Anticipatory Grief, Anxiety, and—of course—COVID-19

David Kessler, co-author of one of the classic books with Kübler-Ross detailing the 5 stages of grief, interviewed in the Harvard Business Review:

Understanding the stages of grief is a start. But whenever I talk about the stages of grief, I have to remind people that the stages aren’t linear and may not happen in this order. It’s not a map but it provides some scaffolding for this unknown world. There’s denial, which we say a lot of early on: This virus won’t affect us. There’s anger: You’re making me stay home and taking away my activities. There’s bargaining: Okay, if I social distance for two weeks everything will be better, right? There’s sadness: I don’t know when this will end. And finally there’s acceptance. This is happening; I have to figure out how to proceed.

He goes on to discuss ways to manage pandemic anxiety, including focusing on the present, mindfulness, etc.

And then the bombshell: He’s adding a sixth stage (Finding Meaning) to the classic five.

And, I believe we will find meaning in it. I’ve been honored that Elisabeth Kübler-Ross’s family has given me permission to add a sixth stage to grief: Meaning. I had talked to Elisabeth quite a bit about what came after acceptance. I did not want to stop at acceptance when I experienced some personal grief. I wanted meaning in those darkest hours. And I do believe we find light in those times. Even now people are realizing they can connect through technology. They are not as remote as they thought. They are realizing they can use their phones for long conversations. They’re appreciating walks. I believe we will continue to find meaning now and when this is over.

There will be a pre-COVID and post-COVID world, and they will not be the same. The question is how much of this tragedy can act as a hard reset, enabling us to stop the distraction, infighting, and isolation and start making progress on the things that really matter to us as individuals, as a society, and as a species.


Sara BJ 04.14.20 Reply

I see the psych influence is strong in this one!!!

As a student, how important is residency name/prestige when pts choose who to see? Obvs pt dependent, but curious to see her experience.

Also she started PP. Was that simply for more freedom and finances? No thoughts of PSLF?

Ben 04.14.20 Reply

Most patients don’t really care, and the ones that do may not be the kind of patients you want. Most come as direct referrals from colleagues (both docs and therapists). You and your work are your best business card.

As for the second question, control and flexibility. Solo practice is a way to go back to the way medicine used to be where you could really focus on taking care of patients. Psychiatry is particularly well-suited. Finance optimization was not a contributing factor at all. PSLF would have been nice, but with our second child coming the time was right to make the transition. We were just aggressive and paid off her loans instead.

Julia Clemens 04.15.20 Reply

Similar boat here: did she have interest in psychotherapy – i know programs often work with nearby institute for a 1 year type certificate? Or she does mostly med management and works in-house with psych social workers?

Ben 04.15.20

Her residency had an excellent psychotherapy focus, more than most. She does do therapy but mostly med management. A lot of patients come from their therapists in the first place, but also the patient costs are lower with an LCSW. I’d say she actually refers out to psychologists more often for therapy except for patients who specifically need something less commonly offered like DBT.

Jonathan Wilmer 04.15.20 Reply

Yo, any updates to the book recommendation list for psych peeps?

Ben 04.15.20 Reply

Nope, but always happy to update if something else comes along. Other than modernization every couple of years I’m usually amazed at how little the needle moves on medical texts. I should probably add a few more to the psych-related reading list though.

Daniela 04.19.20 Reply

Ben, this question is for your wife if you don’t mind. Anything she would have done differently in residency now that she’s graduated? Thanks!

Diane 04.30.20 Reply


Ben 04.30.20 Reply

I’m reporting back: she actually says no, but she says the best thing she did in residency was finding herself a niche to really become an expert in and help define her practice. In her case, she didn’t do fellowship but completed a track in Women’s Mental Health.

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