We have become familiar with the three phases of our response to Covid-19: containment, delay and mitigation. Many of us are also familiar with Dr Elisabeth Kubler-Ross's stages of grief: denial, anger, bargaining, depression and acceptance. There is an important distinction between the two. The first is linear, the second is not. We know that we have now moved into the delay phase in our response to the virus. The hope is that we will stay in it as long as possible before moving to mitigation.
Despite all the pleas, some people remain firmly stuck in the denial stage. "It won't happen to me" is a view that used to be seen as typical of many adolescents, resulting in frightening and risky behaviours. Sadly, we know adults of all ages somehow believe they can behave however they want without considering the serious and maybe fatal consequences. Denial can be an important and healthy mechanism, protecting us when reality is just too difficult to take in. Getting stuck in the denial phase is dangerous.
We don't want to get stuck in the 'anger phase' either. Nor do we want to avoid it. Anger dealt with well is healthy and essential. Anger bottled up can lead to depression and/or unexpected explosions of temper. The novelty of schools being closed has probably worn off, so children are getting narky. Why wouldn't they? The novelty of working from home has probably worn off too and understandably, lots of adults are getting narky. We know that there will be hundreds of thousands of people who will lose their jobs, with uncertainty as to when and how they will earn again. How could they not feel angry? Yes, we can direct our anger towards the virus, but that is easier said than done. It might not be very satisfying either. So, our anger can leak out to affect people in ways we regret. Covid-19 is not young children's fault, not politicians' fault, and not the fault of people who were in the wrong place at the wrong time and became infected. Getting stuck in the anger phase is dangerous.
Bargaining is something that is so ingrained in our culture we might not realise how skilled we are at it. Parents doing their best to work from home with children who are looking for attention are swiftly becoming experts at it. "If you do this, then I will do that..." may work, but it can also backfire. "But you saidddddddddd...", can become an all too familiar phrase. Bargaining can lead directly back to anger. Denial can become very tempting.
And what about depression? The World Health Organisation describes depression as the leading cause of disability in the world. It has been described as 'the common cold of psychiatry', with one in four people seen as having depression at any one time. We know feelings of depression are normal and appropriate in response to loss. People right across the world right now have lost their work, income, social contacts, freedom and, sadly, people they loved to Covid-19. Just as we might ask, "How could we not feel angry?", we can equally ask, "How could we not feel depressed?" Feeling depressed is understandable and appropriate. However, we don't want to sink into severe depression. It is easier to have depression than we might think. I remember being told at a conference that all that needs to happen to develop it is to stop having fun.
Two definitions of depression I find particularly helpful are 'anger turned inward' and 'a sense of hopelessness about the self, the world and the future'. If we look at depression through the 'bio-psycho-social' lens, we can see how we can each take responsibility for managing our own well-being. Depression can be affected by the use of substances such as caffeine, alcohol, sugar and medication. Insufficient sleep and insufficient exercise can bring us down very quickly. So can isolation, particularly if we experience it as enforced rather than voluntary. The more depressed we feel, the easier it is to start comparing ourselves unfavourably to others and to feel worthless. We do not want to get stuck in the depression stage and there are excellent resources on websites such as aware.ie, hse.ie and beyondblue.org.au to help us prevent that.
Kubler-Ross's fifth stage is acceptance. This has been perceived by some as 'giving up', which is different. Acceptance of the reality of Covid-19 and the measures we each need to take to deal with it is essential.
We don't suddenly reach the acceptance stage and stay there. We may be accepting and then slip into the other stages of denial, anger, bargaining or depression in any particular order.
The reality of Covid-19 is unsettling. What comes after mitigation? What would it be like if we knew that there is a fourth phase that we are not yet aware of? A stage we could call recovery? Recovery will be different for each of us. As part of this recovery phase, we will move back and forth between Kubler-Ross's five stages of denial, anger, bargaining, depression and acceptance. David Kessler co-authored two books with Dr Kubler-Ross and his most recent book is 'Finding Meaning: The Sixth Stage of Grief', (Scribner, 2019). 'Finding meaning' will become an important part of the recovery phase of Covid-19.
What would it be like if we could find meaning in what we are doing right now? Whether we are self-isolating, social distancing or continuing to work outside our homes, what we are doing has meaning for others as well as for ourselves. If you struggle staying at home, please think of the people who are safe because of you. If you are venturing outside to support others and are feeling tired and maybe a bit hopeless, please think of the people who are safe because of you.