affects our well-being, unlike the so-called positive eustress). In addition to this aspect, in a recent review (Brooks et al., 2020), it emerges that other aspects that make staying at home (stressors) even more complicated are the fear of being infected and/or that of infecting others; feelings of isolation from the rest of the world, boredom and frustration; not having adequate sources of livelihood (such as water, food, clothing or an uncomfortable place to stay); the absence of clear information and guidelines from the bodies involved in the safeguarding of public health, etc.

However, there are strategies that we can adopt. First of all, evaluate every possible improvement that we can make to our domestic spaces in order to feel better, trying, for example, to create and/or preserve private spaces only for yourself / and if you are at home with other people, or to make it less oppressive the house where you live if you are alone.

The same goes for our time. Taking time for yourself is essential to take care of yourself, as well as using technology to stay connected with other people, avoiding isolating yourself emotionally from others. In addition, it is important to maintain a routine that allows you to mark the days, characterising each day of the week by a specific activity, so as not to lose the sense of time.

In these moments, however difficult it is, it is important to focus on the here and now rather than on the future. And I'm not saying it's simple, but we often use our planning and design skills as ways to control our anxious states about the future. However, the situation appears so uncertain from so many points of view, that now this mode only risks taking away precious energies and increasing distress.

Therefore, set yourself short, achievable and short-term goals that allow you to build brick by brick a solidity that will certainly serve you in the future. 

In this particular historical moment, everything is out of control, and there is a strong sense of uncertainty. What advice would you give to a bereaved person to allow them to rebuild their identity after the loss of a loved one?

The mourning of a loved one in a situation like this brings with it an accentuated sense of unreality and the difficulty in feeling and elaborating the fact that one's loved one is really dead. This feeling can also occur in a context of normalcy, particularly when the deceased person lived far away.   

What you can do is control what little is possible, in front of an event like death, so out of control and to which you can never give an explanation.

In other words, we can play an active role by first thinking about how to sanction the death of a loved one in our mind and in our personal history. This is possible through a ritual that allows to process the mourning. Usually, this function is performed by funerals, but in this context, what to do? Each of us is unique, and as such, a person can choose which personal ritual they want to carry out, also on the basis of the relationship they had with their loved one who has passed away and the feelings they experience.

Everything is legitimate: writing a letter putting the words you wanted to tell them black on white, drawing (useful for children and teenagers, but not only), listening to songs, cooking special dishes that remind you of the deceased, any act that has a meaning for yourself and that allows you to feel what the loved one has left you as a legacy within their own identity.  

All the people who are important and meaningful to us occupy a place in our inner world. We notice it in a thousand ways: when we recognise some of them in the gestures we make, or when they suddenly come to our mind when we smell a perfume. 

This is what allows us to have them with us forever and to feel them embedded as parts of our complex identity. People living far from their loved ones may be more aware of this mechanism.

What are the psychological repercussions caused by not being able to visit a loved one in the days preceding death?

When it is not possible to visit the dear one in the days preceding death, the suffering and anguish for what is going on are accentuated, and other strong feelings join the sense of unreality, such as the sense of guilt and anger.

The sense of helplessness could be overwhelming, with repercussions on not only mental but also physical well-being. However, helping us to remember that current impediments are objective and do not depend in any way on us is important. And that death is never something we can accept.

There is no right time to lose someone important. In this regard, once again the rites come to our aid, preparing ourselves once for the mourning that is about to take place: recover from your mind the good memories you have of your loved one, what makes that person important for you, and how they will be able to live within you forever.

Another fundamental thing in this regard is to keep in mind that there are people who find it difficult to feel, handle and accept these feelings, who are constantly engaged in an arm wrestling with themselves that leads them to "pretend nothing is happening" and to think that they simply have to move on after the death of a loved one "as if nothing had happened". In this case, the risk of long-term repercussions on one's psycho-physical well-being is high. 

We expats are in a particular situation because, even if we want, we cannot travel at this moment. How to manage the sense of guilt and helplessness generated by the fact that we cannot go and say a last goodbye to that dear one?

Guilt and helplessness are extremely common when people are faced with the death of a loved one.

"I could have done more '" is a mantra that you will often hear. However, it is important to be careful of this mental trap in which we risk falling because it makes it appear as if nothing we do or have done is enough. We cannot fight death, even if we are health workers. But what we can do is to give our best in many different ways: honouring the loved one who passed away, supporting other family members (especially teenagers who might be involved), talking about them, helping other people in simple ways (ad example by calling someone we know to be in difficulty at home alone) to the more complex ones, feeling that we can be useful to others. 

These are considerations that apply to everyone, near and far. In fact, we are currently witnessing a paradox linked to this situation, namely that physical distances seem to have lost their importance. Strangely, we all share more or less the same problems and similar moods, regardless of the country we are located in, paradoxically making us all feel closer. 

We can take this as a moment to realise how much the inner and emotional closeness is far stronger, lasting and more important than the physical one, and that everyone can find their own way of giving the last farewell to their loved one from any distance. 

Given the impossibility of organising a funeral to give the deceased last farewell, what would be alternative forms of mourning and sharing our pain?

Ritual for humans is essential for mourning, and the funeral is the most classic of the rites that exist to assist people in this difficult task.

How to do without?

My advice in a situation like this is to do something when it happens, concentrating on the here and now, without thinking about putting it off when you can.

Waiting and passing time, in fact, risks making the mourning process even more complicated, leaving you immersed in strong emotions that are difficult to tolerate.

Creativity helps us to do this (and if you think you don't have it, ask someone for advice, or take a cue from the options I mentioned above).

Tell others about your loved one who has passed away, about the role they played for you. Sharing is a central aspect: share the pain and all the other emotions that go through you with all the means you have available, technological and otherwise.

What are the symptoms of discomfort on a physical and mental level, caused by unprocessed mourning, to which we must pay attention and in the presence of which it is advisable to contact a specialist?

There are situations in which mourning can, unfortunately, become pathological.

In general, there is always an impact of mourning on our psycho-physical and social well-being, and its elaboration depends on many factors related to the extent of the loss, the history of the individual and his personological characteristics, as well as the context in which it is inserted.

We speak of Persistent and Complicated Mourning Disorder when negative experiences such as sadness, guilt, envy, anger (all feelings normally related to mourning) last for more than 12 months for adults (6 months for children), with persistent ruminations relating to the circumstances in which death occurred, and often somatic symptoms (e.g. sleep-related problems, loss of appetite or binge eating, apathy, easy fatigue, dysfunctional conduct such as the use of drugs or alcohol).

In this case, asking for help from a specialist is fundamental as this considerable time indicates that the mourning of our loved one has not been elaborated and accepted, and that it seems impossible for the person to go on.

In this regard, it is important to underline that accepting does not mean forgetting but making space in one's mind to be able to progressively recover the meaning of one's life that in the face of some mourning we feel we are missing, with the feeling that nothing makes sense and there is no more positive aspect.