Melissa: We've been talking about mental health during this second pandemic holiday season. COVID-19 has claimed more than 5 million lives globally. That means many families have an empty chair at the holiday table this year, including many families in our Takeaway community of listeners.

Pam: Pam Nugent calling from Malden, South Carolina. Differences for this year's Thanksgiving last year, my husband was alive, died from COVID in February. This year will be very difficult.

Melissa: Pam, thank you for leaving that voicemail. We are so sorry for your loss. Dr. Sonya Lott is a licensed psychologist specializing in prolonged grief, and she's here to help us through coping with grief and loss during the holidays. Dr. Lott, it's so great to have you back on the show.

Dr. Lott: Thank you, Melissa. I'm really grateful to be here, to talk about such an important topic.

Melissa: Let's just start with the ways that the holidays can be so difficult for so long. Even if you didn't lose your loved one directly at the holiday, what is it about them that can trigger such grief?

Dr. Lott: The end of the year holiday season in particular is a time that we expect to be with our loved ones. There's the expectation from society that we should be joyous and happy. For so many people, that's just not what it's like. Not just because of this being the second year of a pandemic. It's oftentimes for people that their grief is still unresolved from previous years and the holidays heighten that, or even if it is resolved, oftentimes when we gather together with that person not present or people now with the pandemic, some family members have lost several members of their family, then it's difficult.

Melissa: In general, do we-- I'm always of multiple minds to be clear, not trained in any way as a therapist or a psychologist. I'm wondering, do we directly address it? Do you put up the photograph, do you evoke the name when you're going around maybe during your thanksgiving gratitude session or, do you do the avoidance, like let's just pretend and not keep bringing up what might be painful, I'm just wondering what are the most adaptive ways for managing this?

Dr. Lott: There isn't just one way, one best way. It really depends on the individuals that then gathered together and Thanksgiving is around the corner now, but it's really helpful to have a conversation with family and friends that we're planning to gather with or who this year, we may be declining to gather with, about the best way to honor the loved one and to allow the sadness, rather than try to avoid it and also try to lean into moments of joy, if they show up. It can be both. People's hearts know that the person isn't there. We don't have to talk about it, to know that's true. It's better to find a way to allow what's already in your heart to show up.

Melissa: I'm wondering if there's particular advice for children who may have lost caregivers, grandparents, aunties, uncles, maybe even their parents?

Dr. Lott: Melissa. That's a really difficult situation to have to try to manage. It depends so much on the age of the child, the personality of the child, the age, how much they understand about what death is, and what it means not to have the loved one there. If it's a parent, it may be very different than if it's an auntie or an uncle. It's most important to try to find space as the adult in the room, if you will, to try to be present with where the child is and what the child needs. Try to have a conversation with the child in language that they understand, that's age-appropriate and allow them to be able to express their emotions, particularly their sadness.

Melissa: I'm wondering if grief, both for children and adults might show up as though it's something else like anger or hyperactivity. I'm wondering if there are ways that we can be sure we're recognizing when something is grief. Even if it doesn't show up like tears.

Dr. Lott: We can't always know for sure. It's more common for males to express anger. We give men permission to do that more than we do women, but yes, grief shows up in a lot of different ways. Emotionally, can be anger, confusion, difficulty making decisions, sadness, guilt about perhaps if I would have noticed that he was more fatigued than he had been, or if I had noticed that she was having headaches frequently, then maybe I could have done something and maybe they wouldn't have died. There are many different ways that grief can show up emotionally, but it can also show up physically.

Fatigue, as a physical characteristic of some other illness that may lead to death, but it may be a part of a grief response. It can be headaches as a part of a grief response. Spiritually feeling hopeless and that there isn't a God if you believed there was one before. It can show up in a lot of different ways. We can't always know as the individual experiencing it, or as a friend or family member, who's witnessing it. Even if we're sharing the same grief, we don't always recognize the different ways that it shows up.

Melissa: I want to talk a little bit about the prolonged and maybe even delayed experiences of grief. My elder sister, with whom I'm very close, lost her husband years ago now. There are moments when I realize I've forgotten like, "Oh, that happened years ago," but then it occurs to me, but no, every Thanksgiving, every Christmas is still some moments without her beloved partner, father of her children. Are there ways that whether you are the person who's experienced the grief, or if you are the beloved of someone experiencing the grief that is seemingly years ago, but still trying to hold space for it in a holiday setting?

Dr. Lott: Grief is lifelong. The sadness around the loved one, no longer being here, wishing they hadn't died. Then really being reminded acutely of that during special events and holidays. If it's not our immediate loss you're right. We do tend to forget that. I think because we're going into the second-holiday end of the year holiday season in a pandemic, more of us are aware that many of us are grieving or still grieving. Just let the person know. "I recognize that this might be a difficult time for you. I'm here for you." If you are really emotionally available for them. We're afraid of saying the wrong thing, but often, acting as if what is, is not, is more painful than actually saying, "I don't know what to say, or I'm not sure how you're feeling, but I want you to know I'm aware that this might be difficult time for you."

It's naming it and giving the person permission to be where they are, if they are, particularly sad on that day. It's really the naming that's most important, because people who are in grief sometimes very commonly feel like people are tired of hearing my grief. If somebody is experiencing what we call prolonged grief, where it's been more than a year since the death of the loved one, but the grief still feels very acute and it's pretty persistent and interferes with the person's day-to-day functioning. That's what we refer to as prolonged grief disorder. It's very common, especially with that situation for people to feel like everybody else must be tired of my grief because I am.

Melissa: A final question for those who are facing this holiday and maybe they don't want to be isolated. They don't want to be all alone, but they also don't necessarily-- maybe their appetite isn't back for eating a big meal or they just don't want to manage all of the expectations of a holiday meal. Are there ways to be together without having to do it all? Ways to give oneself permission to be maybe a little bit more alone?

Dr. Lott: Yes. I always tell individuals to, and again, Thanksgiving is upon us, but I tell individuals to not volunteer or say, no, they typically are the person who does the big holiday meal if that's the case. To give themselves a respite this year, if they're feeling really tender or especially if this is the first Thanksgiving, or first Christmas season, without the loved one. Try to give yourself permission to not be the host this year. That's the first thing because of the pandemic, we aren't traveling as much. If you typically would get on a plane to go across from East Coast to West Coast or something far away, don't do that this year. The situation with the pandemic offers a way to say no, when you may have felt guilty or perhaps would have felt guilty to have done that Pre-COVID. The other thing is I tell individuals don't decline an invitation until it's time to leave your home, to go wherever you're heading or planning to go.

You may change your mind, if you say, no, you close the door too soon, you may change your mind. Something may shift for you, so that that day, when you're getting dressed, you may decide that you are up for it. You can always leave early, but make the decision that's going to serve your highest good when it's time to put that plan into action.

Melissa: Dr. Sonia Lott is a licensed psychologist specializing in grief. Thank you so much for joining us.

Dr. Lott: My joy, thank you so much, Melissa.

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