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GREAT MAINTENANCE. Covid-19: how to mourn in times of pandemic?

For over a year, more than 100,000 people have died from Covid-19 in France. Bereaved families were sometimes unable to pay the tribute they would have wished to their loved one, in particular because of the health measures taken to fight the epidemic.

To understand the consequences of this pandemic on the mourning process experienced by those around the victims, franceinfo interviewed Marie-Frédérique Bacqué, professor of clinical psychopathology at the University of Strasbourg, and author of numerous books on mourning.

The psychologist analyzes the particular suffering of people trying to mourn as the crisis continues. She also gives advice that can help you get through this ordeal.

Franceinfo: What are the consequences of the current health situation on the grieving process?

Marie-Frédérique Bacqué: For a year now, the conditions of mourning have been complex for people who have lost a loved one to Covid-19. In the spring of 2020, there were restrictions for these patients then at the end of their life. It was impossible to approach them for fear of contamination. We then extended the measures to all patients at the end of their life, whether or not they were affected by Covid-19. Many people died isolated, alone, subjected to the vagaries of hospital services, even if the nursing staff did their best with patients and families.

Thus, many bereaved people have not been able to see their missing loved one again. The difficulties of bereavement have increased. I am thinking in particular of a young woman from overseas, who was unable to take the plane to go to her mother’s bedside. She could only follow the funeral on a tablet. In terms of expressing suffering, it is hard when it is impossible to be consoled by the presence of loved ones. Fortunately, the restrictions were quickly eased and there was the possibility for the closest members (children, spouses…) to approach the dying.

With health restrictions, funerals remain limited to 30 people. Does this restriction make mourning more difficult?

The possibility of realize the death ofa loved one goes through the testimony of others, who recognize that the death has indeed taken place, then through theidentification: we need sidentify with other people who are there, at a ceremony, a funeral,be surrounded by people who are grieving too. They have gestures, words, attitudes, which will help the grieving person to move forward. It projects itself: “I am going to try in my turn to hold on by identification with the others, because I see that they continue with their life.”

The social group is extremely important to support the bereaved but also to show them how to behave. People have to tell us: “Don’t worry, the ceremony was beautiful, we attended the funeral, it was a beautiful tribute.” VSis a set which certifies that the deceased was treated well and that his destination is well known. The living are embarrassed to lidea that their death might lack something. Smake sure that nis not the case, unconsciously, is very important.

“Being able to travel to accompany the deceased to his final resting place, it helps considerably emotionally to accept death, and, at first, to ensure that the deceased is going to be protected.”

Marie-Frédérique Bacqué, psychologist specializing in bereavement

to franceinfo

With Covid-19, there was a real problem with the rituals that were not performed, when we need to do it in all cultures. People did not see their loved one again, because there was already a limited number of accompanying persons authorized in the hospital. And after death, the funeral remains in a limited circle, gatherings are restricted. However, mourning is a social fact, and it could not be done. The psychological repercussions of this absence of bereavement are more complex.

Does not the difficulty for the bereaved also lie in the fact that their deceased may be in the eyes of others only one dead among many others in this epidemic?

This is a phenomenon that is found in traumatic bereavement, when several people died at the same time in a rather violent way. This is what may have happened during the attacks or in air accidents, for example. If the deceased is not extracted from the group of dead, this mass effect reinforces the impression of violence. The feeling that the loved one is confused in an indeterminate whole is an additional wound. Each victim has a unique, singular and absolutely not interchangeable place.

“There should be national recognition of the victims of Covid-19, but also something that individualizes each death.”

Marie-Frédérique Bacqué, psychologist

to franceinfo

This particular phenomenon was observed in 1995, during the Oklahoma City attack (United States). A far-right man had detonated a vehicle near a federal building and a nursery. There were many babies among the victims. The newspapers then made portraits of each child, which had done a lot of good for the families, helping them to come out of the trauma. It’s hard to imagine and the general public may be shocked, but for those involved, it feels good. With journalists and psychologists, they ask to be expressed. This need to put the unthinkable into words must be understood.

Isn’t it even harder to mourn when the cause of death, the virus, is remembered over and over again?

Obviously this complicates the process, even though we don’t have any data on it. There is a constant reminder of the disease to relatives. The news is bad, many can’t take it anymore, they can’t escape this topic. However, in a period of mourning, people tend to turn away, they want to hear something else, this reinforces the desire for freedom and to escape.

“The opportunity to be entertained is an important element in facilitating this transition back to life.”

Marie-Frédérique Bacqué, psychologist

to franceinfo

One of the stages of grief is realizing that we are leaving the state of sadness, depression, to feel alive again.

Some victims of Covid-19 may have been infected by a member of their entourage. How to manage the possible feeling of guilt, if one is at the origin of this fatal contamination?

It follows the same mechanisms as being responsible for a car accident in which a loved one is killed, for example. It is a typical situation of guilt and responsibility. None of these people wanted to kill their loved one, but the responsibility is undeniable. It is particularly necessary to support these people, within the framework of family intimacy or with a psychologist.

These processes are based on speech, so that the person expresses what he thinks and also what he does not think. People express themselves spontaneously, they let unconscious elements emerge, and among them we can work on elements of guilt, of questioning. Sometimes we manage to overcome it by taking responsibility, asking forgiveness. Ceremonies can also be an opportunity to tell what happened, to publicly acknowledge responsibility, and to be able to integrate it instead of pushing it away, even if the guilt remains present.

Psychologist Marie-Frédérique Bacqué, author of several books on bereavement, gives advice that can help get through this ordeal made even more difficult by the pandemic.  (JESSICA KOMGUEN / FRANCEINFO)

The epidemic has claimed the lives of many elderly people, including many grandparents. How to explain this brutal bereavement to their grandchildren and how to support them?

The important thing is to tell a child the truth. But we have to adjust this truth: we are not going to confront it with morbid details. It is very important to pronounce the word “death”. In the case of Covid-19, the children know very well what it is, they go to school, watch television and hear a lot about the epidemic. It is enough to explain to them, in words appropriate to their age, that their parent or grandparent had this disease. It is then necessary to establish a progressive causality: “Your grandmother couldn’t breathe, so at the hospital they gave her oxygen, but it wasn’t enough.” A child is perfectly capable of understanding all of this.

What is difficult for a child, who still considers the adult as an almighty being, is to see the distress of his parent. Many parents hide to cry in the face of grief, but children see it, feel it. They have no illusions and it is necessary to explain to them that the parent is in a situation of grief, that he is temporarily overwhelmed by the mourning. It is always necessary to put words on things, so that the children understand the reason for the sadness of their parent. They are quite capable of accepting it, of realizing that their parent is feeling a strong emotion.

Are there rites to reinvent to mourn in times of a pandemic?

For the moment, the question of the commemoration of the death of the first victims, who died in March 2020, arises. These birthdays are normally the occasion to have a ceremony. This is the first thing that will help the bereaved, but due to the restrictions, these ceremonies did not really take place and will not be able to take place in the coming weeks. Some of my patients are so demoralized that they no longer have the energy to organize these ceremonies and that is a shame.

“What do you do when you still can’t get together? You have to find substitutes.”

Marie-Frédérique Bacqué, psychologist

to franceinfo

There could be discussions, public messages, to encourage loved ones to do something. The forms that this can take remain to be defined, especially in view of the health context. A mourning aperitif at a distance? Messages left online? Photos, audio messages? These possibilities can be explored by people familiar with digital technology, mainly the younger generations. We do not know if digital technology helps in mourning, but it is an issue that needs to be worked on today.

Do these bereavements made even more difficult by the pandemic risk having long-term psychological consequences?

Yes, it is obvious. For example, when a person has lost both parents in a few days, he has great difficulty, he is very sad, depressed. There are great difficulties for the bereaved. In fact, it is possible that in several years some will develop mental disorders, especially if there is no speech. If people are isolated, if they are not helped by the health network, it is they who will have a hard time. It is in our interest to do prevention to insist that people talk, by phone, by internet … If we go to a professional, things will be fine and we can eliminate the risk of trauma.

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