South Africa is currently experiencing significant death and non-death losses, and the immediate implementation of a nationwide COVID-19 bereavement initiative is critical. This is the sentiment of Dr Nelia Drenth, a member of the South African Association of Social Workers in Private Practice and a keynote speaker at the Mental Health & Psychology Conference taking place on 11 June 2021.
“Effective treatment of complicated grief requires awareness, clinical expertise and access to support,” says Drenth. “In South Africa, resources unfortunately are not freely available and grief therapy is not always regarded as essential. It is therefore essential that communities are educated on normal grief and bereavement coping strategies. I have found that once people understand their grief, they are able to manage it.”
Drenth is the author of the thesis: Complicated grief in the South African context – a therapeutic intervention programme. She details that approximately 10-15% of grieving individuals are expected to suffer from complicated grief.
“The term ‘complicated grief’ has been around for quite some time. It is also known as chronic or prolonged grief,” says Drenth. “In simple terms, it’s a term that is used when the pain of loss simply overwhelms the person experiencing grief and they find it impossible to return to their normal daily routine. It is possible for this kind of struggle to endure for years.”
Most bereaved people experience a more gradual recovery over a period of time. This is what is known as normal grief. As frightening as the pain of loss can be, most of us are resilient. We may be shocked, but we still manage to regain the balance. That there is anguish and sadness during bereavement cannot be denied. But there is much more. Our reactions to grief seem designed to help us adapt and accommodate losses relatively quickly so that we are able to go on and live productive lives.
Complicated grief (CG) can be identified by a myriad of symptoms including constant, recurrent and intrusive thoughts of the deceased, a preoccupation with sorrow and excessive bitterness and extreme isolation.
In 2020 and 2021, in the grip of a global pandemic, complicated grief has become a far more prevalent condition. As deaths have occurred during this time, the physical, mental and social consequences of isolation and social distancing may impact the potential for complicated grief.
Under pre-loss circumstances, research shows that family members of people who died in hospital were at higher risk of complicated grief. In one survey, the inability to say goodbye prior to death was significantly associated with complicated grief. Other studies show that severe pre-loss grief symptoms, lower levels of social support, lack of preparation for death and guilt predicted complicated grief conditions, – all relevant factors when facing death in the context of COVID-19.
Says Drenth: “While clinicians should not assume that all patients or family members are experiencing complicated grief now during the height of the COVID-19 pandemic, it is important to understand how current circumstances may set the stage for complicated grief to occur after death.”
It is also important for healthcare workers to be given the tools to deal resiliently with their own circumstances. Published in February on the National Center for Biotechnology Information and entitled: Witnesses and Victims Both: Healthcare Workers and Grief in the Time of COVID-19, the paper states: “In the intensity and pervasiveness of COVID-19, healthcare workers’ (HCW) fears for themselves, their colleagues and their own loved ones are often in conflict with professional commitments. Even at the dawn of promising national and global vaccination programs, significant HCW morbidity and mortality in COVID-19 has already become clear. It continues to grow and these effects will likely last far into the future. Given the risks of complicated grief for HCWs in the setting of COVID-19 deaths, individual HCWs must put every effort into their own preparation for these deaths as well as into their own healthy grieving.”
“A person with complicated grief needs grief therapy, provided by an experienced professional,” says Drenth. “Medication is often needed and it is to the advantage of the grieving person to have a multidisciplinary team on board. It is obvious that a consequence of the current pandemic can add to complications in bereavement which can again lead to complicated grief and it is society’s duty to ensure that people are equipped to manage the impact of the increased deaths experienced by individuals, families and healthcare workers alike.”