This May, Damen, a young accountant, began our telehealth session by saying, “I don’t know why I don’t feel like doing anything. But nothing is really wrong.”
Damen had felt lethargic and sad for weeks, and he couldn’t understand why. “With tax season winding down, I should be ready to relax. And the cold weather is behind us,” Damen said.
As he described his confusion over his anhedonia, I recognized that it was precisely because spring was in the air that he was struggling. Last spring, just as Damen’s office was overrun with taxes, his father died of COVID-19. Their family hadn’t been able to be at his hospital bedside. Unable to have a traditional funeral, the family held an online memorial that left Damen feeling “unfinished.”
Damen had believed he’d moved on. He’d told me, “It’s not like I’m the only person who grieved without a normal funeral process.” But I didn’t think his malaise was about the funeral. Damen was re-experiencing grief in a way he didn’t recognize.
Anniversary reactions—feeling grief at the same time of year that we initially experienced a loss—can overcome a person with emotions like sadness, irritation, and anger, and they can interfere with coping with a profound loss. The deaths of beloved family members and friends usually trigger the most powerful anniversary reactions. As those anniversaries arrive, many of us feel like we’re losing our loved ones all over again.
These strong emotional reactions to anniversaries can sneak up on a person in large part because they surface subtly, often outside of awareness, through environmental cues like the slant of the sun, the time of evening dusk, or even the sound of a sportscaster on TV. These environmental triggers are deeply entwined in our memory and the context of our loss. In Damen’s case, I recognized that the warm air, smell of blooming lilacs, and all the tax work had sent him back to the emotions he felt when his father died.
I asked him to trace back and pinpoint when his lethargy set in.
“It started when the weather changed,” he said. He immediately recognized that the time of year correlated with his father’s illness and death.
Once Damen understood he was experiencing an anniversary reaction—mourning, not depression—he was less confused by his mood and was immediately more able to talk about what he was experiencing.
It’s critical for clinicians to recognize anniversary reactions. When clients describe their experiences as depression, we naturally think of solutions like prescribing medication, talking about relationships, or finding ways to raise energy and reframe negative thoughts. But those methods to lift mood won’t be productive when the suffering is mourning. Grief requires a different process than depression: reflecting on the loss, which is real and should be honored as significant.
Given the magnitude of the losses suffered over the last year, and the new possibilities for social gatherings, it’s inevitable that in coming weeks and months most of us will either experience an anniversary reaction or interact with someone who’s grieving. Social isolation magnified the sense of loss for many people in grief. As our world tries to heal from the devastation of the last year, therapists can play in a crucial role in helping our clients address their own and their communities’ losses. I’ve found that people need different types of support for their varied forms of grief:
For those processing an anniversary reaction to a death:
It’s important to tell clients about anniversary reactions. Once Damen saw that he was re-experiencing grief as part of a common phenomenon, it became easier for him to stop judging himself as “weak” or “stuck.” As we talked, he realized how much he loved his father and was a bit surprised at all the ways he missed him.
I suggested that Damen could find a way to honor his memory of his father. One of the most difficult parts of his grief came from not having been able to be with his father during his death or have a wake and funeral.
People are often unsure how to bring their grief into their community after time has elapsed, so I brought up the idea that wakes, sitting shiva, and memorial services are valuable because families and friends can share a sense of community that helps them feel less alone. It can be harder to achieve that connection once time has passed. I told Damen I thought it would be helpful to connect with close friends and family members to discuss his father’s life, and I suggested that he could initiate a gathering or ritual to create an opportunity for the shared grieving and reminiscing that would’ve occurred at a wake.
Damen reached out to his father’s friends, and after talking with them he saw that he shared his loss with a community that cared about him. He wanted to anchor that feeling with something more personal with his sister. Because they could finally be together in person, Damen asked her to join him to create a ritual to mark the anniversary of their father’s death. They each wrote about their positive memories with him and met at their father’s gravesite to read their memories to each other. They left their messages of love wrapped around flowers they left at the site. By initiating these shared remembrances, Damen was able to overcome his feelings of being alone in his grief.
For those experiencing life-changing losses that aren’t deaths:
Anniversary reactions arise in response to many kinds of losses, including miscarriage, job loss, divorce and the end of long-term intimate relationships, moving away from a beloved home, or an unsettled end of an important friendship. When working with clients who’ve faced these losses, therapists may have to point out that their negative emotions could be springing from anniversary reactions. It’s also especially important to reframe their experiences as grief and loss. We therapists often spend time on resolving hurt and anger, and clients may not realize the weight of their grief, which can slow their recovery.
My client Galen told me that she’d been feeling irritable, angry, and anxious. I asked her, as I’d asked Damen, to retrace back to when the change in her mood began. She identified a recent sunny Saturday when she’d cried all day. I asked her if those feelings were familiar, and she connected them to living alone, which was fairly new to her and exacerbated by the isolation of social distancing. She then had the surprised realization that a year earlier her partner had walked out on her on exactly such a sunny weekend morning, leaving her shocked and bereft.
Galen had thought she’d bounced back from the breakup and was unprepared for an anniversary reaction. As often happens when the anniversary connection is made, she better understood the source of her negative emotions, and so she was better able handle her anxiety, focusing on her current ability to function alone and to enjoy her friends and their support.
For those re-connecting with wider social circles after loss:
As many of us re-enter workplaces and social lives, some people may fear re-connecting with wider social circles, especially if they lost a loved one. They may anticipate having to share difficult news, among other challenges. Preparing clients for sharing this information can help them garner support.
My client Carole began seeing me after her daughter’s death by suicide several months into COVID-19 isolation. While her close friends knew about her daughter’s death, many acquaintances did not.
As social events began again this spring, Carole knew she’d have to begin telling people. She belonged to a card club, a group of women she hadn’t seen in a year, and they were scheduling meetings again. Carole knew they’d greet her with “How was your year?” and she dreaded the question.
I asked Carole if she’d want to know that an acquaintance had had a death in the family and if she could handle that information. Her answer was “Absolutely! I want to know, and I can handle knowing.” That helped her see that her card club would share that point of view. I asked her, “What do you think might happen if you tell them? Are you comfortable telling them one at a time, or do you want to tell the group all at once?” We talked through different scenarios and her fears. She was still unsure whether she would tell them and decided to wait to see if it “felt right.”
Carole invited the group to her house. As she anticipated, one of the women immediately asked, “How was your pandemic?”
“Shitty,” Carole replied. She felt frozen inside waiting to see what would happen.
“Why?” someone asked.
Carole took an even bigger leap and told them that her daughter had died by suicide.
Conversation stopped. None of them had had any idea of what Carole had been through.
This group of women, all over 65, immediately put down their cards, asked her about her experience, and offered solace and commiseration. They acknowledged that Carole had had to bear her enormous loss virtually alone and opened the space for her to talk about it. Carole was deeply relieved that she’d told these women and that they’d responded with comfort.
For those who didn’t experience a major loss and want to ask friends, “How are you?”
I can only imagine what the scene in Carole’s living room would’ve looked like if she’d been honest with a group of people with less experience dealing with grief and loss. Acquaintances with fewer life experiences might’ve been left speechless in the face of such raw grief. Carole might’ve been left sitting with her wounds of grief opened and no balm of acceptance and understanding to help her heal them. And a less empathetic group could’ve been uncomfortable for the rest of the gathering, knowing they were avoiding a painful topic dropped like a bomb into what they’d imagined as a fun reunion.
We can all work on being more empathetic toward people who’ve suffered losses, especially this year. As therapists, we can help our clients prepare to encounter people in grief as they re-enter their social lives.
This year of death and loss did not touch everyone the same way. Some of us did not lose a job, relationship, or person close to us. And now, as a year has passed and we greet people in person again, we’ll see people whose parents, spouses and friends have died. In normal times, we would’ve attended services, dropped off food, or expressed condolences in person. But now we may not have interacted with them at all in over a year.
We’d be wise to discuss with our clients the possibility that they will encounter someone in grief. To prepare clients, I discuss with them how to acknowledge a loss. I suggest:
Ask an open question. After initial group greetings, find a moment to converse with the person one-on-one, and prepare to start a conversation with, “I haven’t seen you since your mother died. How are you doing?” That allows your friend the space to talk about it if they want. This open question bridges the gap of seeing someone for the first time and may give an opportunity for the hug that you both missed at the time of the death.
Bring it up. A friend who lost a loved one has not forgotten it. No one forgets the death of a loved one, and their loss is never far from their minds soon after the death, especially near the first anniversary of death. Asking how a friend is faring a year after their dear one has died won’t ruin their day. Instead, it may be a mark of the respect you feel for that friend. I recommend preparing to share a memory of the departed as they talk with the friend in mourning. When people know that others remember their losses and remember their loved one, it helps them grieve.
Send a handwritten note. I recommend sending a card or note to their friend around the anniversary of their loss. A note can be short and simple and say something like, “I’m thinking of you and your family this month, remembering it was about this time last year that you lost your mother.” A message of remembrance is especially important for people who lost loved ones during the pandemic because it can ease the feelings of aloneness they felt during their grief.
Get beyond the Facebook post or text message. When you take the time to write words with your own hand and mail the message, you are sending part of yourself. I urge my clients, especially younger ones, to give that a try. Social media posts or texts are fine for what they are, but they’re not a replacement for the intimacy and connection of a handwritten note.
The suggestions I’ve offered here are simply some of the ways to open the door with clients who are uncomfortable discussing death and loss. When we model comfort in discussing difficult experiences, we help clients find the right tone, language, and attitude to strike in their relationships with others. Amidst the devastation wrought by COVID-19, our ability to model empathy and respect has never been more important.
Margaret Wehrenberg, Psy.D., is a clinical psychologist, author, and international trainer. Margaret blogs on depression and anxiety for Psychology Today. She has written nine books on the topic of managing anxiety depression, and her most recent book is Pandemic Anxiety: Fear. Stress, and Loss in Traumatic Times.
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