Pandemic grief could become its own health crisis

By Hope Edelman

As the nation mourns more than 500,000 lives lost a year into the coronavirus pandemic, another pandemic wave is building — of grief. It poses a potential public health crisis of its own.

For the past century, Americans’ response to grief has been to minimize its impact and suppress the emotional pain. We treat grieving as an individual affair, with mourners responsible for “getting over” their losses, mostly in private. Social isolation during the pandemic has made grieving even more solitary.

But grief wasn’t always treated this way. For centuries, communities came together to mourn the passing of an individual as a loss to the polity. Victorian mourning practices were extravagant social affairs involving rituals that the bereaved and fellow citizens followed for months, sometimes years, after a death.

Then came the one-two punch of World War I and the 1918 influenza pandemic. With so many deaths occurring so fast, mourning rituals became prohibitively expensive and social mourning was effectively impossible to maintain. Like today, large public gatherings were prohibited and quarantines enforced. Funerals shrank in size, mourning periods contracted and families were left to grieve in isolation. By the 1920s, grief in America had largely gone underground.

A century later, grief is again a widespread issue. With each covid-19 death affecting an estimated nine survivors, more than 4.5 million Americans are grieving loved ones lost to the virus. Beyond deaths to other causes, there were additional U.S. fatalities last year: gatherings with family and friends, classroom learning, millions of jobs that won’t return. Collectively, we lost a way of life in 2020.

Yet there has been no sustained outpouring of public support for mourners, as happened after the devastation of 9/11. Instead of a broad acknowledgment of mass distress, our nation has been mute with grief. Pandemic skepticism has also disparaged the losses some have experienced.

This is a precarious state for a nation. Grief is cyclical, especially around anniversary dates. Even under optimal conditions, many mourners experience a dip in functioning at the one-year mark. We should expect this to happen, starting this month, with the one-year anniversaries of the first wave of pandemic deaths and lockdowns. One year isn’t far on the long arc of adjustment, but it’s well beyond the point that most people expect visible evidence of mourning to last. Collectively failing to grant each other permission to express distress beyond the first weeks after a loss can have profound health consequences.

In children and teens, unaddressed grief can manifest as trouble sleeping, depression, anxiety, behavior issues and lower self-esteem, a 2015 study found. Research from 2018 found it leads to aggression and academic or work struggles. In adults, unaddressed grief can manifest as depression, anger, anxiety, and substance use and abuse. Medical research has linked unaddressed and suppressed emotions to a host of physical ailments later in life, including hypertension and autoimmune disorders.

President Biden’s remarks on Monday, acknowledging not just the lives lost but also the loved ones mourning, are a good start. In addition to promoting professional help, there are steps that we citizens can take to address this siloed bereavement and help head off a looming public health crisis.

We can start by viewing grief support as part of our essential social contract. Those who are grieving need acknowledgment and understanding from family and friends. This starts with taking their losses seriously and accepting their reactions. Listening to their stories of a loved one’s life and death with compassion, instead of judgment, is key; so is confirming the coronavirus’s threat to human health if their loved one died of covid.

As in 1918, public health restrictions have affected the rituals people typically rely on for comfort and support. Funerals have again become stripped-down facsimiles, with some long-standing ethnic and religious traditions abbreviated or abandoned. Some families have postponed memorial services — and their own expressions of grief — in favor of planning to hold shows of respect when groups can again gather safely.

Today’s mourners should be helped to hold on to whatever rituals remain, even if that means attending a memorial service two years after a death. Rituals allow people to draw on the comforts of the past while projecting a loved one’s influence forward.

New rituals can be developed, too. Even repetitive, everyday acts such as drinking morning coffee from a mother’s favorite mug or touching a loved one’s framed photo when passing by can bring comfort if performed with intention. Folding the memory or values of a lost loved one into new traditions is a way to continue honoring the lives they lived.

Finally, participating in public acknowledgements of those who have died provides a larger meaning and context for the half-million deaths that otherwise risk being minimized or, worse, forgotten.

Everyone eventually loses someone dear, some of us sooner rather than later. Mourners’ unexpressed distress can manifest in them physically and in their interactions with others — in how they work, raise children and create policy. Validating and supporting the bereaved at the time of loss is not just the compassionate thing to do — it’s a necessary investment in the collective good.

Complete Article HERE!

What to Do With the Restless Dead?

Chickamauga National Military Park

by John Beckett

Here are the last questions from the most recent Conversations Under the Oaks. They’ve been edited for length and clarity, but I’ve done my best to preserve the thinking behind the questions.

What are your thoughts on the restless dead? We have a potter’s field here locally that I feel very drawn to. It was recently rediscovered and is the resting place of the homeless, the unidentified, the stillborn, etc. from around the 1900s to the early 1960s. I feel a deep connection to this place. Any thoughts?

There is a very old idea that people who die sudden and/or violent deaths, who die with unresolved issues, or who do not receive proper funeral rites do not move on to whatever comes next, but instead remain here as earthbound spirits. Alternatively, their souls – the essence of who they are – may move on, but the “energetic remains” of their trauma sticks around and occasionally the living bump into it.

I have some experience with this, but I’m far from an expert in it. If you have serious specific issues, I recommend you find someone who’s dealt with this a lot more than I have. But in general…

First, simply listen

What do you feel? What do you hear? One voice or many voices? Is there an attempt at communication, or is it just noise?

A few years ago I visited Chickamauga National Military Park, site of the second most deadly battle of the U.S. Civil War. I grew up 15 miles from Chickamauga and visited it occasionally – I always felt like the dead were near. But on this trip, I heard them screaming. Here’s what I had to say at the time:

By my belief system and the belief systems of most, those who died here went on to the afterlife, however you conceive of such a place. Those who believe in reincarnation would likely assume that many have been reborn, perhaps several times.

Perhaps there are a few souls trapped here 153 years later, but surely not many. Perhaps the physical remains (both human and man-made, like the cannons) facilitate a connection across the realms. I don’t know.

I just know I heard the dead screaming.

First, I would listen. I would make offerings to all those there, and if possible, to specific individuals. Keep in mind that most were Christians in life – be respectful of their beliefs and expectations, without disrespecting your own.

I would help keep the place clean, to the extent that such activities are permitted by the landowners. People get nervous when anyone takes an interest in a cemetery – they often jump to conclusions of malefic magic, even if they have no idea what that means.

I would not attempt to cleanse the place. I wouldn’t attempt to help any spirit “move on” unless I was sure I was dealing with one individual spirit and not either energetic remains or a conglomeration of spirits.

Mainly, listen.

Worship and Magic in Paganism and Christianity

Here’s a question on the different approaches to magic in Paganism and Christianity.

I’ve been thinking about the underlying structure of magic and religion. With Christianity, it seems like they combine devotionals to a deity with executing magic to invoke the deity’s power. With Paganism, it seems like there is more focus on magic as an individual practice.

A question like this requires the disclaimer that Christianity and Paganism are both broad and diverse traditions. Southern Baptists, Roman Catholics, and the United Church of Christ are all Christians, but they take very different approaches to it. Likewise, Gardnerian Wiccans, Celtic Reconstructionists, and kitchen witches are all generally (though not universally) considered Pagans, but they have very different beliefs and practices. So any attempts to compare “Christianity” and “Paganism” are necessarily broad, high-level, and will have many exceptions.

Further, much of what’s generally considered “folk magic” is done in the context of a Christian worldview, even though it’s unsanctioned. This question is concerned with official approaches, so that’s how my response is structured.

Let’s start with some definitions. Worship is declaring what is worthy. Magic is the art and science of creating change in conformance with will (that’s Crowley’s definition – I haven’t found a better one). Religion is the common beliefs and especially the common practices that bind a group of people together.

Magic: one form or many forms?

In orthodox Christianity, magic can only be done with the intercession of the Christian God. Therefore, it makes sense to incorporate pleas for such intercession with rites of worship.

In most forms of Paganism, magic is understood in a broader sense. My Threefold Theory of Magic says that while magic works by the intercession of Gods and spirits, it also works by our manipulation of unseen forces, and by psychological programming. So while we can incorporate magic into our worship (and I frequently do, especially in the big High Day celebrations), we have other options that Christians don’t.

Further, we have many different magical systems: energy work, herbal magic, stones and crystals, sigil magic, visualization, bardic magic, and others. These diverse systems lead to a diversity of practice.

All religions have something to say about magic, even if what they say is “magic doesn’t exist.” What they say about magic will determine how – or if – they work magic. Pagans see magic as much broader than Christians see it, so we have more approaches to working it.

Predictions for the next few years

The last question is a big one.

I’m interested in your thoughts on the next few years: predictions about Pagan culture and the Big Tent, but also how things are going to go with Nazi Pagans. And predictions for the spiritual side of things.

I occasionally mention the Big Tent of Paganism, but my enthusiasm for it has significantly waned over the past few years. My dream was that we would build robust individual traditions, and then work together on issues of common interest and to build pan-Pagan institutions. But it’s clear there is little interest in building those individual traditions, much less working together across traditions. The vast majority of Pagans simply want to do their own thing in their own way, and far too many live in mortal fear of someone “telling them what to do.”

I think we’re going to have to do a lot more work of creating traditions before people will start to congregate around them. And those traditions are going to have to be centered around things that people can do on their own, because that’s what they want.

I’m sad that the questioner mentioned Nazi Pagans. Or more exactly, I’m sad that they felt the need to mention them. Because they do. There are Nazis and White Supremacists in our wider society, so of course some of them are going to find their way to Paganism. I don’t think that’s going to change. We can and should attempt to isolate them and to deny their legitimacy to use Pagan concepts and imagery. But forget reclaiming the swastika – it’s lost for at least a hundred years, and maybe forever.

The currents of magic are getting stronger

On the spiritual side of things, I think the intersections of this world and the Otherworld are going to become stronger and more frequent. Expect more encounters with the Fair Folk. The currents of magic are going to continue to strengthen – that means if you can work magic, you can work more and better magic. What won’t change is that those who practice regularly will do more and better magic than those who don’t.

We are in the early years of Tower Time. It’s not going to be 2020 for the rest of our lives, but things in general are going to be challenging. But the chaos that is disrupting normalcy is also creating new opportunities: in business, in politics, in religion, in magic, and in virtually every area of life.

Those who pay attention and seize the opportunities will thrive. Those who cling to the past will not.

Complete Article HERE!

Between The Rhymes

— Writing Universal Songs


One of the biggest challenges any songwriter faces is how to turn their own story into a universal story that an artist and millions of his or her fans will like. Most of us find it relatively easy to write OUR story, but much more challenging to write our truth in that universal way.

Early in my career, I wrote a song that I thought I crafted very well. It was called “She Stopped Livin’ The Day He Died”. It was the sad but true story of my grandmother who was so dependent on my grandfather that, when he passed away at age 51, just spent the next 25 years of her life in a sad place.

I painted beautiful pictures of their life together before he passed away. I described his job at the factory and her life as a homemaker. I even used their real names in the song. When I played it for my family, they cried. I thought I had a masterpiece.

So, I confidently walked in to my publisher’s office and told him I “thought I had one”. That’s what we said when we thought we really nailed a song. He listened carefully to my song all the way to the end. I was ready for the “Way to go!!! Garth will love this!!”

It never came. Instead, his response was “That’s the saddest crap I ever heard.” He wasn’t one for sugar-coating anything. I was so upset. I couldn’t imagine why he didn’t love my song.

I asked him what was wrong with the song and he simply said “Garth doesn’t want to tell his audience YOUR grandmother’s sad story night after night.” He went on to explain that the key to writing a hit song was telling MY story in a way that millions of people relate it to THEIR story.

It took a while to sink in, but I finally realized that there is a difference in a great, well written song and a great, well written hit song.  What’s the difference?  Universal emotion.

My publisher challenged me to take my song about my grandmother and find the universal emotion behind it.  So, I spent weeks playing and studying that song until I finally thought I had it figured out.

The universal idea or emotion behind my song was that losing someone sometimes makes us feel like a part of us died.  So, I started working on song ideas that would express that feeling in a more universal and less personal way.

First, I decided that writing about someone dying might limit my chances.  Not many artists are searching for songs about death.  There’s no better way to bring a crowd down at a concert than to start singing a good death song.  That idea led me to a more universal (and positive) thought.

I realized that losing someone you love doesn’t have to be talking about dying.  In fact, more people would relate if I wrote a song about losing a love interest just because the relationship ended.  Armed with that knowledge, I looked through my title database and found the perfect title! 

It just so happened I was headed to my publisher’s cabin to write with him (Kim Williams) and Danny Wells.  Both Kim and Danny already had hits.  I did not!  So, I came armed with a bunch of strong ideas.  The first one I threw out was “While You Loved Me”.  Here’s the lyric we wrote.

While You Loved Me
If I ever write the story of my life,
Don’t be surprised if you’re where it begins
Girl I’d have to dedicate every line on every page
To the memories we made while you loved me

I was born the day you kissed me
And I died inside the night you left me
But I lived, oh how I lived
While you loved me

I’d start with chapter one, love innocent and young
As the morning sun on a new day
Even though I know the end, I’d do it all again
‘Cause I got a lifetime in while you loved me

I was born the day you kissed me
And I died inside the night you left me
But I lived, oh how I lived
While you loved me

Copyright 2000 Sony/ATV Music

That song expresses the same universal emotion as my song about my grandmother, but in a MUCH more universal way.  Almost everyone can relate to being broken up with by someone you love.  Only my family can relate to my grandmother’s story.

Rascal Flatts cut an amazing record, “While You Loved Me” went on to sell a million records and it became my first top ten hit, landing at #7 on the Billboard chart.  And, it was inspired by the story of my grandmother. 

All of that to say, the key to writing a hit is finding YOUR truth and then finding the UNIVERSAL truth behind it.  That universal truth is the ticket to success as a songwriter.

All the best,
Marty Dodson

Complete Article HERE!

Patients With Poor Health Literacy Less Likely to Elect Hospice

By Jim Parker

Patients who have low levels of health literacy are more likely to seek intensive curative treatment at the end-of-life, as opposed to choosing hospice care. In addition to disparities in hospice utilization associated with race or ethnicity, a patient’s understanding of their condition and the available treatments may also be a contributing factor, according to a recent study in the American Journal of Hospice & Palliative Medicine.

Health literacy is the degree to which individuals can obtain, process and understand basic health information and services needed to make appropriate health decisions, according to the Institute of Medicine. A health illiterate patient may have a strong overall ability to read or have an advanced education but have a limited understanding of information specific to health care.

“Medicare beneficiaries who resided in low health literacy areas were likely to receive aggressive end-of-life care,” the study indicated. “Tailored efforts to improve health literacy and facilitate patient-provider communications in low health literacy areas could reduce end-of-life care intensity.”

Patients who lack an understanding of health care information or terminology, do not understand their own illnesses, or who misconstrue the nature of hospice or palliative care may lack the necessary tools to make an informed decision about their end-of-life wishes

For the study, researchers conducted a retrospective analysis of nearly 650,000 Medicare fee-for-service decedents who died between July and Dec. 2011. They used a Health Literacy Data Map to calculate health literacy scores by ZIP code. For the purposes of this study, a score of 225 or lower was defined as low health literacy. Aggressive end-of-life care measures included repeated hospitalizations within the last 30 days of life, no hospice enrollment within the last six months of life, and/or in-hospital death.

Close to 83% of decedents in low health literacy areas pursued aggressive end-of-life care, compared to about 73% in high health literacy ZIP codes. Patients in low health literacy areas were also much less likely to utilize hospice.

Low health literacy is very common in the United States, often impacting older adults. As many as one-third of Medicare enrollees have a low-level of health literacy, and research indicates that this increases across-the-board health care costs by as much as 5% annually.

“Elderly managed care enrollees may not have the literacy skills necessary to function adequately in the health care environment,” a Journal of the American Medical Association study found. “Low health literacy may impair elderly patients’ understanding of health messages and limit their ability to care for their medical problems.”

Complete Article HERE!

Society’s End-of-Life Problem

Americans have unequal access to the benefits of advance care planning

By Mara Buchbinder

As COVID-19 death tolls mount rapidly, palliative care experts have urged Americans to have difficult conversations with loved ones about our end-of-life wishes. With death all around us, they have argued, it is now more urgent than ever that we plan for our deaths.

But in addition to having “the conversation” about end-of-life wishes, we should also grapple with deeper societal questions about who gets the privilege to plan.

It may sound perverse to suggest that a cancer diagnosis could be a fortunate event, but cancer compels people to anticipate death in a way that many never will. Most people will never have the opportunity to choose when, where and how they die because death comes unexpectedly, or the circumstances impede planning. If anything, my research on the desire for control at the end of life has taught me that death, all too often, ignores our plans.

But planning has nevertheless been a prominent focus of nationwide public health efforts to improve end-of-life care over the past several decades. Advance care planning is a broad term that encompasses talking with loved ones and health care providers, appointing a surrogate decision maker and recording end-of-life preferences in writing. Advance care planning enables people to legally document their wishes—for example, to avoid life-prolonging treatment if one is unlikely to survive or to attain a certain quality of life—in case they become incapacitated.

Such planning is particularly important for COVID-19 because of the vital use of mechanical ventilation among the sickest patients. Contemplating decisions about life-prolonging treatment in advance takes on heightened importance in a climate in which critical care resources are scarce and in which intubation puts health care workers at increased risk for contracting the virus themselves.

Americans do not engage equitably in planning for the end of life, however. Black Americans consistently utilize less advance care planning than white Americans. The reasons for this include worse access to medical care, especially culturally sensitive medical care; religious beliefs and cultural values that favor leaving decisions to God; and mistrust in medicine rooted in historical legacies of mistreatment, experimentation, and racism. Yet without the benefit of planning, Black Americans are less likely to receive care consistent with their preferences.

These inequities are all the more painful in a year in which police brutality and anti-Black violence brought the Black Lives Matter movement to the forefront of public consciousness. The tragic deaths of George Floyd, Ahmaud Arbery, Breonna Taylor, Elijah McClain and many other Black Americans highlight not only a foreclosed opportunity to engage with death as an object of anticipation and planning, but also, more fundamentally, a systemic failure of white Americans to acknowledge and uphold the value of Black lives. When the system has failed and shortened Black lives at every step, can we blame Black Americans for a reluctance to engage with the very same system to plan for death? From this perspective, advance care planning may seem tantamount to acquiescence.

This is not to deny that advance care planning and communication with loved ones are important and useful goals for all Americans, regardless of race or age. I teach a seminar for second year medical students on Death and Dying in America, in which I ask them to interview a partner or family member about their end-of-life wishes. I don’t want my students—many of whom have never experienced the death of a loved one—to confront the discomfort of speaking with patients about death before having done so at home. This year’s exercise was particularly poignant, as several students had family members in ICUs, or working on the pandemic’s frontlines.

But I also ask my students to think critically about who gets the privilege of planning: to examine the cultural values that underlie the expectation for choice at the end of life and confront racial inequities in advance care planning. When we advocate for more conversations about death and dying, let’s make sure that a piece of this conversation is facing the tough questions about who among us will get to plan and choose.

Complete Article HERE!

When is ‘dead’ really dead?

What happens after a person ‘flatlines’

By and

How long should doctors wait after a “flatline” appears before they can declare a person dead? How can they be sure that heartbeat and circulation will not return?

The most common way that people die is after their heart stops beating. However, there is limited evidence for how long to wait to determine death once the heart stops. This missing information has repercussions for clinical practice and for organ donation.

A fundamental principle of organ donation is the dead donor rule: donors must be dead prior to recovery of organs, and organ recovery must not be the cause of death. A lack of evidence about how long to wait before declaring death creates a tension: if doctors wait too long after the heart stops, the quality of organs begins to decline.

On the other hand, not waiting long enough introduces the risk of going ahead with organ recovery before death has actually occurred.

Our interdisciplinary team of doctors, bio-engineers and experienced clinical researchers has spent the past decade studying what happens when a person dies after their heart stops. We focused on patients in the intensive care unit who died after life support was withdrawn, since these patients may also be eligible for organ donation.

In particular, we were interested in understanding whether it is possible for the heart to restart on its own, without any interventions like cardiopulmonary resuscitation (CPR) or medication.

A closer look at end-of-life flatline

Our recent study, published in the New England Journal of Medicine, presents observations of the dying process of 631 patients across Canada, the Czech Republic and the Netherlands who died in an intensive care unit. All patients’ families consented to participate in the research.

In addition to collecting medical information about each patient, we built a computer program to capture and review heart rate, blood pressure, blood oxygenation level and respiratory patterns directly from bedside monitors. As a result, we were able to analyze end-of-life flatline patterns for 480 out of 631 patients — including looking at whether and when any circulation or heart activity returned after stopping for at least one minute.

As it turns out, the classic flatline of death is not so straightforward. We found that human heart activity often stops and restarts a number of times during a normal dying process.

Out of 480 “flatline” signals reviewed, we found a stop-and-start pattern in 67 (14 per cent). The longest that the heart stopped before restarting on its own was four minutes and 20 seconds. The longest time that heart activity continued after restarting was 27 minutes, but most restarts lasted just one to two seconds. None of the patients we observed survived or regained consciousness.

We also found it was common for the heart to continue to show electrical activity long after blood flow or pulse stopped. The human heart functions as a result of an electrical stimulation of nerves that causes the heart muscle to contract and contribute to blood flow — the pulse you can feel in your arteries and veins.

We found that the heart rate (electrical stimulation leading to movement of the heart muscle) and pulse (movement of blood in the veins) only stopped together in 19 per cent of patients. In some cases, electrical activity of the heart continued for over 30 minutes without resulting in any circulation of blood.

Why understanding death matters

The results of our study are important for a few reasons.

First, the observation that stops and restarts of heart activity and circulation are often part of the natural process of dying will be reassuring to doctors, nurses and family members at the bedside. Intermittent signals on bedside monitors can sometimes be alarming if observers interpret them as signs that life is unexpectedly returning. Our study provides evidence that stops and starts are to be expected during a normal dying process without CPR, and that they do not lead to regained consciousness or survival.

Second, our finding that the longest pause before heart activity restarted on its own was four minutes and 20 seconds supports the current practice of waiting five minutes after circulation stops before declaring death and proceeding to organ recovery. This helps to reassure organ donation organizations that practices of determination of death are safe and appropriate.

Our results will be used to better inform policy and guidelines for the practice of organ donation internationally. For donation systems to work, when someone is declared dead, there must be trust that the declaration is really true. Trust allows families to choose donation in a time of grief and allows the medical community to ensure safe and consistent end of life care.

This study is also important for improving our broader understanding of the natural history of death. We have shown that figuring out when dead is really dead is perhaps not so simple. It requires careful observation and close physiologic monitoring of the patient. In addition, it requires an understanding that, just as in life, there are many patterns that the dying process can take.

Our work is a step towards appreciating the complexity of dying and suggests we must move beyond the idea of a straightforward flatline to indicate when death has occurred.

Complete Article HERE!

Grave matter

— Germans seek new ways to talk about dying

Mourning speaker Louise Brown in Hamburg.

Lockdown and a hit Netflix series are inspiring alternative grieving rites, from chocolate and painted stones to memorial workshops


On a plane tree-lined shopping street in Berlin’s fashionable Gräfekiez neighbourhood, two children are glued to the front of a brightly lit ground-floor office space, decorated with the understated minimalism of a design agency.

The object of their curiosity is a Lego window display, showing a miniature cemetery and a coffin carried by four tiny pallbearers, complete with black top hats.

“I love this”, says their mother as Birgit Scheffler, the co-owner of funeral home Das Fährhaus (The Ferry House), steps out of building’s front door. “It would be nice if death becomes less of a taboo for my kids’ generation than it was for my own.”

Das Fährhaus’ inviting exterior is a deliberate contrast to traditional funeral parlours, who usually have “blacked out windows or drawn blinds, and maybe a dead fly lying on the window sill”, as Scheffler put it.

Specialising in alternative or bespoke funerals, her undertaker’s business is one of several ventures that are currently brightening up a German way of death that used to be considered one of the gloomiest, most ritualised and rigidly regulated in Europe.

“In postwar Germany, our grief culture was shaped by the legacy of the two wars”, said Scheffler, 43, who used to work in marketing and distribution for a media company before retraining in 2017. “In a culture that was focused on building something new from the ruins, death was pushed aside.”

The psychoanalyst couple Margarete and Alexander Mitscherlich famously diagnosed Germany with an “inability to mourn”, a phrase that was amplified by the 1968 student movement and has since echoed through the country’s postwar history.

Coronavirus, however, is proving a catalyst for a new way of talking about mortality. “Death is suddenly at the centre of our lives”, Scheffler said. “The first thing many of us do when we wake up is look at the number of people who have died in the last 24 hours.”

A national conversation about dying has captured the radio waves and television screens. In My Perfect Funeral, a critically acclaimed new series for radio broadcaster Deutschlandfunk, interviewees describe how they want to be put six feet under.

Netflix’s recent The Last Word, meanwhile, stars German comedy star Anke Engelke as a widow who reinvents herself as a eulogy speaker. “There is no wrong way to mourn”, says Engelke’s voiceover in the concluding episode. “Death is only terrible if you take it seriously.”

Scheffler and her co-owner Sahra Ratgeber opened Das Fährhaus in August, at a time when neighbouring shops were struggling with social distancing requirements and losses incurred during the spring lockdown.

New hygiene rules have also proved a burden for undertakers, limiting the number of people allowed to attend funerals and requiring embalmers to wear additional PPE. Open-casket funerals have been banned; the bodies of those who have died of or with Covid-19 are buried in body bags.

Yet among bereaved families the lockdown has inspired creative new ways to send off the departed. This year, Das Fährhaus has organised a funeral in which mourners were allocated time slots to adorn the grave with painted stones rather than the conventional flowers. At another, family and friends dropped chocolate bars rather than sand onto the coffin of a deceased chocaholic.

Her business offers mourners the opportunity to build their own coffin or work with a ceramicist to make a bespoke urn. “The more elements of the funeral relatives or friends can create themselves, the better.”

Increasingly, she said, people were getting in touch to put down specific instructions for their own funeral in writing: one woman dreamt of being buried in her wedding dress, a composer wanted to make sure some of her works were burned alongside her.

A heightened sense of one’s own perceived uniqueness may be associated with the much-derided “snowflake generation” of the 2010s, but Scheffler said she has noticed a change across all ages. “Even people in their 70s and 80s are becoming more creative.”

Outside the German capital, with its high tolerance threshold for alternative lifestyles, more traditional last rites still prevail, said Louise Brown, who presents the My Perfect Funeral podcast. A Hamburg-based journalist for print and radio, Brown has since 2015 also worked as a Trauerrednerin, a freelance “mourning speaker” for those who don’t want a eulogy to be spoken by the clergy.

While the tradition of such “free speakers” goes back to the free religious movement of the 19th century, other aspects of the typical German funeral remain unusually heavily steeped in tradition. The country is one of the few in the world where coffins or urns must be buried in a cemetery, the so-called Friedhofszwang, and where scattering the ashes of the cremated or dividing them between family members is banned.

“Most Germans still have a small-c conservative attitude to death”, said Brown, 45, a dual British-German citizen. “The organ music at the start of the funeral, the church bells on the walk to the grave: to many people these rituals still matter”.

What was changing, she said, was the bandwidth of what could be said in a eulogy: “People want more personalised speeches, and they no longer want me to skirt around the conflicts and the difficult phases in a person’s life.”

Interviewing family and friends in preparation for her speeches, said Brown, was like leafing through a photo album: “Often the funniest, most honest and authentic pictures are filed loosely near the back pages. The pictures that were taken on the fringes of the official photo session on a holiday, after an award ceremony or a 50th birthday. The pictures no one tried to pose for, the ones we thought were too blurry or out of focus. In a funeral speech, these are often the images that the bereaved most identify with.”

The pandemic has also constrained the jobs of mourning speakers, forbidding not only communal singing but also the customary post-funeral meet-up over coffee, which Brown says can be more important than the funeral itself.

“After the body has been laid to rest, there is usually a moment where the bereaved are both still very vulnerable and very open with each other. The intimacy of these gatherings isn’t something that you can recreate in a Zoom call.”

In times of Covid-19 families are increasingly opting for cremations, in the hope they can postpone the communal get-together until after the pandemic is over (urns, unlike coffins, can be put into storage for up to six weeks): according to Germany’s national association of undertaker’s, cremations now make up 70% of all funerals.

But even before Germany’s severe second wave and the ensuing Christmas lockdown squashed hopes of get-togethers in the near future, many had started looking for alternative new rituals. Graphic artist Anemone Zeim started her “remembrance workshop” Vergiss Mein Nie (Forget Me Never) seven years ago, helping bereaved people to come up with creative projects that conserve memories of their lost ones: films cut together from old Super 8 footage, scarves recycled from a late grandmother’s favourite jumper, or lampshades patterned with a deceased friend’s handwriting.

“You can’t solve your grief with a checklist”, said Zeim. “You need to get creative to find individual solutions. You need to use your hands to stop you getting trapped in your brain. That’s what we help with.”

In recent months, requests for her agency’s services have doubled, with emails flooding in not just from the Hamburg area where her business is based, but from across Germany, Austria and Switzerland.

So-called “grieving tools” sold via Forget Me Never’s website, such as funeral cards, an “anger capsule” for writing down unresolved feelings towards the deceased, or “flower tears” containing bulbs and a clump of soil, have been in high demand.

“We’ve been working flat out”, said Zeim, “not necessarily because more people have died because of coronavirus but because people who have suffered a loss have been shacked up in their own four walls. There are advantages to that too: you don’t have to deal with the social stigma of grieving in public. But the danger is that you can become wrapped up in your sorrow.”

Zeim said she expected demand to keep on rising in the new year. “The process of mourning can take months or years, and not just individuals can mourn, but societies too. We as a society are already grieving for the toll that this pandemic has taken of us. We just haven’t realised yet.”

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