3 minute read

Ah, high school. I’m not sure what your experience was like, but as a shy, awkward thing, I found comfort in my high school’s theatre troupe and Latin club crowds. I relished acting in low budget school plays, competing in city and statewide Latin competitions (I know, nerd alert!), and I even went to a prom or two. While painful and deeply embarrassing at times, my high school years were formative and the connections I made there influenced my next life steps in both purposeful and inexplicable ways.

I invite you to think back to your high school years. Using your imagination, picture the mélange of memories like script in a word document you typed up on your computer screen. Now, carefully highlight each line. Look at you keyboard. Locate your “delete” button. Hit it. And poof. Gone.

How does it feel to see those memories so easily erased? Or worse, what if those memories were never even made in the first place? Generations of teenagers have had several of their growth experiences interrupted by the Covid-19 pandemic.  With the mass cancellation of their proms, plays, and competitions, many feel robbed of their high school experience.

Others still have turned to social media and services like Zoom to maintain some sense of connection and normalcy. While messages to “stay strong and carry on,” flood social media, they only offer temporary relief. In fact, it’s very common for people to hit a breaking point where they simply cannot be strong anymore. It may be helpful to pause and mourn what was hoped for and what could have been when these difficult moments of truth arise, especially for teens and families who have experienced major losses and life derailments.

With so many external stressors going on (e.g., paying bills, keeping a job, battling the virus),  parents and guardians may feel at a loss with their children’s low mood and inflated media use. Underlying symptoms of depression and anxiety that were well-hidden with avoidance activities and the over-scheduled routines of American school children may be rearing their heads full force as we near the anniversary of school shutdowns. How can families approach such big, overwhelming, and uncontrollable events and emotions, especially when the sense of loss might be exacerbated by the very real pain of the death of a loved one?

When I worked in a Women’s Health Clinic as a BHC trainee, I would often use Elizabeth Kübler Ross’ Five Stages of Grief to help patients process various forms of loss. I would print out a worksheet and have them write at least one “I statement” for each stage. For example, for the denial stage, a patient might write, “I cannot believe that I have x diagnosis.” The five stages with brief explanations by Therapist Aid (2013) are as follows:

Denial: Individuals may refuse to accept the fact that a loss has occurred.

Anger: When an individual realized that a loss has occurred, they may be angry at themselves or others.

Bargaining: The individual may try to change or delay their loss.

Depression: The individual has come to recognize that a loss has or will occur. Depression is a precursor to acceptance.

Acceptance: The individual comes to accept their loss.

It’s important to note, that these stages are not linear, and we as complex humans can fluctuate through all of them several times a day and over a lifetime. Not very comforting, I know, but awareness of how one is feeling is an important step.

Fashioning a similar writing exercise around the five stages with the teens and families you work with in your clinics during this pandemic could potentially lead to vulnerable and honest conversations about the expectations they had for themselves and their family this past year. Reflect with them how their lives were utterly changed and normalize the feelings that arise around those changes. Writing and talking through your patient’s stages of grief can help begin a change in perspective. A change that may help raise gratitude for the small accomplishments that being at home can provide, as well as increase their satisfaction level in partaking in activities and events that were withheld for so long (e.g., like finally going out to dance again with one’s friends).

I invite my fellow BHCs to check-in with their adolescent patients and their families. I remember so many of mine were happy to talk to someone other than their family members after being quarantined in one place for so long! Ask them how they are doing amidst so many unanticipated life changes. If they mention feeling depressed or anxious, try this journaling exercise with them. Reflect on which stage of grief they are in.

We have all experienced some kind of alteration due to this pandemic. My patients took  comfort in the fact that they did not have to grieve alone. To my great delight, my discussion of loss with my patients led them to open this discussion with their own families, bringing a little more understanding and compassion to an uncertain time in the world.