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Lucy Hooberman: The frontline of grief

Friday 12 March 2021

My personal experience of bereavement trauma and academic work on PTSD tell me how much work lies ahead. Let’s come together on 23 March to reflect on those we have lost to Covid


We’re into the anniversaries now. The anniversary of the outbreak in Wuhan, the first World Health Organisation emergency warning, the plight of Cremona in northern Italy, the first death in the UK, and now the anniversary of the first day of the first UK lockdown on 23 March. 

This, though, is not like Hillsborough or the Manchester bombings, 7/7 or the Asian tsunami. The impact is broader, more dispersed, shared on a global scale but bespoke in personal consequence. Whilst we know now that we are all truly in this one together, the myth of the virus as a leveller has been busted. Our myriad individual experiences of Covid-19 have revealed a nest of structural inequalities. 

When it comes to bereavement, on the other hand, you might expect us all to be on the same playing field of life experience. Yet that, too, is a myth.

Anniversaries are much loved in journalism as portals into the past. What will we get on the first anniversary of the first lockdown? A balance sheet reflecting the lives lost and the cost of the lockdowns against the supposed “world-beating” success of test-and-trace and the undoubted achievement of vaccine roll-out? A dashboard that, at time of writing, tells of the 117,799,584 cases worldwide and the 2,615,018 deaths? 

But wait: aren’t we supposed to be on the “runway” or “flightpath” to recovery now? Shouldn’t we just emerge into the spring, pick ourselves up and move on?

Last May I fell through my own, rather different anniversary portal. Waking suddenly in the middle of a Sunday night, pulled from sleep by my dreaming brain, crying, producing the tears that roused me. It may not sound like much in prose, but it felt like my body saving me from drowning in tears. 

Luckily, my waking self knew soon enough that I was experiencing something I had experienced before. My body was literally doing this to me, again. “The task is not done, you can’t postpone it, it has to be done!” – I heard the voice of the therapist who had helped me though historically-diagnosed PTSD, related to an experience ten years before that very night.

I had, I thought, moved on; completed my “task”. I was at peace with the story of my mother’s death a decade before, or so I believed. Was it just the fact of the tenth anniversary which conjured up the flashbacks? 

At any rate: it didn’t take a huge leap of imagination to extrapolate from my own predicament to the enormity of the situation we would all be facing. The World Economic Forum called the then state of lockdown “the world’s biggest psychological experiment”, predicting that we would all pay the price three to six months after the lockdown(s) ended. 

They referred to the well-established relationship between physical and psychological trauma in the context of natural disasters or terrorist attacks: in the first tent you tend to the victims, before putting up a second tent to tend to the survivors. 

Yet, even as the emergency tents were going up in Central Park last April to contain and treat a deadly and contagious virus, there was no secondary tent to prepare and treat relatives, emergency and healthcare workers for the shock and fear they were feeling; to hold out a helping hand.

The pandemic feels like a natural disaster out of the blue – even though there had been so very many warnings of its arrival since 2005. On the first anniversary of the 2004 tsunami I travelled with UK families whose relatives had died in the crushing of the wave. I took part in the official Thai ceremonies of remembering, and the no-less-official but much less formal British ceremony. 

I read all the notes prepared by the Foreign Office and those, much more detailed, files prepared by the UK police who were leading the body identification process – and were still there, one year on. Still completing the task; getting it done so that families might know something. 

I spoke to family members and consular staff who had all cancelled their Christmas to support the clear up and rescue operation. But what has never left me, were the tearing-up eyes of the senior police officer from the West Midlands police force who shared a little, sparing us from the visceral detail, of his experiences whilst showing us around their makeshift, temporary but still standing morgue. 

He had not gone on rotation with the other staff. He had not had a break for a year. It was clear to me that nobody had attended to his psychological needs even though the Red Cross was on site. Perhaps the particularly tough reputation of his particular force held him back from seeking help; perhaps it was not easy back then to ask for help. But just listening seemed to be an act of witnessing shared, so to speak. 

In 2020, some did start to predict a symmetrical “tsunami” of mental health problems that would follow the physical, mortal toll of the pandemic. Neil Greenberg, professor of military defence health at King’s College London, called for practices and procedures to be put in place to support NHS and other frontline staff, and to help them process what they were seeing and having to do at the time. 

A minor flurry of research papers addressed the question of how to support bereaved people – drawing upon the lessons of the consequences of natural disasters, the nearest approximation they had to hand of what lay ahead – in a context where deaths were mounting up at horrific scale, and suddenly, and relatives were powerless to intervene. 

Another looked at the lessons of previous pandemics. An American paper even produced a “bereavement multiplier” to calculate best the scale of the potential problem. Their conclusion was that for every person who died, there would be nine bereaved – and that calculation was conservative, based on very tight kinship groups. Other research suggested that the very process of grieving had become more complicated during the pandemic. 

Consider how many people are in the frame, and what they have already been through. Self-evidently, it will not only be the global force of frontline staff who will feel the effects of their service when the initial intensity of the crisis subsides. Their relatives, lockdowned, separated from them, and no doubt feeling powerless, will also pay a price. 

Equally, we must consider bereaved families and individuals – hundreds of thousands in total – prevented from being with their loved ones in hospital, or in care homes during the critical stages of the illness and at the time of death; prohibited from mourning fully with others, at a funeral gathering they would normally have lovingly arranged themselves; unable to hold memorial services, or perform funeral rites and rituals in person, and perhaps not feeling able to give full voice to the depth of their own private loss in the context of the global death toll. Pandemic grieving is no ordinary grieving. It is full of potential roadblocks along the way.

Last week, I called Cornelia De La Fosse, the specialist grief therapist who had treated me eight years ago, to catch up with her, and with my former self (she uses the technique known as EMDR – Eye Movement Desensitisation and Reprocessing).  

I mean, who knew you could get full blown PTSD from “complicated grief”, or an “arrested grief cycle”? I certainly didn’t at the time of my mother’s death, in spite of my own academic research in this area. And the field has definitely moved on since I was treated by Cornelia.

“There is more awareness now that it doesn’t always go well,” she acknowledged during our call. She always recognises unresolved grief in a client, she says, “even if someone lost a parent at 18 and they are coming to me at 37, I have to go there with them”. There may have been good reasons for postponing the job of grieving for so long – sometimes because a widow has to bring up small children, sometimes because they simply couldn’t face it. “[But] the task has to be completed for peace,” she says. “People need to have a good story”. What, though, if there isn’t a good story to be had?

Given that, in the West, we mostly don’t wear mourning clothes any longer to show the world that we are grieving – and to request, symbolically, respect and support for that state of being – how do we signal that we might need help?

The anniversary portal opened and swallowed me up last May because, even then, relatively early in the pandemic saga, I felt a profound resonance in the stories of the many who, like me, had been prevented from being with their sick or dying relative, to care for them, to be with them as they died. 

I had made my promise to be there. It’s a sacred promise, even if you have no faith. And if circumstances outside your control prevent you from being there it can lead to terrible feelings of guilt and anger allowing you no peace, or sense of completion. You cannot create a good narrative for yourself about the end of your loved one’s life. A path beckons to deep complications and possibly PTSD.

I can attest to the fact that you don’t have to have been on the frontline – either on the battlefield or in the NHS – to be traumatised. It’s your own frontline. Away from the headlines, the numbers, the dashboard and in your own bubble, trauma is real.

The Collective Psychology project published a prescient paper in May called ‘This Too Will Pass’. It’s a lovely collection of the things we do to move through grief. As they write: “The nature of the crisis goes right to the core of how we live and die as social beings, and forces us to look our unease with death squarely in the face. We are experiencing widespread loss, and this inevitably leads to the need to grieve. As such, we recognise that grieving well and collectively will be essential”

What did I do after the triggering episode passed? Living in lockdown since last March, my options were limited. I have done what I can to spread awareness of the need to share my experiences in moments of reflection, away from the relentless news agenda. 

Surely there were others looking for ways to look back, collectively, on the year we have had living and dying with Covid-19? It was too early for memorials. So I sought to combine my professional and personal research, and contacted a truly world-leading expert on the treatment of trauma and PTSD in the military. 

Professor Albert “Skip” Rizzo, director of the USC Institute for Creative Technologies in California, deploys a combination of virtual reality and cognitive behavioural psychology. He was thinking along the same lines, could see what was coming and was pivoting his own research and successful practice to treat healthcare professionals. 

I also spoke to Professor Neil Greenberg at King’s College London, to my colleague at Warwick University, Alan Chalmers (professor of visualisation), and to our medical school. Could we do the research required to import best practice from the successful treatment of the military to our care of health professionals and ordinary citizens? That remains to be seen, dependent on grant funding and collective will. 

Meanwhile, I was introduced to the National Day of Reflection campaign organised by the charity Marie Curie (supported by the wonderful Forest of Memories project) and started to volunteer behind the scenes. Meeting weekly on Microsoft Teams, and with constant email contact.

I’ve seen the idea blossom from a spoken word poem about grief from last summer to a full-blown campaign with packs for schools and other organisations. So, on 23 March, do join us in a minute’s silence at midday to reflect and connect with one another. Have a look at the series of talks and debates that are being held; add your voice and your actions. Take it from me: it will make you feel better.

A grief curve is not linear. Don’t expect to get through it in chronological order from day one, without the eddies and flows. Waves of grief will cascade over the months and years to come. Don’t expect the government to publish charts about the prevalence of people grieving or to provide an inoculation against pain and anger.

Trauma is like the virus. It can reassert itself if you do not complete the job of work to suppress it, edit it, rescript it, test, trace and isolate it before it takes hold again. It’s not something to do alone. This too will pass, and once the initial work of grief is done the qualities of the memories change slowly but surely into a more peaceful presence inside you – making you you again, and weaving that lost presence into a new relationship with your future.

Professor Lucy Hooberman is Professor of Digital Media & Innovation at Warwick University

Marie Curie National Day of Reflection

Find out more here.

The process of grief

The three stages of grieving according to EMDR therapists:

  1. Avoidance – you can organise the funeral, but you can’t start with the pain of grieving
  2. Confrontation – long to-ing and fro-ing period in which you confront the loss, go through the pain of separation, experience anger, and have to deal with anniversaries
  3. Accommodation – coming to terms with your emotional wounds and a new sense of understanding and healing

What to look out for in yourself or others

“They themselves can often sense if they have difficulties; intrusive images of the deceased, hypervigilance about everyone else’s safety, and avoiding situations, places, or anything to do with the deceased, excessive crying, not being able to talk about it, might need to have external help.” Cornelia de la Fosse, specialist grief therapist

Where to go for help

AtaLoss: bereavement charity offering a range of services