MSU Extension Healthy Relationships

In 1969, Elisabeth Kübler-Ross wrote a book about the five stages of grief: denial, anger, bargaining, depression, and acceptance.  Since then, there have been numerous books and articles written about grief and loss. Everyone grieves in their own way and in their own time.  There is no predictable beginning or ending to the process.

Normally, friends and family have rituals to recognize and ease pain through funerals, wakes, sympathy cards, sharing food and spending time together. During the outbreak of the novel coronavirus, many of these rituals have been prohibited, which can lead to added challenging feelings of distress.

In July 2020, authors Yusen Zhai and Xue Du published a journal article titled Loss and grief amidst COVID-19: A path to adaptation and resilience, which acknowledged that many individuals are experiencing significant losses due to the COVID-19 pandemic. Zhai and Du describe different types of loss and caution that not recognizing and finding ways to cope with the stress of loss can lead to disruptions in physical and mental health. The authors discuss five types of loss:

1. Primary loss, such as the death of a loved one.
2. Secondary loss, which are consequences of primary losses like companionship, intimacy or family status.
3. Multiple losses, such as employment, housing, medical insurance.
4. Stigmatized loss, such as facing shame for contraction and/or transmission of COVID-19.
5. Ambiguous loss, such as separation from family and friends.

Dr. Pauline Boss has spent years studying and writing about family stress. In particular, she has helped to bring the subject of ambiguous loss into forefront of social and emotional health and well-being.  Ambiguous loss is any loss that is unclear and therefore has no closure.  Boss describes it as a problem that comes from a situation, not from your inner self.  The concern is that loss without closure denies the family or individual of social acknowledgement or rituals, such as a funeral and other normal means of coping as described in the Kübler-Ross model. Families and individuals struggle to heal and move forward with their lives when closure or moving forward feels quite uncertain.

There are two type of ambiguous loss:

1. Physical absence with psychological presence (missing, disappeared, kidnapped, military deployment, quarantine due to pandemic).
2. Psychological absence with physical presence (traumatic brain injury, coma, dementia, addiction, autism, depression, Alzheimer’s disease).

Dr. Kathleen Burns-Jager, a counselor with the MSU Employee Assistance Program, notes that some of the losses we are all facing have to do with the interruptions to the family life cycle. This includes the cultural rituals we share during births, deaths, birthdays, holidays, school, vacations, graduations, baby showers, weddings, sporting events and more. Many parents are experiencing a collision of roles, which involves some loss of freedom. Some have had to adjust to working from home, home schooling and continuing to provide all the home maintenance that comes with raising a healthy family (physically, socially, emotionally).

People are experiencing losses and feelings of uncertainty related to the usual structures of their lives that have been shifted or pulled away indefinitely.  Burns-Jager recognizes that part of the problem is that there is not a finite ending to all of this. This can be a source of constant stress. Realizing there will be a new normal, but not knowing what that will be like, or when it will happen makes it hard for people to plan anything or to reassure themselves that things will be okay. It’s important for people to ground themselves in their own resilience and remember to accept what is lost but also to look forward to what is possible.

With all this stress that can build up, it is important to focus on ways to build your resilience to stress. Some strategies include:

• Developing resiliency and find comfort in the ambiguity. Remind yourself that you will get through this.
• Using mindfulness to accepting your feelings as they are, when they come up.
• Finding mastery of the controllable aspects of everyday life, such as cleaning house, cooking, laundry.
• Practicing acceptance and letting go and being comfortable with the imperfection of life. No one expects you to be the perfect parent, spouse, significant other, teen, etc.
• Reaching out to others and finding comfort in community and society. This can be done virtually over the internet, phone calls, and through cards and letters.
• Including daily self-care such as rest, recreation, accepting help, and finding humor in life’s situations.
• Sharing stories, remembering the past, enjoying pleasant memories.
• Concentrating on making new memories. Create new ways to celebrate life's events, through virtual birthdays/baby showers/weddings, celebratory car parades or regular virtual family get-togethers.

Michigan State University Extension offer a variety of online classes to help people improve their resilience to stress, such as RELAX: Alternatives to Anger, Stress Less with Mindfulness and Powerful Tools for Caregivers.