What If I am left alone? Addressing the biggest fear in the times of Covid-19 pandemic

Relatives touch each other's hands through a plastic film screen and a glass to avoid contracting Covid-19 in Rome. (Cecilia Fabiano/LaPresse via AP, File)

By Dr Veena Krishnan

Will my loved ones die of COVID-19? Will I be left alone? The biggest fear -the fear of losing loved ones to the coronavirus (COVID-19) infection is no more just a feeling or anxiety. It has become part of reality.

Since the second wave of Covid-19 has hit, we are being struck by enormous anxiety and fear of getting infected, it is increasing our emotional stress. Children are getting infected, isolated and hospitalised, this experience in itself is traumatic enough and to add to this grandparents and parents are getting infected & then losing them by death would be the saddest experience which many of them have faced. Fear, grief and helplessness over losing a parent, being alone in isolation without any support and managing the cremation all of this is significantly overwhelming not only mentally but physically too and is imposing a big challenge for our fragile health system along with our social system.

Significant number of people who have died are in their late thirties leaving behind their bereaved children of all ages. Children have been left alone as their parents were hospitalised or have lost their entire immediate families. They are left to deal with parents incurred medical expenses, most of them are even left to fend for themselves due to stigma & lack of empathy. Some brutal cases have been reported of children being deserted by their fathers after their mothers died of Covid-19.Most of them abused emotionally and sexually. With helplessness overpowering the youth who are struggling to deal with this COVID calamity, this trauma is bound to have a negative impact on their physical, mental and emotional development in the long run.

Last year one child’s father passed away, they were not able to pay the loan instalments to the bank (father had taken to starting a business which again failed due to COVID). He does not know how he will manage as the bank has been harassing them and they fear they might lose their home, which will add to their distress. This year twelve-year-old twins were left behind with a schizophrenic mother to take care of after their fathers passing away while grandfather and uncles had closed their doors to them and in fact declared them out of their will. There are many such heart wrenching stories and what to do for them is a big question.

Research reveals that generally before 18 years of age, normally about 4 % of children are affected by the loss of a parent through death and losing a father is more common than losing a mother which leaves them financially burdened too.

The loss of one or both parents is associated with a high vulnerability for children, both from a short and long-term perspective. Studies have shown an increased risk of mental health problems and threats to emotional well-being for affected children like anxiety, depression and a perceived lack of control over what happens in one’s life. Death of a parent has also been associated with increased somatic symptoms and development of stress sensitivity and is also interconnected to an increased long-term risk of suicide. A child’s problems post bereavement may also appear as concentration difficulties or behavioural problems and delinquency. A longitudinal study by Brent et al. reported that suddenly bereaved youth had lower competence than non-bereaved youth in the areas of work and future education planning.

As it is, the death of a parent is a highly stressful life event for children in any circumstances but losing them suddenly under traumatic conditions of the pandemic is all the more traumatic. It is generally agreed that an anticipated death is easier for children to cope with than sudden loss—just as it is for adults—because forewarning seems to provide an opportunity to prepare cognitively. The children who have experienced this sudden loss can re-experience the traumatic event through intrusive memories, thoughts and feelings which will have long term effects. Changes in the family situation and family roles post bereavement could be another challenge. After the death of a parent, some children live with their surviving parent, while other children live with another person, like a stepmother, stepfather, grandparent, aunt, uncle, sibling, adoptive parent leaving them more vulnerable for abuse of all kinds. Which makes them lose their self-worth if they are made to feel unaccepted and unwanted.

If the surviving parent is unable to process the grief and is struggling with their own sorrow, they may experience psychological difficulties themselves. The parent who is left behind must also deal with additional stressors of being a single parent and the sole provider while the child struggles with his grief. The child then not only takes the brunt of the negative emotions but also feels rejected by the emotionally unavailable parent. This population of children are seen to have attachment issues in their relationships in the long term. Children going through such a phase are in significant need of support, which is seen to be missing during this unfortunate time and insufficient support can be very detrimental.

Helplines like 1098 are being flooded with cries for help, how many actually are getting support and help is very scary and questionable. In many cases, NGOs are helping the government in shifting these children to shelter homes, coming across through WhatsApp, Facebook & other social media platforms requesting people to take custody of children whose parents have passed away. It is not just illegal but dangerous for these children compromising their safety. It could lead to trafficking in the name of help! Lack of awareness on this subject may do more damage. People need to be sensitized to immediately contact child right protection panels.

As per the Childhood Bereavement Estimation Model (CBEM) it is estimated that 1 in 14, will experience the death of a parent before they turn 18. This number will nearly double by the age of 25. This is a real problem for adolescents and young adults. Teenagers’ brains are still developing, and when something as distressing as losing a parent happens it can have major negative effects on their mental health.

Some children can also develop prolonged grief disorder that is persistent and disruptive. Here the child may also experience difficulties in accepting the parent’s death and difficulties in moving on in their own lives. May have feelings of bitterness, and a sense that life is meaningless as part of the detachment syndrome. When a parent dies, the children and the remaining parent/caregiver may need advice and support in their grieving process, so that their mental health needs are met and so that they can continue their development in a positive direction.

More attention and much work needs to be done towards this population by having a proper functional system in place.

When to Seek Professional Help?

As with adults, the distinction between normal and pathologic grieving in children is not always clear.Bowlby’s warning signals regarding bereaved children include:

· The Presence Of Persistent Anxieties (As Fears Of Further Loss Or Fear That They Will Die),

· Hopes Of Reunion And A Desire To Die,

· Persistent Blame And Guilt,

· Patterns Of Over activity With Aggressive And Destructive Outbursts,

· Compulsive Care-Giving And Self-Reliance,

· Euphoria With Depersonalization & Identity crisis,

· Accident Proneness, self-harm, suicidal intent

Raphael categorizes disturbed behaviour was suppressed or inhibited bereavement responses, distorted grief or mourning (grief characterized by extreme guilt or anger), and chronic grief being manifested by acting out.

Unwillingness to speak of the deceased parent, expression of only positive or only negative feelings about the deceased, exaggerated clinging to the surviving parent, absence of grief, strong resistance to forming new attachments, complete absorption in daydreaming resulting in a prolonged dysfunction in school, or new stealing habit or other illegal acts may also be a cry for help.

It is essential for parents/ guardians to be alert and aware of danger signals so that they know if and when they need to seek professional help.

How a child grieves is vital to their immediate and long-term future. Struggles with mental and emotional toll, their inability to save their loved ones, anger expressed as a failure of healthcare. It should be our wakeup call for the expected immense mental health pressure on this population.

Supporting children and youth deal with grief

NEED OF BEREAVEMENT CLINIC to provide right support at the right time can help a child to face the future with confidence and hope.

Communication & connection is the need of the time

States should enable Child Welfare Committees to actively monitor the well-being of such children.

As India grapples with the unfolding calamity, we must also reflect on the systemic failures that have been unmasked by the crisis. The current situation did not come out of the blue. What are we going to tell these children in future, when all this situation is over, so many will be left behind parentless- we have to take a stand to safeguard these children emotionally and mentally. Have a proper system in place. Struggle with mental and emotional toll, failure of healthcare, should be our wakeup call for the expected immense mental health pressure on this population.

(The author is a senior consultant clinical psychologist. Views expressed are personal and do not reflect the official position or policy of Financial Express Online. She can be reached at Veena.krishnan7@gmail.com.)