COVID-19 will be a defining moment in our lives. We have all been affected differently in this crisis-some more directly than others-but one thing we share is the multitude of emotions that come with physical isolation and the threat of a very serious pandemic. For many of us, these emotions can be explained and normalized through an exploration of grief.
Five Stages of Grief by Kubler-Ross
Years ago in nursing school I remember learning about the five stages of grief as outlined by Elisabeth Kubler-Ross in the 1960’s. They are described as a cycle, often taking the following order:
· Denial- includes feelings of shock, numbness, fear
· Anger- at self, a person, group, or a higher spirit
· Bargaining- “what if...” and “if only…” Feelings of guilt
· Depression- deep sadness and withdrawal
· Acceptance- coming to terms with a new normal
In the mainstream medical world we mainly talk about and honor these emotional phases when working in hospice or end-of-life care. Other than that, culturally we tend to be rather uncomfortable with grief and often choose to endure it alone or expect that we just need to “be strong” and get over it. We also tend to associate “grief” with sadness and depression alone, disregarding that one’s feelings of anger, denial, or bargaining actually may be part of the process instead of an emotion to feel ashamed of.
Chinese Medicine: Cycles and the Lungs
As I started on the journey to learn Chinese Medicine, I found deeper meaning and importance to the grief cycle. This greater understanding has been valuable to me in my work with cancer patients as grief is such a common experience for both patients and also their family.
Chinese medicine sees the physical body as inseparable from the mind and spirit. Emotions are associated with physical organ systems and have the ability to flow in harmony with the body or to stagnate and cause disharmony and even disease.
In addition, instead of viewing the world in linear fashion, Chinese medicine takes a much more cyclical view in alignment with the natural world and the cycles of yin and yang, expansion and contraction. The seasons in a year are a good example. Winter is seen as the point of deepest contraction or yin with shorter days and cold temperatures. As spring comes and plants burst forth from the earth and the days start to lengthen, we move outward into expansion. Summer is the season of full expansion or yang with long days, warm weather, and blossoming and fruiting plants. Fall is the season where we start contraction again, moving back towards winter with leaves falling off the trees and days becoming shorter.
We see a similar pattern of expansion and contraction within a lifetime, the moon cycle in a month, and the sun cycle in a day. Things big and small can be seen to reflect this. Below is one way we look at expansion and contraction of yin and yang, and a parallel to how we often see the five stages of grief illustrated. It is clear in a Chinese medicine perspective that the five stages can be seen as another cycle of expansion and contraction within an emotional experience of grief and loss.
Grief in Chinese medicine is often associated with the Lung organ system. While grief is a natural and appropriate feeling when experiencing loss, if we also do not embody the strength of the paired organ the Large Intestine, and its ability to let go, we may become stuck in a pattern of grief leading to physical weakness in the Lung organ and its functions including immunity. The Lungs are also an important rhythm keeper in the body, ensuring that the breath, heartbeat, and other regular body functions continue to stay on time. Furthermore, COVID-19 and the subsequent inflammatory response in the body can severely impact the lungs. All of these factors make it even more important to support the Lungs through the rhythmic cycle of grief.
COVID-19 and Grieving
As we continue on this new journey of lockdown, there are many reasons you may be experiencing grief. There is certainly the loss of activities, travel plans, work, financial security, school, and time with friends and loved ones. There is the anticipatory grief when we think about the possibility of losing a friend of loved one to the disease or the concern for the economic impact on our futures. There is also the feeling of collective grief as we hear about the tremendous loss of life throughout the world and the extreme conditions many front-line health care providers are encountering.
From my personal experience, I feel like I have been constantly feeling the 5 stages of grief; I can see how they have manifested for me in a greater sense over the last month, but also in the course of a day. While I generally have been feeling more acceptance recently, I also feel I can wake up with that feeling then read a new article or hear of another cancellation and go through the emotions all over again.
How to Find Expansion
What makes this time even more challenging is that it is all happening during spring. In the cycle of the year, this is a time of energetic expansion. Our instinct is to come out of winter contraction, get outside, make plans and socialize. There is a buzzing and excitement in spring as the world warms up, the days get longer, and we anticipate the season of full expansion in the summer. With social distancing orders in place, many of our usual avenues to expand have been squandered and we are feeling the loss.
What can we do? We need to connect with this energetic expansion in ways that may not be our norm. We have a golden opportunity with the current forced pause in our lives and it’s not that we need to use our time to learn a new skill or be productive! We need to tend to our emotional selves and find movement from grief by reconnecting with the world around us.
· Get outside- while abiding social distancing rules (alone or with you household, 6 ft apart, etc) you can still be outside during this crisis. This is an important time of year to feel the sun on your skin and the wind in your hair. If you can, exercise outside everyday by walking, running, or biking. Try to wake earlier with the sun and enjoy a cup of tea or coffee either outside or by a window and use all of your senses to savor the early morning sun and the return of spring. If you are feeling a loss of connection to other people, work on finding a new stronger connection to nature- you will be rewarded!
· Connect with people- finding a deeper connection to the natural world can be profound as discussed above. But we can still find connection with our friends and loved ones even if it’s a little outside the box. Try to make more time to put down screens and share quality time with the ones in your home. Schedule video chats with friends and family so you can still have that happy hour or other missed social time. “Walk” with a friend where you both plan to walk at a certain time and talk on the phone while you do it. One thing we’ve been doing with our daughter is writing more letters to her friends- she has so much fun with it and then feels so loved when she gets a letter in return.
· Breathe- now is the time to incorporate deep breathing exercises into your life. Whether it’s via YouTube yoga videos, meditation, or just increased consciousness of your breath several times a day, you will support both your energetic and physical Lung system for health.
· Focus on optimizing your physical cycles- to better move through emotional cycles, we must also be flowing through our physical cycles. In Chinese Medicine we always ask about your sleep, appetite, thirst, bowel movements and for women, your menstrual cycle. Why? If one of these areas is out of balance, we will have trouble treating whatever else you may be coming in for. Supporting these daily rhythms also supports your Lung and Large Intestine organ systems which are important in your ability to flow through grief. This is a great time to focus on getting a lot of sleep, eating well, and hydrating. If you are still having trouble with any of these cycles, reach out to your acupuncturist or naturopath for a virtual or in office visit. Herbal medicine and acupuncture can be really helpful.
Finding Meaning
More recently it has been discussed that there is a sixth stage of grief: finding meaning. I see this all the time with my patients who are going through cancer treatment. Even those who are medically “cured” at the end of treatment still go through the grief cycle as they process the loss of their life before cancer. They often struggle emotionally after treatment, but with guidance and self-care many of them find transformation through this process. Time and time again I’ve seen clients make significant changes in their lives for the better. Some may start exercising to reduce their risk of cancer recurrence, find they love it and then start to volunteer teaching exercise classes to inspire other cancer patients. Some may realize they are unhappy in working their very stressful job and change careers allowing them to spend more quality time with their family. In all of these cases, they are finding new meaning after grief and begin to thrive from it, even if they are still dealing with physical issues from their cancer or treatment.
I think we have tremendous opportunity to transform from the challenging collective experience of COVID-19. We don’t have to use our time productively to prove something right now. Own your emotions, let yourself move through the stages and then move through them again (and again!) without judgement. Support yourself and find connection to the earth and to your loved ones in whatever way you can and explore the energetic expansion of spring in a way you haven’t been able to before. Breathe, and take care of your body.
Even though there is a long road ahead of us and most of our lives will never completely return to how they were before COVID-19, if we honor our grief hopefully we can find acceptance. If we choose to do this consciously and in connection with nature and others, I think we can also find more meaning in our lives and hopefully have a collective transformation of our culture for the better.
Carli Gaines, RN, LAc