One of the most powerful effects of the coronavirus pandemic runs just below our collective consciousness. Lying beneath the news about symptoms, case numbers, and possible cures is the ever-presence of grief and loss. The deaths of more than 69,000 Americans (as of May 5, 2020) creates a widening circle of mourning, as each person’s passing affects a number of their loved ones. Hundreds of thousands are grieving right now, and none of us is immune to it.

News reports remind us of the cultural icons we have already lost to coronavirus—singer-songwriters, rock stars, actors and actresses, renowned writers. “When famous people die, we may not know them personally but they are part of our collective identity, so we lose a part of that identity when they pass away,” says Roger McIntyre, MD, a professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit at the University Health Network in Toronto. “We don’t talk much about that kind of loss, but it’s a major issue for people.”

And then there are those who weren’t famous, but whose loss is particularly piercing: the 90-year-old woman who had survived a concentration camp during the Holocaust only to be cut down by covid-19. The young ER doctor who died by suicide after being overwhelmed by what she had seen, and those she had been unable to save.

We hear the stories about overflowing morgues and entire nursing homes devastated, and families losing several members within days of each other. As spring blossoms incongruously, sadness is in the air. And that sadness and grief—whether from the direct loss of a loved one, or from the larger societal losses (including that of our usual way of life)—is intensified and made more challenging for the over 45 million Americans who have a mental illness.

“We all have a degree of capacity to endure stress and pain,” says Michael McGee, MD, Chief Medical Officer of The Haven, a psychiatric treatment facility located in the Central Coast of California. “You might call that our resilience capacity or functional capacity. And if you’re struggling with mental illness, whether anxiety, depression, substance abuse, or another condition, that will reduce that reserve and make you more vulnerable to being destabilized by the stress of the loss.”

Add to that vulnerability the fact that the present situation is almost a perfect storm of stressors around loss, because certain circumstances make grieving more complicated—and the pandemic combines many of those circumstances simultaneously.

“This is bereavement overload, stress overload, many forms of traumatization, many kinds of losses, coming together in this difficult time,” says Therese Rando, Ph.D., BCETS, BCBT, Clinical Director of The Institute for the Study and Treatment of Loss in Warwick, RI. “We’d be hard-pressed to create a scenario in a movie that would have more high-risk factors, from a grief perspective, at one time. Even in World War II, the enemy was external—it was out there, you saw their planes and tanks—it wasn’t invisible and internal. And we’re being vicariously traumatized even if we haven’t faced loss directly in our own families or among our friends.” Rando describes five of these high-risk factors, each of which will have a more profound impact on someone with mental illness:

So How Is Coronavirus Affecting Grief, Specifically?

1: Suddenness: A sudden, unexpected death adds to the trauma of loss, says Rando. So, for instance, grieving someone lost in a car accident will be more complicated than grieving someone who slowly slipped away from illness. And with covid-19, even if the person is hospitalized for a time before passing away, there is the extra burden of not being able to be with them because of the risk of infection, making their passing more similar to a death by accident or violence. “That means many of the things we could normally do—be with them, console them, say our goodbyes—are not available.”

2: Lack Of Rituals: One of the cruelest aspects of this coronavirus is that the usual coming-together of funeral gatherings is prohibited. This can have a direct effect on your ability to process grief, says Rando. “The lack of touch and social support—someone wrapping you in their arms and comforting you while you weep—is very significant, because that connection allows us to release many of our emotions,” she says. “At the beginning, grief is so overwhelming. Or sometimes, what people feel is numbness. Being with other people can help with both, whether you’re feeling too much and missing consolation, or not feeling anything and need people to help you move into that, so you can talk about the person you’ve lost and begin to process.”

3: Social Isolation: Research shows that this is a powerful high-risk factor for difficulty with grieving, even before covid-19 days. And with stay-at-home orders, Rando points out, “you not only don’t have access to your social support group, but also other diversions that help us manage adversity and grief.” You may not be able to go to the gym to work out your tension, or go out to dinner with friends, or to a movie to distract yourself.

4: No Structure: If you’re home all day because of the pandemic, your usual structure has been ripped away. “In the midst of grief, we need things to hold onto and count on,” says Rando. That could be a work routine, a regular practice of faith, or daily activities like sending the kids off to school. Grieving while in this limbo offers no framework for getting through the day.

5: Guilt: Especially if you weren’t able to be with your loved one when they died, the loss can bring a great amount of guilt, says Rando. “Even though it wasn’t your fault—illegitimate guilt feels just as bad as legitimate guilt.” Covid-19 also brings with it the aspect of preventability: Could I have somehow protected this person? Maybe they didn’t have to die. You can also feel that society isn’t sufficiently recognizing your loss, says Rando. Front-line workers and prominent people get the headlines, but many thousands are slipping away unnoticed. Rando compares it to the family members of those who died on 9/11 and were window-washers or waitstaff at restaurants, who saw fire-fighters and financial titans being lauded while their relatives were ignored. “That can be a source of pain that under different circumstances wouldn’t pertain,” she says.

Mental Illness Makes Coronavirus Grief Even Harder

These complicating factors are challenging for anyone suffering a loss during the pandemic, but they hit people with mood and personality disorders much harder. They can re-trigger anxieties, traumas, and unhealthy behaviors, and the general stress, isolation, and fear can magnify the grieving process. Here’s what the experts say about how grief—whether for a particular loss, or the generalized grief we all feel in this shattered time—impacts the most common mental health conditions, and how to cope with loss during the time of covid-19.

Anxiety

First of all, it’s safe to say that almost everyone in America is more anxious than usual right now. Everyone worries on occasion, especially in times of greater stress, but for the close to 7 million Americans who have Generalized Anxiety Disorder, or GAD, worry, dread, and unease can be a constant companion. One hallmark of GAD is catastrophic thinking, in which the mind races to the worst-case scenario, even in situations where the risk is minimal. Signs of GAD include inability to relax, feeling tense, muscle tightness, difficulty concentrating, intrusive thoughts that cause worry, feeling jumpy and on edge, heart palpitations, stomach upset, and constant dread.

Coping with Grief and Anxiety:

“Grief always has some amount of anxiety to it,” says Rando. If you have been living with GAD for a while, you may have a leg up in having already learned some anxiety-management strategies that other people haven’t had to employ. “Pull back from the worst-case scenario thinking, like ‘everyone’s going to die, and I’ll be left alone,’” says Rando. “Tell yourself, wait a minute, that doesn’t have to happen, I can work to prevent this. Statistically this doesn’t usually happen.” Rando also recommends abdominal breathing from deep in the diaphragm. “It calms the body down. When you get panicky and breathe quickly from your throat, that induces more physiological anxiety and disrupts the carbon dioxide-oxygen balance.”

“At times of stress, there are two options that are available to the human being,” says McIntyre. “One is to freeze, the second is to take control of the situation. The latter will likely increase the likelihood you’ll get thru this with a better outcome.” While grieving in these extraordinary times, taking control means structuring your day, making sure you’re sleeping enough, and “portion control,” McIntyre says. “Not just of food and alcohol, but social media and news media. You need information, but 30 to 40 minutes twice a day is more than a sufficient portion.” Exercise is also a great “vaccine against stress,” he adds, even if it’s a workout routine done in your living room.

Bipolar Disorder

People with this condition, previously called manic depression or manic depressive illness, typically have mood swings that cycle between manic episodes and depressive episodes. When manic, a person may be irritable, excited, reckless, have racing thoughts and feelings of grandiosity, and sleep very little. In depressive episodes, mood can plummet into darkness, and you may feel hopeless or empty, take little pleasure in daily activities, and sometimes have suicidal thoughts.

Coping with Grief and Bipolar Disorder:

“For a person with bipolar disorder, it’s especially important to have structure to your life, because of the illness’s intrinsic unstructuring nature,” says McIntyre. When you combine the lack of structure that comes with major upheaval like lockdowns, and the sudden lack of structure that happens after a loss, someone with bipolar disorder is especially vulnerable to having a major episode. “You should prescribe yourself things to do throughout the day,” says McIntyre. “Also, sleep deprivation can very negatively affect the stability of someone with bipolar, so preservation of normal sleep behavior is job number-one.”

These behaviors are helpful to anyone struggling with life during a pandemic, but they can impact people with bipolar disorder more powerfully, McIntyre says. Similarly, we’re all social animals who need social support and connection, but someone with bipolar tends to be “more sensitive to real or perceived fragmentation of their social network than are others,” he adds. So, reaching out, whether by phone or online conversations using Skype or similar technologies, is especially crucial for someone with bipolar who is struggling both with loss and isolation.

Depression

As with anxiety, everyone feels down now and then—and the circumstances of the pandemic and lock-down have made many people sad and blue. But for the nearly 18 million people who have clinical depression, grief and sadness is constant and often has physical manifestations like crying fits, insomnia, under- or over-eating, and sometimes thoughts of suicide. Add a major source of grief like the loss of someone important in your life, and depression can spiral.

Coping with Grief and Depression:

One complicating factor for many people with depression, says Rando, is that while you really need social support, it’s hard for many people to reach out for that when they’re depressed. That’s one of the best things you can do, rather than keeping yourself locked down in a situation that’s not helping you grieve. “When you’re depressed, you tend to think in very negative ways about yourself, the world, and the future,” says Rando. “You think, ‘This is never going to change. I’m never going to feel better.’” That’s why cognitive approaches can be helpful: recognizing your recovery will take a while, that it may be two steps forward, one step back. “It’s especially important for someone who is depressed and grieving to build in brief periods of positive distractions,” Rando says. “Marinating in your grief and focusing on your pain makes you feel worse and won’t help you move forward. This isn’t betraying your loved one, it’s helping you grieve more healthfully. Take positive time to remember your loved one, put on a funny movie, watch a sunset. You can’t grieve 24-7 without breaks.”

Spiritual approaches can also be helpful for grieving with depression, as well as with other disorders, says McGee. “Put cognitive and spiritual approaches together,” he suggests. “Look at it cognitively, if you can, balancing that there’s loss but there’s also goodness. Remind yourself that the universe is perfectly designed to have impermanence, change, and loss.” Mindfulness techniques can help you get there cognitively, McGee adds. “It’s ‘see the pain so you don’t be the pain.’ Practice simple attending, mindfully, being aware. Tell yourself that ‘good’ or ‘bad’ depends only on our ego point of view, and when it’s ego against the universe, the universe always wins.” Try to see that in a non-judgmental way, he says. “We wouldn’t have life without death. Realizing the vulnerability of life makes life more precious.”

Obsessive Compulsive Disorder

This form of anxiety has a strange relationship to our current situation: While everyone is being told to be extra-careful about germs, wash our hands frequently, and go out of our way to keep things clean and disinfected, someone with OCD may well have been struggling in the past to reduce those behaviors. The disorder is characterized by obsessive thoughts that feel out of control, and compulsive behaviors that seek to ease the obsession—and often those compulsions revolve around cleanliness and germs, and/or compulsively organizing and cleaning to gain a sense of control.

Coping with Grief and OCD:

“Our current situation with loss and a pandemic can be a hellacious experience for someone with OCD,” says Rando. “OCD symptoms seek to maintain order to keep anxiety under control, but there’s little order right now, so symptoms may flare.” Any loss will pose a greater challenge with someone with OCD, because death itself is ultimately not controllable. Add in the worries and fears about germs and contagion, and OCD can kick back in big-time. Try to self-soothe, suggests Rando, by telling yourself, “This is creating anxiety in everyone. I’ve had these feelings and behaviors before, they may increase right now, but I can find ways to manage that.”

Those with OCD may also be soothed by the kinds of mindfulness that McGee suggests, which emphasizes that “the universe is perfectly imperfect. There is a hidden harmony of chaos and order that’s going on, and it’s all part of nature. Only from our ego point of view is this situation bad, for instance—from the virus’s point of view, it’s great.”

It’s especially important for people with OCD to keep their intake of media down, because the constant advice and scary headlines can make their anxiety spiral. In some ways, it may be a relief that everyone is having to exhibit what might previously have looked like compulsive actions, so someone with OCD may feel that the world is “catching up”—as long as they stick to the recommended behaviors, and not beyond.

Post-Traumatic Stress Disorder

Many people associate PTSD with soldiers returning from the front lines, but it can result from other traumatic experiences, such as domestic violence, rape, or a bad accident. PTSD is a form of getting “stuck” in the experience, experiencing nightmares, flashbacks, emotional detachment, and feelings of hopelessness. It’s what many healthcare workers described, especially as hospitals fill up and no proven treatment is available.

Coping with Grief and PTSD:

The sudden death of a loved one is considered one type of event that can lead to PTSD to begin with, so going through a loss when you already have the disorder can be especially overwhelming—like layering trauma upon trauma. “Losses are well-known to trigger other losses and traumas from the past,” says Rando. “People aren’t just dealing with the loss at hand. It could be other deaths, other abandonments.”

The key for someone dealing with PTSD, she says, is to recognize this connection: that they’re reacting not just to what’s going on now, but what went on in the past, and separate that out from the current situation. “Remind yourself, ‘I do have resources now. I’m no longer the 20-year-old I was when that happened. I’m going to find a way to access resources and move forward.’ Just because something gets triggered doesn’t mean it has to take over where you are now.” Then use the tactics that are helpful with grief in general, no matter your underlying condition: exercise, prioritize sleep, reach out to others, distract yourself, realize that this is a process that will take time, but that it will get better.

With a death toll that’s ticking up every night on Worldometer.com and shouting out from the top of every article and news segment, it’s really no wonder we’re all feeling that collective sense of grief. We’re mourning for the people those numbers represent, of course, but we’re mourning for what it means to our normal routines and our future too.

Schizophrenia

People with this brain and behavioral disorder may have trouble separating reality from fantasy, may have delusions and hear voices, and have difficulty organizing or expressing their thoughts and emotions. Often both chronic and acute symptoms recur throughout a person’s life, although new medications are helping more people with schizophrenia function.

Coping with Grief and Schizophrenia:

A major stressor, such as the death of a loved one, can sometimes prompt a short-term occurrence of schizophrenia called Brief Psychotic Disorder—so it’s not surprising that there is a powerful connection between grief or loss and increased symptoms of schizophrenia. “People with schizophrenia on average are a bit lower-functioning than people with bipolar, and on average tend to have smaller support networks, often because of the impairment of the disease,” says McIntyre. So being hit with the disorientations of a pandemic along with a major loss is a powerful destabilizer. Another issue: The health-care system in general is overloaded right now, and for schizophrenics, “to a large extent the health-care system often is their social network and is critical to their ongoing maintenance of their function.”

The most important thing for someone with schizophrenia and coping with grief to do, says McIntyre, is to stay in touch with their care provider—by tele-medicine if necessary and possible—and to make sure they’re keeping up with their medications. Also, suicide risk is much higher for schizophrenics than for the general population, at the same time that we’re seeing an increase in suicide rates due to various aspects of the pandemic. “People need to have a very low threshold for reaching out to their care providers,” says McIntyre. “ERs are still open, and we’re concerned that people won’t utilize health care right now. So, don’t hesitate.”

Substance-Abuse Disorder

This umbrella covers abuse of various substances, including alcohol and drugs like opioids, and also covers a range of symptoms from mild to severe. Generally, the disorder is defined using three criteria: needing more of the substance over time to achieve the same effect, withdrawal symptoms when stopping use, and being unable to quit even if you know you have a problem. It also often overlaps with other mental illness like anxiety, depression, and bipolar disorder.

Coping with Grief and Substance-Abuse Disorder:

“The situation we’re all living through is ripe for substance abuse,” says Rando. “It’s understandable—you want to step back, chill, reduce anxiety, calm down.” And in fact, alcohol consumption has significantly increased in the general population in the past two months. But even for someone who doesn’t have a disorder around something like alcohol, using it to cope can backfire, she adds. “It may calm you down for a few hours, but then it raises your level of anxiety again. That’s why it’s common to wake up at night after you’ve been drinking, feeling even more anxious or depressed.” Alcohol, along with other drugs, is also classified as a depressant, so it can worsen feelings of depression.

Alcohol is also how many people have traditionally tried to blunt their grief, so the combination of loss and lockdown is especially challenging for someone who has abused substances in the past. Suffering a loss can seem for some like a threat to their abstinence, but many who have gone through getting sober have amassed great resources—and this is the time to use them. Reach out whenever you’re tempted, whether it’s to a sponsor, a therapist, or an understanding friend or relative, and talk it through. Reactivate the cognitive approaches that have worked before: picturing how giving in will only make you feel worse and put you back on that treadmill, and how good you will feel staying sober. Take breaks from your grief, as Rando suggests, to distract yourself and feel some pleasure, whether it’s self-care like a hot bath or a social connection.

 Looking for Help?

There are tons of resources to help get through this:

Suicide rates could also rise, so it’s more important than ever for everyone to recognize the signs and to know the lifeline number: 800-273-8255.

Last Updated: Aug 13, 2020