Over the weekend, the surgeon general warned the public that, due to the rising death toll from the coronavirus pandemic, this week would be “the hardest and saddest week of most Americans’ lives,” comparing it to Pearl Harbor and 9/11. And President Donald Trump himself, who has often sought to downplay the danger of the virus, said on Saturday that there will be “a lot of death.” With the number of COVID-19 deaths continuing to creep up, lots of Americans will be grieving in the weeks and months ahead.

On this episode of the podcast Social Distance, Katherine Wells and James Hamblin call Lori Gottlieb, the author of The Atlantic’s weekly “Dear Therapist” column, to answer listeners’ questions about supporting loved ones, dealing with depression, and grieving during the pandemic.

What follows is an edited and condensed transcript of their conversation.

Listen to the episode here:

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Katherine Wells: Lori, we wanted to first just give you our condolences. I know you wrote a column to yourself recently.

Lori Gottlieb: Yeah. In the midst of the coronavirus, my father died, and he did not die of the virus. He had complications from congestive heart failure. We knew that he was going to die in the coming weeks or months, but when somebody dies in the middle of what’s going on in the world right now, it’s a very, very different experience. It’s a very surreal experience, layered on top of an already surreal experience.

I’m Jewish, and we sit shiva, which means for seven days, normally, people would be coming in and out of the house constantly, grieving with you, sitting with you, bringing you food, comforting you, telling stories, sharing memories. It’s a really meaningful part of the grieving process.

And we couldn’t have that, of course. You come back from burying your father, and nobody is there. People FaceTime; people call. But it’s not the same as physical presence.

One of the things that I noticed is that if somebody died of something unrelated to COVID-19, it’s almost like, because everything is surreal for everybody right now, you don’t feel as alone. You feel like, Wow, my world has been shaken up and there’s no normalcy to my life. But there’s no normalcy anywhere. There’s a collective grief. Everybody’s grief is unique to them, but I also feel like there’s also a collective grief that we’re all sharing.

Wells: That was actually something I wanted to ask you—if it’s appropriate to call that feeling grief. What does grief really mean?

Gottlieb: Grief is the pain of loss. And it doesn’t have to be a death. It’s any kind of loss that causes you pain. People are minimizing certain losses because they feel like they aren’t valid. You’re missing your college graduation, for example. That’s a loss, and you grieve that. But it’s not the loss of a life, for example, or the loss of a job. As I always say: There’s no hierarchy of pain. There’s no hierarchy of grief. Grief is grief and loss is loss.

Wells: Why don’t we ask you a couple of questions on behalf of our listeners? We’ve gotten many that we thought you were best suited to answer.

James Hamblin: We have a listener question here, a very thoughtful one:

Hi. I graduated college last May, and I landed an amazing job that I loved, with great people and health care and a living wage. Unfortunately, I was laid off due to COVID. I’ve fallen into an extremely deep depression from this economic downturn and quarantine. And I don’t know what to do about it. And I’m trying to stay mindful, but I guess I’m wondering if there are any ways to stay productive. Does it matter if I’m being productive? Should I just chill out? I just feel so completely lost and directionless and can’t cope with this. It’s not even a real question. I’m just in deep distress.

Gottlieb: It is a real question. I think what she’s asking is how to deal with her depression. One thing she’s trying to do is to try to be productive, because she doesn’t have the job now and she doesn’t quite know what to do with herself.

But being productive is not going to help her manage the underlying loss. We’re going back to grief. This was a huge loss. A lot of our sense of self is tied up in what we’re doing every day. The usual Here’s what I do; here’s who I am. And so all of a sudden, she’s got this big blank every day when she wakes up. What is she going to do?

What I would say to her is that I think she needs to reach out to a therapist. Because I think that this can really spiral downward. Being more productive can help somewhat, but I also feel like she needs to talk to somebody about this loss.

Wells: I do wonder about that question about productivity. I imagine a lot of people who have lost their jobs, even those who maybe wouldn’t say they were feeling depressed, would be at loose ends for how to deal with this open time.

Gottlieb: So let’s say that you aren’t in that deep despair, but you are feeling lost. I think it’s really important to have some sort of routine, and not the routine that you had before. I think a lot of people are trying to replicate that routine, and then they feel like a failure, because you can’t really replicate it.

So I would say, make a sort of coronavirus routine for yourself. Every night, it’s really helpful to sit down before you go to bed, and say, “Here’s what tomorrow is going to look like.”

And I don’t mean overprogram yourself. A lot of people are overprogramming themselves because they’re so afraid of having any length of empty time. Getting dressed and showering are really important. Making your bed is really important. And eat your meals at regular times. Plan one or two things that you want to accomplish the next day. And that’s it. One or two things.

Wells: A listener wrote in concerned about her sister. Her sister lives alone and is prone to depression. She usually deals with it by getting out and doing things but can no longer do that.

Gottlieb: If she could take the sister into her own home, then they are an isolated unit, and they don’t go anywhere. I think we really need to look out for people who are alone during this time. I know a lot of people have taken in people who were living alone so that they don’t have to be alone during this time. And I think that’s a fantastic idea.

Wells: And then the last question for you, Lori. This is from Ashley:

Hi. This morning, my cousin in his early 30s passed away from COVID-19. In addition to the normal grief of something like this, there is an added devastation that we can’t hold a funeral for him in the foreseeable future. It’s extremely painful to think he was alone when he died. And we now can’t come together as a family to mourn him. As the number of COVID-related deaths continues to rise, I’m realizing this is a grim reality that more and more families are going to have to deal with. This is obviously quite macabre, but I’m wondering if you guys can discuss this aspect of the pandemic and how people are dealing with it.

Gottlieb: So, earlier we were talking about what happens when somebody dies and it’s not COVID-related. What so many people are experiencing right now are the COVID-related deaths. I think people feel like they don’t have a way to honor that person.

But on top of that, there’s this feeling that they weren’t there for them. You know, they couldn’t be there in person. So there are a lot of people who feel like, I wasn’t there. I wasn’t there at the most important moment when I needed to be there.

There is an added loss, on top of the loss of not having the person there anymore, of not getting to have some kind of goodbye, and knowing that that’s an opportunity we will never get back. So what do you do with all of that?

I think that part of it has to do with forgiveness. I think sometimes the instinct is to blame oneself: What if I could have done it this way? Or, What if I could have come to the door or the window? Or, What if I could have had them put me on FaceTime in the ICU? Whatever it is.

Everybody did their best. And I want people to remember that this is unprecedented. Everybody was doing the absolute best they could do. And so just forgiveness and a little bit of self-compassion that you did the best you could. I think that focusing on what didn’t happen is simply a way not to focus on the pain of not having the person there. So I would advise people to sit with your grief, not about the guilt and what you did and didn’t do and about how things worked out or didn’t work out. I think it’s more about integrating the loss into your life as opposed to kind of getting through it.

And I would just say the last piece of this is what I wrote for parents in Monday’s column, but I think it applies to everybody: You’re doing great. We’re all doing great under these circumstances. And we’re so concerned about What should I be doing? Should I be doing more? Should I be doing something better? Just the fact that you are waking up and you are listening to this podcast and trying to eat your meals on time and maybe putting on some clothes—you’re doing great.

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