How To Mourn In Times Of Pandemic COVID-19?

The pandemic situation we face is unprecedented. It has changed our way of living and experiencing the world and our way of dying and say farewell to those who die.

Grief is a normal process, product of our ability to bond deeply and have relationships that nourish and enrich us. It is an experience that deserves to be shared, accompanied and sustained by hugs, glances, words of affection and respectful silences.

It is the process that allows us to continue relating to the deceased person in a way that is no longer physical. Grieving in the company of loved ones – if we so wish – allows us not to feel alone in the face of pain.

Allowing us to carry out the process of mourning in times of the COVID 19  pandemic includes additional challenges, since in many places family visits are being restricted, which prevents us from being physically present with someone who is in an end of life process. This measure has been adopted in several countries and in most of our health services.

Each person has a particular way of reacting to a painful or difficult situation that is largely influenced by their personality, coping styles, the relationship with the deceased person and the circumstances of the deceased person’s death.

There are a variety of emotions and questions that appear and stay with us that we need to embrace in a loving way. Grief is part of life and each person will experience various sensations that do not deserve to be treated as pathology. If we are going through a loss, let’s not add more pain to what we already feel, let’s take care of ourselves as a priority. The context requires it.

Most people will carry out a healthy grief process, which will allow them to reach a new way of relating to that person and their physical absence. However, it is estimated that approximately 10% of mourners are at high risk for developing complicated grief reactions that would benefit from the intervention of a mental health professional.

Some possible risk factors that may indicate a troubled mourning process are: having a previous history of mental disorders, perceived or actual lack of social support, sudden or traumatic death, lack of preparation for the event, or deaths in contexts of hospital ICUs.

If we add to this the context of COVID 19, in which there will be many deaths related directly to the pandemic or indirectly due to other pathologies that have seen its management restricted globally – the repercussions in the medium term regarding Mental Health cannot be ignored.

We encounter restricted family visits as a measure to safeguard new infections, as well as mass farewells at the end of life. The high emotional load handled by health personnel can make communication with family members difficult. Funerals are not allowed except for a very limited number of participants, as are other farewell rites.

The social support that is usually present may not be so readily available at the moment or in ways that are not the usual ones. Family members and grieving people may have other stressors. Just turning on the TV can increase our anguish and prevent us from connecting with moments of pain so necessary for the grief to be elaborated.

If you know someone who is going through a painful loss or is your situation, there are red flags that we should be aware of for help:

• The existence of thoughts of death
• Inability to function in different personal and professional roles
• Feeling sad most of the time, with the attending inability to connect with enjoyment, and the life that follows, which in part allow us to balance the pain.
• Use of distraction elements that are harmful, such as increased consumption of alcohol and other substances of problematic use.

If you feel that you are having a hard time dealing with the loss in addition to having to deal with other circumstances, it is time to pause and try to identify what is necessary to continue, even years after the loss.

Psychological therapy can provide you the support required to be able to explore and connect with painful feelings and / or memories, and – if needed – antidepressants can be sometimes indicated to support therapy. On the other hand, certain commonly used tranquilizers can, on the contrary, interfere with the natural grieving process.

Cristina Sade, MD

Psychiatrist

Team Psiquiatras Online

The mental health of our country is suffering. This is probably not news to anyone, but the actual statistics might surprise you. According to the WHO – World Health Organization – 23.2% of Chileans, almost 1 out of every 4 people, have some type of psychiatric condition.

Of countries in the OECD – Organization for Economic Cooperation and Development – Chile ranks second for the highest increase of the suicide rate over the last 15 years. Anxiety disorders, major depression and stress have been steadily and considerably increasing in our population.

Considering all this, the obvious question arises: why don’t people who need it seek professional help? There are many answers to this single question: high costs, low insurance coverage, shortage of specialists in the public system, and the inability to travel sometimes great distances to urban centers. 

Given the dire state of affairs in Chile, it is urgent to increase public spending on Mental Health – which is a mere 2.1% of the overall healthcare budget – and increase the coverage of mental healthcare benefits. But also, for much of the population, one challenge that must also be overcome is that of geographical distances. 

Telemedicine has been one of the greatest recent innovations in medical technology. Indeed the medical field is buzzing with talk about bringing people closer to health, no matter where they are on the planet. 

“Telepsychiatry is one of the four major fields that technology will open in the future of this medical practice, at a level almost as important as the development of psychotropic drugs during the twentieth century,” says The Future of Digital Psychiatry study, published in August 2019 inCurrent Psychiatry Reports.

According to the study, development of telepsychiatry will greatly benefit patients, for instance by facilitating early diagnosis and the creation of personalized treatment plans.

But perhaps most importantly, given the ease of digital communication, telemedicine creates a convenient platform for the specialist to partner with patients and closely follow their treatment.  

Telepsychiatry has already been tested in the northern hemisphere and has demonstrated an efficacy on par with face-to-face consultations, and, furthermore, as this particular specialty in great part relies upon an examination of the patient’s mental state (as opposed to purely physical) it offers a good alternative in cases where time-consuming travel might otherwise prevent a patient from finding adequate care.

For at least a decade telepsychiatry has been used In Spain’s public health system as a tool to diagnose patients, prescribe medication, and conduct psychotherapy. Doctors of Spain’s National Association of Private Psychiatry have affirmed that by adjusting ”…the communicative behavior of the professional and applying the necessary protocols, the patients show great satisfaction throughout their treatment”.

Sometimes cultural influences — such as a lack of emotional education, or the notion that we must “be strong” in the face of adversity — cause many people in our country to ignore or underestimate their mental health problems. Unfortunately, these problems, if not properly treated, will end up affecting our family, work life, and many other aspects of our lives in general.

The main objective of the digital world is, ultimately, to erase the distances that limit interpersonal communication. Being a state-of-the-art tool, we can only expect that the medium will consistently improve thanks to ongoing research.

Telepsychiatry, in the end, is rich with promise for our country. Indeed, Chile’s geography and civic composition concentrates the majority of its medical specialists in urban centers and leaves too many citizens with urgent mental health needs stranded. We can look forward to a time in the not-so-distant future in which telepsychiatry better meets the mental health needs of our population by more easily partnering specialists with those in need.  

FEAR – Get Rid of Fear and Live Well in the Present

Have you ever wondered why you feel fear, why you feel anxiety and cannot get rid of it? The answer may be in your thoughts. As I often remind my patients, our thoughts are the source of our feelings and emotions, and it is from our feelings and emotions that we derive suffering. We are very often attached to our thoughts and the fact that for us they are “right”, we are attached to certain outcomes, or certain way things should be, and when we are disappointed, we tend to find fault in the universe and we tend to have negative and painful emotions, such as anger and fear. 

But, what would happen if you changed your thoughts? Well, your emotions would change as well, since they are a product of your thoughts and your attachment to them. We cannot change our feelings, but we can certainly change our thoughts. 

When we get afraid of something, and the thoughts of that fear are all consuming, we dwell in the fear. The word “dwell” means to inhabit. When we inhabit the house of fear, that is, we dwell on our fears, we cannot inhabit any other place, we cannot inhabit the house of what is, the house of the present, where our happiness can be found. 

When we are fearful, we are not living our lives well in the NOW. Whatever we are afraid of keeps us from enjoying the here and now, it may even keep us from realizing the good that is happening in our present, and so we miss it. 

Happiness is our natural state when we aren’t delving into our thoughts. Fear is the kind of thought that causes us to suffer and fear is born from the attachment we have to certain outcomes in life. 

Now, fears have the ability to become realities, since whatever we think about tends to be our reality. Our brains cannot distinguish between a real threat (say, a lion in the wilderness) and an imagined threat (say, being abducted by aliens). To our brains is all the same, which means that if you dwell in the house of your fear, then that fear IS your reality, even if it hasn’t come to past. Quite often, our fears never actually come true in our lives, but we spend an inordinate amount of energy and large part of our lives worrying about them, instead of living and enjoying the present and what it has to offer. 

Of course, you may be thinking, “but fear is useful too, if we didn’t feel fear of the lion, it would probably eat us!”. And that is true, but once we learn about how dangerous lions are, we will never get too close to one, much less in the savanah. So, when we learn what is dangerous, and learn to avoid it, our thoughts are free to go in a different direction, to take care of other aspects of life. But, when we have a fear, we try to solve it, and that is good, the problem is that we attempt to do that by thinking about our fear over and over again! We are flooded with thoughts of our fear so much so that it becomes our EMOTIONAL reality. 

Our thoughts are powerful, and often they are more powerful that the thing we fear itself! By thinking constantly about our fears, we transform them in our reality, we create a self fulfilling profecy. 

So, what can we do then to find relief from our constant fears? Dr. Robert Puff suggests the following steps:

1. When your fear arises in you, acknowledge that you have that fear. Make it yours and don’t shy away from it. Accept it and do not judge yourself for having it. Forgive yourself for being afraid. Know that it is natural to feel fear and let yourself be. 

2. Think about the scenario that scares you. Is there something you can do to avoid it? Is there something you can do to fix the situation as it stands today? Examine the issue, try to find a solution. Do this efficiently, without dwelling. If there is a solution to your fear, then tackle it with action. 

3. If there is no solution to this fear, if there is nothing you can do to make things better or to avoid that which has you scared, then begin to work on accepting what is. Ask yourself, can you live with that? Can you say you will be ok if that were to happen? Ask yourself, how can you adapt to the situation? How can you accept that this is the way things are going to be now and adapt to it? This is where the real work is, in accepting what is and adapting to it. 

4. Finally, just live well now, love well now. Focus on what is happening right now, on what you can do right now that will soothe your suffering, what would be fun, pleasurable, noble, enriching, that would quiet your mind. 

In the NOW there is no fear, because fear is of the future. Since fears come from our thoughts, once we have done all we can regarding the possibility of our fear coming true, let’s occupy our minds with the NOW, so there will be no room for fear. When our minds are still, there is no fear. Because fears need thoughts as fuel, once we quiet our minds from our intruding thoughts, there will be no fears.