Coronavirus: Recognising disenfranchised grief amid COVID-19

Many people are experiencing free-floating anxiety in response to the adaptive challenges and uncertainty associated with COVID-19. Anxiety can reduce capacity to concentrate, and to plan and organise activities.

Helpful guidance has been provided by government and non-government agencies on the benefits of maintaining routines, social connections and exercise, and the potential harms of isolation, lack of access to purposeful activities, and increased alcohol consumption. However, there are other psychological consequences of the essential constraints associated with the pandemic; awareness of these consequences can enable people to understand and manage their emotions. Foremost among them is disenfranchised grief.

Grief is a normal and familiar psychological process that follows bereavement or other major loss. When grief is experienced after a loss that is acknowledged by others (such as the death of a family member), it elicits increased support, and is often accompanied by formal rituals or ceremonies. Some people will experience the tragedy of being bereaved by COVID-19.

Disenfranchised grief is the term applied to experiences of loss that might not be recognised, either by the person or by others. As with recognised grief, disenfranchised grief is accompanied by disbelief and shock, yearning for reality to be different or as it was before the loss, and then uncertainty and sadness as reality grows. The process is more difficult because unrecognised losses tend not to attract increased social support or rituals. They can be isolating and induce powerlessness, rather than the problem-solving that's needed to reduce the psychological pain.

A growing list of losses

The essential public health responses to the COVID-19 pandemic are engendering losses.

We are losing liberty, autonomy and agency as everyday activities are restricted, some precluded. Privacy is being lost as we're scrutinised increasingly closely for adherence to health behaviours to reduce potential to infect others. At the same time, paradoxically, participation is lost because privacy is enforced through required isolation and seclusion.

Occupational identity and capacity to earn an income are fundamental to adult individuality, sense of purpose and meaning, and autonomy. Losses of these are profound, and associated directly with demoralisation and depression.

Social connections are predicated on trust. Although public health messages identify the specific risks for COVID-19, in social interactions, everyone is suspected of being infected, with the potential to put others at risk of contracting the illness. Trusted relationships, which are essential to psychological wellbeing, are diminished.

Activities that provide regular engagement with other people with common interests are enjoyable, provide structure to life, and maintain emotional equilibrium. They also offer essential sites for discussing life situations, experiencing empathy, and exploring solutions. Social media are proposed as an alternative to in-person meetings, but sustained empathy can be more difficult to experience through interactions on social media than those in person.

When people feel understood and supported, rather than criticised for continuing usual activities, they're more likely to adapt their behaviour to the benefit of all.

Closure of institutions, and restrictions on the size of gatherings, have an inevitably adverse impact on events and experiences that are lost permanently. Weddings cancelled or reduced to tiny gatherings of a small group of witnesses, sporting fixtures that form part of our sense of identity and belonging, school formals, and milestone birthday celebrations postponed or withdrawn – each incurs grief, as what had been anticipated with joy and pleasure is experienced as being withheld, even stolen.

Everyone is experiencing loss. Legitimate claims of personal losses are therefore constrained by the need to consider the public good, and to behave altruistically. In comprehending public behaviour, and in the calls for more effective health messaging, we propose that appreciation of the impact of disenfranchised grief might be useful.

Recognising loss requires more than anxiety management. People are being criticised for failing to take health-protective messages seriously, and flouting rules. Apparently inexplicable behaviours such as gathering at the beach could be understood as reflecting disbelief and yearning for life to be unchanged. A punitive and shaming reaction from frustrated authorities is understandable, but it might be more effective to demonstrate empathic recognition of what it's like to be prevented from doing normal social activities, and to offer reassurance that these aren't lost forever.

Messages to initiate useful conversations

Part of the health message could be to encourage people to ask others what they've had to give up that's important to them, and why they're important. This approach would initiate conversations that allow disenfranchised grief to be recognised, and mitigating steps to be taken in an environment of communal support and collaboration.

Public messaging informed by an understanding of disenfranchised grief is more likely to be experienced as helpful and reassuring. Messages could be consistently prefaced by an acknowledgement that restrictive measures will be difficult, not only economically but also socially. There could be suggestions for how to maintain social intimacy while implementing physical distancing.

When people feel understood and supported, rather than criticised for continuing usual activities, they're more likely to adapt their behaviour to the benefit of all.