When my dad passed away suddenly towards the end of 2019, my family all gathered together under one roof as we went through the awful first weeks that anyone who has been bereaved will know well – organising the funeral, the death admin, letting the many friends and family members know. It is gut-wrenching, exhausting, numbing, awful. But we got through it together – we took a divide-and-conquer approach, with each of us taking on different tasks. One of mine was dealing with the necessary steps to register my dad’s death, which was made more complicated as he had recently had surgery in an attempt to save his life. My mum was in such a state of shock she couldn’t process any information. But part of my job as a counsellor in a major acute hospital is bereavement. So I know these processes well.
As the days and weeks passed, we found that the only way through that sad, dark time was together. We clung to each other, because when someone you love dies the only solace of survival is togetherness with others you love. One of my sisters lives abroad, and eventually the time came when she had to return for work. It was hard for her to be separated from us by distance. We kept up our regular family video calls, but it’s not the same as being physically present with each other. She planned to return in April for my son’s third birthday. But then COVID-19 happened. And lockdown. And none of us could be together.
That has been hard. There is something so vital about physical presence with others when someone you love is gone. The gap they have left is like a void in the world. Connection to others is what keeps you anchored here. And we are physical beings. So much of our communication with each other is non-verbal. So much of the comfort we give each other is not through words. When all connection must be virtual, there is a palpable lessening of solace and comfort. The pain is still raw, but the soothing balm of being with others is not available to us.
I expect there are many people who have experienced something similar in recent months, having lost loved ones from the virus, or the many other causes of death that result in an average of 10-13,000 deaths a week in the UK.1 People who would otherwise be together through one of the most difficult experiences a family goes through – loss of one of their own – have been unable to be with each other.
Kindness and care
My dad’s funeral was a strange day. It was, in many ways, awful. When the hearse pulled up outside our house and I saw his coffin, my stomach plummeted and I felt like I was going to be sick. My youngest sister cried uncontrollably through the burial and I just held her, whispering words I hoped would offer some comfort in her ear. We literally clung to each other.
In other ways, it was a day of love and togetherness. The church was packed. People travelled miles to be with us, to mourn with us, to give thanks for our dad’s rich and varied life. And it helped. It helped to hear the many, many stories of those who had known and loved him. He’d had a whole life before we’d even been born! That day will be etched in my mind for the rest of my life. What mattered was all the people who were there with us, showing us kindness and care, grieving our loss together. I will always remember the hugs, the kind words, the friends who came just to make sure I was OK.
Last year, I worked with a couple whose child had died. When we met for our session the week after the funeral, they reflected that before going through this, they hadn’t realised how important the funeral would be to them, how much of a difference it made to know that their treasured child was cared for by the funeral directors, how going through the funeral ritual was honouring of his infinitely precious little life. What difference could it really make, since nothing could change the fact that he had died, they wondered? It surprised them just how much of a difference it did make – from the compassionate concern of the funeral director as they planned the day, to the service itself, to the people who came to be with them. There is a reason we have funerals – rituals to mark the ending of a loved one’s life. We need them. Humans the world over need to come together in mourning when someone they love dies.
The new normal
But COVID-19 has changed how we hold funeral services. Even at the graveside, we have had to keep our distance and not hug each other. Many people have not even been able to attend the burial of a family member because they live some distance away. We have long known how important funerals are for grief and adjustment to the loss of a loved one. Funeral services are often the process by which the bereaved are able to begin to receive much-needed support from others, to connect and feel less alone in their loss. With evidence of the importance of funerals and rituals for coping with the death of someone we love, the implication is that preventing people from participating and engaging in these rites will detrimentally affect their ability to cope in their grief.2
Funerals are usually just the first step in coping with loss. The hard road that follows is rarely bearable alone. Most people find that as much as going through the funeral ritual is helpful, things feel a lot worse after the funeral is done and life requires us to continue. Many people experience their deepest, most painful and profound feelings of grief between three and 24 months after their loved one has died.3 What helps people through this period, what enables them to cope, is social support from family and friends.4 The support people need is emotional, cognitive and practical, and the evidence is that the majority of people want to receive this support from their friends and families, and only seek the help of professionals when support from their social network is either not available or not sufficient for their needs.4
Although it would be usual for some social support to be in the form of telephone calls and the like, in the normal course of events much support would happen in person. One of the most salient factors for the widowed in particular is loneliness, and loneliness is ameliorated by social contact.5 We know that losing a loved one is one of the most difficult life events many people experience, that the impact of the death of a loved one can be profound, both in terms of mental and physical health.6 We also know that most people find ways to cope through connection to others, through seeking support from family and friends.5 So, what has this meant for the bereaved in recent times, when social distancing and self-isolation have been the status quo? What has it meant for older people who have lost a spouse and are living alone for the first time in their lives, unable to visit their children or grandchildren?
The answer is that grief during this time, like much of what we experienced during the pandemic, has been unprecedented. We, as humans, don’t know how to do grief this way. Our natural impulse is to offer comfort and support to each other, to come together in our grief, to mark and recognise the loss of the precious one who has died.2 We do this by reaching out, hugging each other, visiting the bereaved, cooking for them, holding them while they cry, sitting with them while they remember the person they have lost. We can still offer each other support remotely, but it’s not the same. What we need, more than anything, when someone we love has died, is to not feel alone in the world. And what gives us this more than anything else is the physical presence of someone who cares about us. The thing that we most needed in recent times is the thing we were unable to give or receive. Death is so awful, feels so wrong, because we are not made to be separate. We are made to be together. And this is why we long for togetherness when we grieve.
And how have we, as therapists, worked with the bereaved under lockdown? In some ways, we have been able to do what we’ve always done. We have listened and offered guidance, empathy and understanding. But we have done so remotely, through phone or video calls. Most would not choose to do bereavement work this way. The devastation of grief requires a witness. The bereaved need to be seen as well as heard. They need you to sit with them and not turn away in the face of the abyss, because so many people find it too overwhelming to truly sit with someone who is grieving. Our worst fear is to lose those we love, and to sit with someone for whom this is true means that we face the reality that we will one day sit where they do. So, as therapists, we sit with them, and we don’t turn away. We allow their pain a witness, and we offer them the comfort of human presence as we counsel them.
Are we able to offer this presence remotely? To an extent, yes. We can hold and contain as we listen, as we offer words of comfort and empathise with their pain. But it’s like working with one hand tied behind your back. A colleague spoke of how her client was crying uncontrollably down the phone, and it was so difficult because she couldn’t work out what she was saying. In person, it would have been much easier to understand her words. And even if she hadn’t, she could have conveyed sympathy in her face, in her manner. Another colleague spoke of trying to offer therapy over a video call. The connection cut out just at the point her client started crying, so she missed it and didn’t realise how upset she was once the connection resumed.
I’m not sure I realised the full importance of presence for our clients before lockdown. I’m not sure I realised just how therapeutic being in the same physical space as another can be. In our work at the hospital, we often find that, for parents, we come to represent a connection to their lost child. There is something powerful about the fact that we continue to exist, that they can see us, sit with us, talk to us, even as they can no longer do these things with their lost little one. They no longer see the doctors and nurses who cared for their child; they no longer have the constant hospital visits, but we are still there at the same hospital that became such a significant part of their child’s life story, and so we connect them to that time and place. The connection has pain in it, but it also has deep human resonance.
We know that maintaining a continued emotional bond with a lost loved one is beneficial for coping with loss,7 and we, as therapists, can form part of that connection. It’s why grief therapy often includes encouraging the bereaved to develop post-funeral rituals – acts of remembrance that help them honour the memory of the person who is gone and help them feel connected to them. These can be as simple as visiting the grave, or more involved, such as the family taking part in an activity the lost loved one enjoyed.3
We can still do this work with our clients remotely, help them as they find their way to maintain their connection to the person who has died, but it’s flatter somehow, not as rich. Not only are we not physically present with them in the therapy room; they may not have been able to engage in these rituals with their family and friends. Anniversaries haven’t been marked with others; graves have been visited alone.
How has it been for our clients? I’ve had clients say they would rather wait until they can see someone in person than receive support over the phone, as it makes that much of a difference to them. Pre-pandemic, I suspect many would have been more resilient to remote bereavement work; perhaps some would even have chosen it. The need for connection to others would more easily have been met by friends and family. But in the world we find ourselves in now, the need for the bereaved to experience connection to another person is all the more profound, and their need to be physically present with another person all the more pressing. It’s the difference between listening to a recording of Bach’s St Matthew Passion, or experiencing it live in the Albert Hall.
And for my family? For much of 2020, my mum visited my dad’s grave alone during periods of lockdown. We kept up our regular family video calls, but we couldn’t hug each other. We had friends keeping in touch, supporting us, but was it enough? I’m not yet sure. There was – and still is – so much uncertainty over how long we will need to live and work this way and whether lockdown will repeat again. I wonder what the long-term impact will be on the bereaved? I wonder if there is a different way forward – socially distanced bereavement work? Therapy in face masks? These questions need to be asked and we should take the need for answers seriously.
Next in this issue
1. Deaths registered weekly in England and Wales, provisional. Office for National Statistics, 17 November 2020. https://bit.ly/36Y7YlF
2. Gamino LA, Easterling LW, Stirman LS, Sewell KW. Grief adjustment as influenced by funeral participation and occurrence of adverse funeral events. OMEGA-Journal of Death and Dying 2000; 41(2):79-92.
3. Castle J, Phillips WL. Grief rituals: aspects that facilitate adjustment to bereavement. Journal of Loss and Trauma 2003; 8(1): 41-71.
4. Benkel I, Wijk H, Molander U. Family and friends provide most social support for the bereaved. Palliative Medicine 2009; 23(2): 141-49.
5. Utz RL, Swenson KL, Caserta M, Lund D, de Vries B. Feeling lonely versus being alone: loneliness and social support among recently bereaved persons. Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2014; 69(1): 85-94.
6. Stroebe MS, Folkman S, Hansson RO, Schut H. The prediction of bereavement outcome: development of an integrative risk factor framework. Social Science and Medicine 2006; 63(9):2440-51.
7. Boerner K, Heckhausen J. To have and have not: adaptive bereavement by transforming mental ties to the deceased. Death Studies 2003; 27(3):199-226.