“We’re in this kind of emergency state and everybody’s destabilized,” says clinical psychologist Regina Koepp of the Emory University School of Medicine Department of Psychology and Behavioral Sciences and the Atlanta VA Healthcare System. “It’s really scary, and we’re experiencing loss because we’ve lost our sense of security. And that makes it really tricky. The other thing that makes COVID-19 really tricky is that the destination isn’t clear.” The world is mourning on a wide scale, grieving what we haven’t yet lost. Even if we and our loved ones all make it through okay, there will be enormous loss of life across the country, transforming the makeup of our towns and neighborhoods. And that’s not to mention the loss of routine, economic security, local businesses, and the dozens of other things that once comprised everyday life. We’re collectively experiencing an emotional state called anticipatory grief, where people acutely feel a loss that hasn’t yet occurred, on a global scale. Unlike bereavement, the grieving that follows loss, anticipatory grief lacks a sense of finality. “With anticipatory grief, we’re not anticipating that we’re going to be grieving,” Dr. Koepp says. “We’re in the process of grieving before we actually lose the thing.” Pioneering psychiatrist Erich Lindemann first identified anticipatory grief in the 1940s while studying wives of World War II soldiers who were so certain their husbands would die in combat that they mourned them and moved on while they still lived and no longer loved the men who did return home. Anticipatory grief is common among people whose loved ones have, or who themselves have, a terminal illness, but that’s not the only context in which it’s felt. Susan London, director of social work at the Shore View Nursing and Rehabilitation Center in Brooklyn, New York, said that anticipatory grief and general anxiety have skyrocketed among the center’s patients, families, and staff members since they restricted outside access over concerns about contagion. “A lot of these families have absolutely no reason to believe that there’s anything wrong,” London says, “but because of what they’re anticipating and because of what they think is happening, they’re already creating these scenarios in their head and that will completely ruin their day, their week, their month.” While we tend to think of grief in terms of death, it’s more widespread of an emotional state than that. Grief can bubble up with loss of any form. Dr. Koepp notes that people grieve changes in their lives, from divorce to moving to a new home. Even positive life events, like becoming a parent, can inspire grief, as it entails losing the identity and patterns of behavior to which we’d grown accustomed prior to having children. And Dr. Koepp stresses that grief is messy, unpredictable, and unavoidable, whether we acknowledge it or not. “You don’t get to choose if you’re grieving,” Dr. Koepp says. “If you have a friend who’s going through a major transition, they’re not gonna say, ‘Dude, I’m totally grieving right now. I’m going to do this major shift in my life,’ because we don’t have language for that as a society. They’ll probably say, ‘Dude, I’m so stressed out right now. I don’t really feel like hanging out. I’m drinking too much,’ or whatever it is. But the reality is he’s grieving.” The impact of coronavirus is a natural disaster — except it’s a disaster we’ve never experienced before. And the unknown element of it, per Dr. Koepp, makes the anticipatory grief far more acute. “At least we know when a tornado comes and we know it’s going to be here for 20 minutes or however long it lasts,” she says. “But you know it’s going to come through and it’s going to go away. Or a hurricane is going to come through and it’s going to go away. We have a sense of what that looks like. But we don’t have a sense of what a pandemic looks like at this scale.” Anticipatory grief, like all grief, is unpredictable and varies greatly from person to person. The stages of grief that influential Swiss psychologist Elisabeth Kübler-Ross mapped in her 1969 book, On Death and Dying, are common enough to be plot points on Grey’s Anatomy and The Simpsons. But while the stages of grief are widely known, they’re also widely misunderstood. We think of them as a set sequence, where acceptance follows bargaining and depression, like home plate waiting for a runner to round second and third. But the reality is more chaotic; think of a manic toddler circling bases from all directions, occasionally foraying into the outfield and the pitcher’s mound, collapsing from exhaustion in the home stretch and then returning to first at top speed. “Grieving is messy,” says Dr. Koepp. “It’s very unpredictable. You’d be fine one minute and some artifact or smell or something else reminds you of a memory and then you just get flooded with sadness.” With coronavirus, the threat of infection and illness seems to lurk around every corner of our lives. We feel powerless, and misfortune seems inevitable. The uncertainty and lack of control easily builds into anticipatory grief. “We can’t predict when the nursing home is gonna call, we can’t predict when you’re going to get the next update or who your mother is going to get exposed to or how many times she washed her hands — you don’t have any control over that,” London says. London warns that hyper-awareness of the grim realities of coronavirus can trap people in anticipatory grief. “I think things like ruminating about it is really bad,” she says. “You’ll see that some people with this grief or just the fear of what could be, they will go from person to person and keep repeating how horrible the situation is. And then just the process of reviewing negative information with other people, a lot of the time, it just sticks with them and they can’t move past it. So I think that’s one of the things that you probably want to avoid.” But sticking your head in the sand won’t help anything. Denying the realities of the pandemic puts your physical and mental health at greater risk. “It would help to take the warning seriously and listen to the CDC guidelines,” says Dr. Koepp. “Taking those seriously would be acknowledging that we’re experiencing a big pandemic. If you don’t take it seriously, you might be avoiding the grief process.” London has seen that families who stick to their routines and focus on controlling parts of their life they can control cope better, even when the pandemic is hitting close to home. “I think a lot of people who may have better coping mechanisms, maybe they have other responsibilities in their life,” she says. “They have to work from home. They have to take care of their children. They have enough distractions that they may not be thinking of their ailing loved one all the time.” If you do find yourself locked in a feedback loop of anticipatory grief, small steps can be enough to break the cycle. London recommends starting with simple breathing exercises and seeking out things from your everyday life that provide peace of mind, from reconnecting with friends in conversation or exercising to enjoying a favorite song or show. “You want to try to find a healthy distraction,” she says, “rather than just letting it stick with you.”
