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The Search for Acceptance and Meaning in COVID-19

April 09, 2020

By Andrew Penn, RN, MS, NP, CNS, APRN-BC
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

(Part 3 of a 3-part series)

In my last two blogs, I borrowed from Elisabeth Kübler-Ross’s seminal work on the stages of grief as a frame to understand the emotional work we are all engaged in as we face the COVID-19 pandemic. After a disorienting quick descent through denial, anger, and bargaining, we find ourselves now in the long sea journey of grief and loss. The first four stages were easier to write about: all I had to do was describe what is happening now. What comes next is harder to write about because we are living into the questions, and it taxes my imagination to even be able to conjure the shape that will take.

Awaiting us is the process of acceptance (the fifth stage) and finding meaning in our loss. How do we begin to imagine accepting sickness, disruption, and death, or even more, finding meaning in it?  Let me be clear, I cannot be prescriptive in telling others the meaning of their own losses or even telling others the path through this time.

Part 1 in the series: Navigating the Emotions of a Pandemic 

Grief writer David Kessler has written about the sixth stage of grief, finding meaning. We each must find our own meaning from this event. This is a process that will take time, introspection, and community. And even when we find the meaning, it will remain a poor simulacrum of that which we have lost. What I can do is share guideposts left in the histories and humanity of others who have experienced loss, and to suggest that we try to transit as a community through the difficult days of reckoning that lie ahead.

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California, more so in recent years, has been ravaged by wildfires in the autumn. After the flames are gone, the scorched hillsides seem lifeless. Yet, as soon as the winter rains begin, a hill walker will see mushrooms emerging from the seemingly dead ground, turning the sooted earth into the canvas for new life. Later in the spring, lupine shoot forth in thick sheaves of deep-blue flowers, a fungus that lives symbiotically in their roots fixing atmospheric nitrogen into the soil. Before long, only a few blackened trunks reveal the history of the fire, so quickly does it recover.

For certain, like a wind-swept wildfire, this virus is burning through our world. There will be many dead to bury and much loss to mourn. When the proverbial curve has at last been flattened and rejoined the X-axis, we will breathe a sigh of relief, especially for those whom this is not a story on a news site or even a significant disruption of our daily affairs, but rather a moment in time that marked the loss of a loved one. For those health care workers on the front lines of our emergency and critical care departments, I expect to see the dull-eyed shock of those who have seen too much horror.

Part 2 in the series: Making Room for Grief During COVID-19

We will be called upon to experience all that we don’t have bandwidth to feel right now. For those who have unexpectedly lost loved ones and who could not be with them in their last moments (because of infection control), this pain will be even greater. To be sure, we are experiencing a trauma, as a society, and for many of us, before this is all over, a personal one. Our grief will be felt both individually and collectively and we will need to mourn both as individuals, but also as a community. Grief is not meant to be navigated alone, but rather to be held in the soul of the village in ritual and remembrance, however we define that.

Finding Growth in Trauma

Post-traumatic stress arises, in part, when our assumptions of safety in a benevolent world have been shattered. I suspect that the return to our new form of normal, whatever that looks like, will be a reversal of the process through which we took up defenses against the virus—only much slower. While we may ache for a return of public life, we will likely come out of our shells gradually. What will it be like when we can gather again, to fly on a plane, or to shake the hand of a new friend? Will we ever shake hands again? Or will we regard everyone with the vague suspicion that has befallen us now, where all at once, the threat seems omnipresent and yet nowhere to be found? And what if, in the absence of a vaccine, we have flare-ups of infection? Our response to a renewed threat may be excessive or disorganized, as can be expected from a population that is traumatized.

Fortunately, we know from the post-traumatic stress literature that humans are incredibly resilient. The vast majority of people who experience trauma do not go on to develop post-traumatic stress disorder (PTSD). This is the good news. Even better news is that some can come out of the experience stronger. This is the story of post-traumatic growth. But in order for us to grow from this traumatic experience, we must work through that which we have endured.

To do this, a certain amount of engagement with our loss is essential. While brooding over the trauma is not helpful, thoughtful, purpose-driven reflection can move us towards an experience of meaning and resolution. Traits such as optimism, acceptance, and a search for meaning support the post-traumatic growth process on an individual level, while social support, spiritual groups, and community engagement support healing the larger whole.

So how can we use this horrible event to bring us closer to our values and ensure that the change that emerges will endure? I suspect the change and meaning-making will need to occur on both a personal and societal level.

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