COVID-19 and Disenfranchised Grief.

Abstract

Although death is an inherent part of life, for many it is a terrifying event, which awareness is often to be avoided at all costs (1). However, with the daily updates of COVID-19 cases and deaths, the confrontation with human mortality and physical fragility is unavoidable. Over 100 million confirmed cases and over 2 million confirmed deaths worldwide have been recorded (2). The COVID-19 pandemic is a health crisis unprecedented in contemporary history. Furthermore, an estimate of 9 bereaved family members results from each COVID-19 death (3). Recent evidence indicates that, due to the circumstances in which deaths in the COVID era occur—unexpected and shocking deaths, social distancing, restrictions in visits in healthcare facilities and in funerals—another epidemic is on the rise: prolonged grief disorder (PGD) [e.g., (4)]. PGD is characterized by persistent and pervasive longing for, or preoccupation with the lost one, as well as severe emotional pain (such as, guilt, anger, or sadness), difficulty accepting the death, emotional numbness, a sense that a part of them has been lost, an inability to experience positive mood and difficulty participating in social activities (International Classification of Diseases-11, (5)). With each death that occurs, there are loved ones who will be deeply impacted by the loss, particularly at a time when, due to sanitary restrictions, they may experience limited autonomy, and resourcefulness when coping with their grief. The awareness of these limitations heighten the risk of grievers experiencing their grief as disenfranchised to a degree. Kenneth Doka first formally introduced the notion of disenfranchised grief in 1989 and defined it as the process in which the loss is felt as not being “openly acknowledged, socially validated, or publicly mourned” (1989, p. xv). This experience of grief might pose difficulties in terms of emotional processing and expression, as one may not recognize his/her right to grieve, and in terms of social support, by diminishing the opportunity to freely express their emotions, and to obtain expressions of compassion and support (6). Given the challenges that the disenfranchisement of grief might add to the bereavement experience, it is important to reflect on the risk for this experience in the context of the COVID-19 circumstances. In this opinion paper we aim to frame this in light of the felt limitations in autonomy and resourcefulness in the COVID-19 bereaved, either imposed externally, or internally (self-disenfranchisement).