SIDNEY — As the holidays arrive, what is normally a time for family togetherness can be particularly difficult for those who have lost a loved one. Grief, even supposedly long gone, can resurface through the senses, when hearing a favorite song or smelling a favorite food.

Last year, there were more deaths than births in 25 U.S. states, like Ohio, meaning, for some, this may be their first Thanksgiving or Christmas alone.

Both holidays are good times to reach out in support of those who may be suffering with grief and possibly depression due to loss of a family member, said Amy Krites, MSW/LISW-S, a grief specialist at WellSpace Therapeutics. “It’s also important to share those good memories of missed loved ones during the holidays.”

“When COVID first happened and we were all quarantined, everybody was scared. As a country we were all going through these stages of grief in a way, and most everybody knows somebody who died from COVID,” Krites said.

As a professional, Krites said she was taught the “stages of grief” — denial, anger, bargaining, depression, and acceptance. However, Krites said, grief can be an ongoing process that lasts forever.

“I have had some clients who have lost parents or loved ones to COVID,” said Krites, “and denial and depression are two of the most common feelings in COVID cases.”

Overall, it leaves people feeling disconnected or with unresolved feelings, like “there’s no good reason,” for their loved one’s death, Krites said, leaving them in a state of confusion about the “how” and “why.”

COVID has a relatively new status as a deadly disease, unlike cancer, for example. Grieving people cannot point the finger at a specific responsible party to regain some sense of justice, control, and closure, as they would, say, in the case of a convicted drunk driver. They feel frustration and anger at COVID, a faceless enemy. This was especially true for the indirect deaths caused by being turned away for diagnostic care or surgery when hospitals were overwhelmed with COVID cases. Others failed to seek care in time, reasoning the risk of contracting COVID outweighed their current health concern, and letting their non-emergency condition worsen.

While some may have contracted COVID by ignoring mask mandates, for example, “I have had cases where people had done everything correctly by living a healthy lifestyle, taking vitamins, and getting their vaccination, but then they still died,” Krites said.

Just about anyone who was a primary caregiver for an elderly relative during COVID was terrified of transmitting the virus to their loved one. When the elderly person died, caregivers may have experienced guilt wondering if they may have been asymptomatic and given COVID to their loved one or felt regret that they were so focused on protecting them from getting COVID and providing daily care needs, shopping, or beauty care during salon closures, that they did not spend enough quality time talking with their family member before it was too late and they were gone.

Family gatherings, like at Thanksgiving — especially before vaccines were available — were also taboo, according to health advisors, leading caregivers and elderly family members to feel more isolated than ever.

“When you’re grieving, all you can think about is ‘this person is gone,’” said Krites. “You feel like the world has ended, and ask yourself, ‘how can I go on every day without this person?’ That’s why grief support from family members is very important, especially beyond the first few weeks. I recommend people make that call or stop by for a visit, even if it is once a week just to see how they are doing,” Krites said. “It’s important to check on that person because they are not always okay.”

Children and young adults grieving a parent must also grapple, perhaps for the first time, with their own mortality, and be forced to acknowledge too early in life the physical fallibility of a strong father or the emotional emptiness left by the loss of a supportive mother.

They may also struggle in school if they are bombarded with reminders that cause them to worry about their safety and security, or fear the loss of a remaining parent, leaving them alone.

Maslow’s Hierarchy of Needs is a pyramid-shaped chart designed to help describe and understand behavior. The fundamental gist of the pyramid is to convey the concept that behavioral changes follow a bottom-up approach. Moving upward toward the peak requires attaining each step of the pyramid first.

From the pyramid’s base to its peak are the following five steps: physiological needs (food, water, shelter, clothing, etc.), safety and security (family, employment, health, property, social interactions), love and belonging (friendship, family, connectedness with others, intimacy), self-esteem (respect, individualism, confidence, achievement), and self-actualization (creativity, morality, fulfillment of purpose and potential).

Grief can interrupt the normal position a person has achieved in life, pushing them back down the pyramid. For a child, the loss of a parent can create instability at the very foundational step of the pyramid, because children depend on their parents for their basic needs like food, clothes, and shelter. The loss of a spouse, particularly the primary wage-earner in a household, can easily knock a partner down to the second level regarding concerns about employment and family.

What is interesting, however, is that grief support and alleviation strategies seem to come by using a top-down approach to Maslow’s hierarchy. The upper three levels can make a real difference when it comes to grief alleviation. Friends and family can provide a continued sense of love and belonging at the third step to help ward off loneliness and depression. At the fourth step, work colleagues and supervisors can deliver words of support and encouragement to boost self-esteem which, in turn, provides the confidence needed to take on new challenges and responsibilities alone. At the fifth step, a sense of morality derived from spiritual beliefs might ultimately draw upon and affirm a religious belief in life after death from which to draw comfort.

Some people work through grief on their own, but there are signs a grieving person needs counseling. These include staying in bed all day, not participating in activities of daily life (working, picking up kids from school, etc.), or skipping meetings and social events, Krites advises.

A counselor can also work together with other medical professionals to provide ‘completeness of care.’ These include referrals to or from a family physician who may prescribe a medication such as an antidepressant, or possibly a referral to or from a hospital for a more in-depth, serious case.

While antidepressants can be a vital part of therapy, the 2020 Harvard Medical School article “Going off antidepressants,” warns it can be difficult to stop taking them: “antidepressant withdrawal” can lead to “a relapse of depression;” to help prevent this, “a physician should take steps to minimize or avoid the discontinuation symptoms that can occur if such medications are withdrawn too quickly.”

This weaning-off period while working with a physician to reduce antidepressant dosage may also be a good time to seek counseling for additional support, said Krites.

WellSpace Therapeutics, located at 1130 Wapakoneta Ave. in Sidney, can be reached at 937-638-4726 or through their website wellspacetherapeutics.com.