The world has been hit with a plague. COVID-19 has killed so many. At first, these deaths were just anonymous -- people in distant lands. But then the deaths and illness came here. It keeps getting closer. First friends of friends, then friends and coworkers, then family. COVID-19 left a trail of loss as it crept closer and closer. The devastation to our economy. The loss of our income, savings, and retirement. The loss of our friends’ jobs, then family members’, but hopefully not our own. But how can we know for sure? This then disrupts the illusion that our lives are predictable. Now everything is uncertain. This Pandemic has caused a major disruption to our society. It will never be the same. It will change us forever.


COVID-19 has caused the loss of the illusion that our lives are secure. There is an old Jewish proverb, “Man plans and God laughs.” Well, this is now very real. We do not have the same freedoms. We cannot travel or meet in large groups. We can’t go to our social groups or religious sanctuaries. It has highlighted the cracks in our society. We now must look at each other wondering will this person infect me, kill me? The losses are great and very personal. However, as a society, we are grieving these losses.


Each country has different repercussions that are dealt with based on its history and leadership. Similar to individuals, nations are heavily influenced by past coping. The social context is crucial during this pressing time to predict both present behaviors as well as future coping. Awareness allows us to better develop a plan. As for the American experience, we are steeped in individualism and grit. The country’s diversity has unintentionally set the precedent that a crisis is what it takes to develop a sense of community and self-sacrifice. I see the psychological reaction to the COVID-19 Pandemic following the 5 Stages of Grief defined by Elizabeth Kübler-Ross, a Swiss- American psychiatrist. This is how humans cope with loss and grief. During such a changing time full of unknowns, we must go through these stages to process reality and act with resilience.


The first stage is DENIAL. When we hear of a death or other tragic news our automatic reaction is to reject the news by uttering “no!” These words hold much more gravity than we think, as our minds truly do not want to accept the news. Our brains shut down. The shock is overwhelming. We resort to protecting ourselves in a psychic womb while our brains start to function in a more primitive state. This creates numbness as we are in shock. Our brain tries to cope but is shut down. This can take many forms: “I don’t believe this is real,” “It is a hoax,” “It is no big deal; it will just wash over us and be gone,” “It is just like the common cold or at worst the flu.” These are quotes from our national leaders.


Rather than setting the tone towards acceptance and growth, the United States spent at least a month in this stage. We didn’t know what to do because we couldn’t tolerate the news or accept reality-we didn’t want to leave work; we still wanted to go eat out with friends. We denied the truth of the potentially fatal virus and clung onto our usual ways of living for dear life. We wouldn’t wear masks or social distance. We wanted to believe that if we weren’t considered ‘at risk’, it wasn’t a big deal. But the reality is that COVID is traveling in a domino effect, eventually making its way to someone who is at risk. Fortunately, scientists studying the virus gave us the necessary information to better understand the repercussions of the virus. But still, this stage is so primitive that we became stuck. We wouldn’t believe them, or rather, didn’t want to believe them.


Americans finally came to know and understand the very real and potentially fatal virus, and began to determine just how this would affect their lives. Then appeared Stage 2- ANGER. “It’s China’s fault,” “They did it to cause us harm,” “They were so incompetent that they unleashed it from their secret lab.” “The Chinese markets unleashed this plague,” “It’s the news trying to scare us,” “Fake News,” “My political opponents are perpetuating this,” “The government is trying to control me,” “It is a plot by Bill Gates to control us with his vaccine,” “Our political leaders are inept and not protecting us” “Not everyone is at risk for the virus, so why is everyone being punished?”


The mass demonstrations in the US were, in part, an expression of the frustration and anger about being cooped up for months in fear; being taken away from work, social outings, and school-the safety precautions were perceived as punishments. When animals are afraid, they either fight or flee. It is biological, built into our nervous system. We react from a primitive level and our thinking is survival on its most basic level. We think like animals, utilizing not much higher-level thinking and logic. Anger serves a purpose to defend against the feelings of uncertainty and fear. Anger is an action. By being angry you get to leave your feelings of uncertainty and inadequacy for a while. It helps you feel certain, clear, and confident.


However, anger is a defense mechanism masking what our brain registers as threatening. Anger becomes a problem when it is sustained without the use of other positive coping skills. Unmanaged anger can erupt into aggressive behavior against others. In anger, we refuse to wear masks or social distance. I believe that the Black Lives Matter demonstrations and the Government overreach were not just a cause, but also an expression of our pent-up anger over the loss of our freedom. During quarantine, we experienced significant social change. Due to the circumstances of COVID, it was difficult to get out and help make a difference, thus, adding to our anger. National leaders were blaming spikes in COVID cases on the protests and rallies supporting BLM. At this point in time, the virus is forcing us to lose our livelihood. In times of anger, we huddle together in our tribes to get solace and power. We huddle together and look to our leaders to tell us how to cope. But what if those leaders get stuck in this stage? Or use that anger for political gain? Furthermore, how do we handle anger when the source of the emotion is only being exacerbated as the virus becomes more widespread? Understanding the stages of grief will help move past anger.


The third stage is BARGAINING. We test different coping techniques, try to think the dilemma through, and come up with strategies. We believe there must be an answer, which can be positive if you let it be, almost like a sense of hope. In this stage, in the case of COVID- 19, societal bargains were rather depressing: shutting society down, closing the borders, isolation, quarantining, masks in public, social distancing, and waiting on medication and vaccination. These stipulations added to previous feelings of grief: “But I hate masks, they’re so hot!” “I can’t live like this!” What happens then? We go back into the ANGER stage. Some people will ping pong between anger and denial. Some will go back to bargaining and try new coping techniques. But what happens when new attempts don’t work? What if the reality is too big and overwhelming?


We then go into the fourth stage, DEPRESSION. I believe that is where we are heading. This stage can shut our brains down again in a continuous cycle. Our brains make time feel slower; there is a lethargy. We have problems thinking about the future because the reality we are living in does not project a pleasurable future. Thus, we stop planning and live for the moment. Bad decisions can be made as a result because we do not take care of ourselves. We eat poorly, stop exercising, and become self-indulgent. If we cannot handle this stage, we will regress to a previous stage, like DENIAL or ANGER or BARGAINING. If we can grieve and stay with Depression, we can get past it into ACCEPTANCE. So how can depression be helpful in this process? Depression makes you think deeply. You evaluate your life in relation to the loss. What did we do or not do to make it worse? What is the deeper meaning of what we lost? How will live without these things? Depression is a stage of evaluation. If we can grieve and stay with Depression, we can get past it into ACCEPTANCE.


What is ACCEPTANCE in the Age of COVID-19? Realizing that this virus is a reality. Doing what we can to be content with where we are. The results of the pandemic will not just wash over us and go away; rather, our lives are never going to be the same. School, work, restaurants, shops, will be forever changed. Just like when a teen reaches pubescence and has reached their menstruation or beard and muscles. For these reasons, we must create a different vision of our lives. What do we need to learn? What do we need to do to thrive? We must dig deep into ourselves and our neighbors to create a new society. We start to use the highest levels of our brains. If we can work to this stage of acceptance, not only will we better our own lives, we will better society. If not, this virus will crush us. Acceptance allows us to be creative. The old is gone, so what can we create?


What will your new life look like? You can’t resist this new reality. It is not a new normal, because nothing will be normal again. It will be different. Let go of the past. Focus your energies on creating a different self, society, and world. Different relationships, different job functioning, and a different life. Let the old go and create the new; there is no choice. Was this God who sent this plague? Was it nature? Was it because man has changed our world and this is the outcome?


Acceptance is so important and yet so hard to achieve going forward under the ongoing impact of COVID-19. Accepting and not fighting the reality. You try to do this, but encouragement is not enough; depression avoids embracing the enemy and living with that, as it is not something you can get past without deep acceptance. Do not be discouraged by what is not making sense. The COVID-19 pandemic is not marking our end, but rather, kick-starting new beginnings that we must learn to cope with.

Jay 4

Jay D. Tarnow, MD


Diplomate of the American Board of Psychiatry and Neurology
Certified in General Psychiatry and Child and Adolescent Psychiatry
Clinical Associate Professor of Psychiatry Baylor College of Medicine
University of Texas Medical School at Houston

© Tarnow Center for Self-Management 2020