Stages of grief in times of COVID-19

When somebody mentions the “stages of grief”, what comes to mind? Is it necessarily death or the loss of a loved one? Is it necessarily tied to losing a person (or perhaps pet), or can it be applicable to inanimate things as well? For example, could it be related to a certain stage in your life with all of its major events and minor moments? A time when you felt like everything was going well and you were in control of your future. A time when you knew who you were.

This is what I wrote 2 years ago, when I first decided to focus my artwork on the topic of grief. Of course, this was long before any of us could have even imagined that some measly 30,000 bases of RNA could bring the world to its knees in the form of a coronavirus pandemic. Now we stare death in the face on a daily basis, with many of us losing family members and friends, and fearing for our own lives.

But even those of us who are lucky enough not to have lost anyone close to us, still feel a huge sense of grief. We grieve for our old life, for how it used to be and how it could have been. We grieve for our jobs, our shattered plans, our old surroundings and many things that we have always taken for granted. Something as simple as being able to see our friends, going out for dinner or taking the kids to the park. Undoubtedly, no one can compare loss of a loved one with daily inconveniences, but nevertheless, we all feel like our lives have been upended and we miss a sense of control.

In 1969, a Swiss-American psychiatrist Elisabeth Kübler-Ross introduced the model of Five Stages of Grief, in which she outlined a series of emotions experienced by terminally ill patients. Since then, this framework has found many more applications, including death of others, divorce, and now loss of life as we know it.

While not everyone goes through all five stages and they do not necessarily come in the same order, for the sake of simplicity we can say that after a traumatic event, the person goes through the following periods.

Denial

As the earliest form of grief, DENIAL allows us to put on the blinders and at least temporarily not face the truth of what happened. It gives us time to get ready for the true emotions that are bubbling below the surface.

A few years ago, as I was mourning my previous season of life, I created “The Void”. While in my earlier pieces I did my best to stay true to scientific form, here I have come to border abstraction.  This piece turns the biology on its head, showing the outline of a cell as an empty black space surrounded by three dimensional structures between the cell dendrites. It represents the emptiness we feel after losing what was dear to us.  After photographing it and playing around with Photoshop, I took it a step further and inserted a photo of a grieving young woman in the center.

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Anger

As we begin to face the facts about the circumstances, ANGER comes to the surface. Although we may be consciously aware of the fact that there is no one to blame, we get angry just to express our feelings of loss. Allowing the ANGER to come to the surface can serve as the beginning of the healing process.

In 2017, news about Hurricane Irma inspired me to create “Abyss”, which has come to represent ANGER. Soon after the passing of Hurricane Irma, it was discovered that certain bodies of water in Florida contained a “brain-eating” microorganism called amoeba. These unicellular microbes can enter the body through the nose and reach the brain within a few days. There, they begin their feast, which in most cases is fatal.

In “Abyss”, the amoeba is viewed from the top, with its “mouth” (represented in green) devouring nerve cells (red).  In a way, this process is similar to a hurricane, which “swallows” everything in its way.  The “mouth” of the amoeba is surrounded by the swirling waters and winds of the hurricane with a vortex force present at both macro and micro scale. ANGER can consume us in a vortex-like manner as we get sucked into a whirlpool of uncontrollable emotions. It is up to us to stop it in time before we cause ourselves any more harm.

Bargaining

At this stage we begin to question what it would take to return everything to the way it was before. What could we do to go back in time and restore the feeling of balance? What would it take to fix the situation now?

Obviously, right now it is close to impossible to return to our old lives. But this is not the time to BARGAIN against the rules of masks and social distancing. We must do whatever is in our power to weather this storm by following all of the necessary precautions to stop the spread of the virus. No negotiations.

Nevertheless, BARGAINING can also be seen as a form of resilience, optimism and persistence. In “Hope”, an eye is positioned inside of an hourglass, below a stream of black sand that represents the bad news and negative emotions that bombard us during a difficult time.  We try to hold on to any thread of optimism, but it is often very difficult to find. The hidden white jewel tucked away inside of the iris represents a glimmer of hope that we can find if we look hard enough.

Depression

After realizing that bargaining did not help, we often fall into the state of DEPRESSION. We experience the deep pain of our loss, feel hopeless and view life as empty and pointless.

When I was in graduate school, I worked on finding a treatment for spinal cord injury, which can happen in a collision accident and result in lifetime paralysis. Such traumatic injury to the central nervous system results in a biochemically inhibitory environment, and presents a serious challenge for neurons that attempt to regenerate. In addition to inhibitory biochemical signals, a physical barrier called a “glial scar” forms at the injury site (in red below). Very few cells succeed in extending their axons beyond the glial scar, but with proper pharmacological treatment it is possible to promote their growth. In contrast to healthy cells, axons that manage to pass the scar show a very distorted or “tortured” morphology (right side of the photo below).

“Tortured” shows a temporal continuum, where the left solid side of the nerve represents intact life before an incident. Once the nerve is crushed, a large inflamed scar forms at the site of injury, as represented by the red cells (astrocytes). We do our best to get through, extending small tips of weak optimism that we have left past the scar. But in the end, these slender processes come out bearing a deformed, tortured morphology showing the permanent damage that they withstood. Nevertheless, they keep moving forward.

Acceptance

There is no defined period of time that it takes to go through the first four stages. We may go through them in a linear fashion or keep circling back. Not everyone may reach the stage of ACCEPTANCE, but those who do, put the past behind them and reach the state of quiet equilibrium.

In “Transformation”, a single neuron is shown to undergo its differentiation process. Over time, it not only acquires a more complex morphology, but also specializes its compartments. This process can be visualized by staining the cell with different markers. While an immature neuron typically shows a uniform distribution of a certain protein (and thereby color), over time these proteins will localize in different areas of the cell and form a gradient.  In “Transformation”, we see a neuron with yellow staining of the cell body that extends into the trunks of its processes. However, as they grow further away from the center, the processes gradually begin to lose the yellow marker and transition to a red one that is necessary for proper functioning of the distal ends. I think that ACCEPTANCE shows a similar phenomenon. We adjust to change and move on, transforming ourselves to fit the circumstances. When the extrinsic world cannot be changed, we have no choice but to change ourselves.

Cells are amazing in how they can adjust to their new environment and do what they can to survive and flourish.  I believe we can learn something from these incredible microscopic structures that constitute our brains and get our lives back on track even in the face of COVID-19 and everything it brings with it.

What do you think?  Can you relate to any of the feelings these images represent?  I would love to hear your stories.