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The Human Mind’s Response to the Coronavirus Pandemic — The Five Stages of Grief

Since its emergence at the end of last year, the Coronavirus has been continuously at the forefront of our consciousness and mind space. Reflecting on its impact on our collective psyche, it struck me that our psychological response to this microbe and its effects parallels what the eminent psychologist Elizabeth Kubler-Ross in the late 1960s described as the Five Stages of Grief, in her classic book “On Death and Dying”.

Read on and see if you agree with me.

Kubler-Ross’ five stages are as follows:

1. Denial — Be it at an individual or a national level, or moving from country to country as the virus spread across the world, denial was the predominant reaction at the beginning of the pandemic. In essence, it translated to a feeling of “it can’t be as bad as they’re making it out to be” coupled with “it can’t affect me/us”. This response has unfortunately led, in some countries, to delays in implementing lockdowns and social distancing measures, often with deleterious consequences, as we have seen. At an individual level we have seen this in the form of people continuing to socialize in large groups despite clear directives for social distancing.

2. Anger — The second dominant response has been anger (with its associated manifestation of blame). This was directed towards whoever was considered to be “responsible” for the origin and/or spread of the virus. The earliest target was China, more specifically its wet markets. This was followed swiftly by the WHO being held accountable for covering up Chinese lapses and for not issuing firm warnings early enough. Further, depending on the country, various minorities have been singled out for their perceived role in spreading the virus.

3. Bargaining — In the Kubler-Ross model this involves trying to negotiate with reality or to find positives in an otherwise negative situation. In a variation of this bargaining response, in India, there were hopes that the pandemic would bypass the region altogether or else manifest in a muted form, due to tropical heat, the ubiquitous use of the BCG vaccine, or the fact that malaria is endemic and that the chloroquine treatment is cross-preventive. All of these still remain at the time of writing, of questionable benefit. On another level, as the lockdowns took effect, pollution levels dropped and people began to rediscover themselves and their families and to recognize the positives in the situation. This response, a form of negotiation with the inner spirit, is also a manifestation of this phase.

4. Depression — By far the most concerning psychological response to the COVID-19 pandemic has been depression, stimulated in turn by loneliness and isolation. These are inevitable in an environment where social distancing and quarantine are crucial in preventing the spread of infection. Other Mental health issues are also prone to emerge at this time. These include anxiety, panic attacks, paranoia, hysteria and an overall sense of helplessness in dealing with danger and uncertainty. This is the primary reason why mental health counseling services are of such a necessity at this time.

5. Acceptance — In the Kubler-Ross model this phase consists of an individual exploring options and defining a new plan to cope i.e. moving on. Collectively this is the most productive phase of the response and one that we are just beginning to experience in May 2020. Essentially, this stage comes at the end of the lockdown as life begins to return to something resembling normal, with the added realization that the virus has not gone away. But that it is possible, necessary and important to adapt to its presence and resume regular activities, while maintaining all necessary precautions. Statements from WHO and healthcare leaders that indicate that the virus will be around for a long time to come have helped guide us into this phase. The change in tone of news reports from the sensationalization of each new reported COVID case to more positive stories of recovery and transformation are also a reflection of the change in collective consciousness. The now-clichéd expression “new normal” is another hallmark of this phase. Fundamentally, this phase establishes that acceptance of the reality of a situation is the key to dealing with it.

Elizabeth Kubler-Ross’ analysis of the five phases of grief/loss was the outcome of her extensive research into the psychology of the dying. What makes this psyche distinctive, and what links it with what we face in the current coronavirus pandemic, is the feeling of being confronted with a possibility of death. However, the primary distinction in the Coronavirus scenario, is that while one must face up to the tragic reality that anyone can potentially be affected and take all recommended precautions The statistics still do favor recovery and survival (excepting those at greatest risk ie people who are of advanced age and with multiple comorbidities). And just recently the news reported the discharge from hospital of a 100-year old Coronavirus survivor in Russia!

And so the lessons that emerge are, first, that we should all understand that psychological manifestations and symptoms are an inevitable accompaniment of the COVID-19 pandemic, and that we need to seek help when necessary.

Second, that the acceptance of reality combined with a positive approach and attitude can help combat the virus. In other words, rather than being fearful, we should aim to be prepared, and to protect ourselves by washing hands regularly, using facemasks, and following social distancing norms.

And finally, we need to remember that hope is, and should be, our dominant emotion as we continue to cope with the Coronavirus.

About the author:

Dr Arjun Kalyanpur is the CEO and Chief Radiologist at Teleradiology Solutions. He is an American Board-Certified and Fellowship trained Radiologist, and a prolific advocate of AI in Radiology. He is co-founder of the Telerad Foundation that provides teleradiology services to remote areas in Asia that do not have access to high quality medical care. He was honoured with the ‘Healthcare Entrepreneur of the Year’ award by Frost & Sullivan in 2015.

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