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Host:
This is the best health podcast brought to you by wake forest Baptist health in partnership with MedCost today. Everyone welcome back to the latest episode of the best health podcast brought to you by wake forest Baptist health, Justin Gomez here. And I have, uh, a guest, a guest that's beginning to become one of my favorites. Dr Steve Skogen, uh, is joining us again as we continue our series, uh, about mental health awareness issues and helping people recognize and identify and work through some of, uh, what they might be experiencing as we go through the COVID Coronavirus, uh, pandemic and we have, you know, been thrown all these new definitions of social distancing, um, shelter in place at home and virtual learning for the kids. So it's a whole, whole new world and schedule for us. And uh, dr Scoggin is here to help us process through that, uh, once again and we really appreciate that.
Host:
I will say just at the beginning of of these covert 19 related podcasts, I want to give everyone the opportunity if you're looking for more general information about COVID 19 and what wait for us about this health is doing and what questions you might have. Feel free to go to wake health.edu/Coronavirus wake health.edu/Coronavirus. And we, uh, have all kinds of information, FAQ, clinic updates, myths versus facts, lots of good information as well as all of these podcasts as well. So dr Steve Scoggin, uh, as I mentioned, if you've listened to maybe one of his previous podcasts that he's done with us, he's, he's been a guest a few times. He's the associate vice president for behavioral health and he's the interim chair for the department of psychiatry and behavioral health for wake forest Baptist health. So welcome dr Scoggin. I appreciate you coming back and joining us.
Dr. Scoggin:
Justin, thanks for having me and thanks to, to you and the best health team for these podcasts. I've gotten so many emails about the variety of podcasts, the all been offering, uh, our health system and community. So thank you for the great work you and your team have done.
Host:
Well, thank you so much. We appreciate that. And I know you're, you're very busy these days and um, want to just talk to you for a few minutes and I thought this topic really struck me as interesting, uh, because what we're going to be talking about today is grief and the grieving process and in the context of coven 19 and Coronavirus. And, uh, what we usually hear in terms of grief is, is surrounding, you know, the, uh, possibly the death of a loved one or a family member or someone we care about and um, or some sort of, uh, other monumental loss that that is causing us to grieve. And I really want to, it's really interesting when a dive in here and have you helped us understand what we might be feeling out here in the community. One of the things that we might be trying to process and maybe having identified it ourselves is grief and going through some sort of grieving process with just the way our lives have been flipped, turned around and upside down about, uh, about just with all the shelter in place and maybe some people aren't working, they're furloughed, et cetera, et cetera.
Host:
And, um, this can be really insightful. So I guess it would be great just as a baseline for you to help us understand, uh, just kind of a good definition you all use in your clinical environment when you're working with, with patients. Uh, just give us a baseline almost definition of, of how you guys define grief and how you help people, uh, identify what maybe that's what they're experiencing and going through.
Dr. Scoggin:
Yeah. Well, thank you Justin. Um, yeah, you named it where we usually associate grief with, with death or the loss of loss of a loved one that, um, the truth is we, we, we go through grieves all our lives, grief, uh, all of our life. We, we grieve small losses. Uh, when our kids, uh, leave the home and go to kindergarten, that's not a bad thing. Grief is not always a bad thing, but nevertheless, it's, it's, it's related to a loss that we feel. So we have all these accumulation of many losses throughout our lives. Grief is just our natural body and mind's response to losing something real or imagined. And so it's, it's, it's important that, that we go through those grieves because the way we go through the small griefs in life has a lot to do with how we do it. The larger griefs, like the one in with right now, which, which could involve the loss of someone that we know to Cobra 19 or someone close to us.
Dr. Scoggin:
But it also has to do with the things you're naming, the loss of a routine of what we consider normal. Uh, the, the, the loss of the cadence of our lives. Things that will, we, we take for granted, like you, uh, named social distancing. I'm trying to correct myself these days and say physical distance, same because I haven't really distanced myself socially from anyone. And I certainly have physically distanced myself. So yeah, that seems to capture better for me. What's, what's really going on. So, uh, grief is just a natural response that uh, we all go through our, there's a bodily response as well as the psychological response when we feel a sense of loss that sometimes we can name another time if we can't, can't really name at all.
Host:
Yeah. Well, um, so I guess help us put into context, maybe we've talked a little bit about managing stress and managing, managing anxiety and we've talked a little bit about, um, depression and how that might be, uh, some of what people are going through and what, what they're processing through. Um, so how does a grief, um, differentiate between some of those things that we've already talked about and um, how, what's the best way for us to look to, to maybe identify that that we are going through some sort of breathing process and I guess this will help us once we identify it, help us to process through it. Correct.
Dr. Scoggin:
Yeah, that's a great question, Jason. When we talk about like depression, anxiety, we're usually talking more about clinical presentations of an effect and then a set of symptoms. Grief is a process. It's certainly activated by stress, the loss of something. It's not necessarily a clinical syndrome, although if you, you know, work through your grief, it can become what we call complicated grief. They can have a clinical symptom effects, but grief is more of a of a process that we identified actually back in the forties and fifties after a horrible fire, the coconut Grove fire and the massive loss that that people experienced in that community. We saw people after that, far who lost loved ones go through this process and we started understanding this as a grieving process that had natural normal stages to it.
Host:
So what do we do to process through grief? Do we just kind of wait out the situation and told the situation changes or what are, what are the different, maybe steps, if you will, to go through how we go through the grieving process too. Is there a light at the end of the tunnel with the grieving process? How do we know when we're, when we're done grieving, if you will, you know,
Dr. Scoggin:
well, you're, you're naming the grief is a process and it certainly is a process. And sometimes to understand grief, you have to understand kind of what we would call the stages of grief. Okay. So a grief has, uh, you know, five to seven stages depending upon who you read. And then it is a process. The first stage is shock and denial.
Host:
[inaudible]
Dr. Scoggin:
so in the loss of a loved one, we, we're were shocked that they're gone. We're sometimes denying that they're really gone. It seems surreal to in the coven 19 world. It's the shock that this was happening to us, that we were really in a pandemic. We counter with the stage of denial that this isn't going to last. And then that stage, once we moved through that shock and denial stage, we start feeling the pain and sometimes the guilt of this that has been precipitated by code 19. The, the, the pain that, uh, this is here to stay, that this is, uh, interrupting our lives. Yeah, it's unbearable. Uh, sometimes during this phase, this is when people turn to drugs, alcohol, healthy ways of dealing with things. And then sometimes the guilt of I didn't get it, someone else did get it close to me. We feel some guilt, whether we call that survivor guilt in some ways when we're not impacted by it, the, uh, the illness, but someone else is the next phase of grieving is anger and frustration.
Speaker 3:
Uh huh.
Dr. Scoggin:
People have to wait to find a way to mobilize their frustrations in this gives white anger. You may find yourself lashing out at people, blaming people. Um, it's our way of trying to control what's happening is coping 19 has made our lives somewhat uncontrollable. This invisible illnesses exerting a lot of control over us and to get frustrated, it's normal and natural and to get angry about that is as well. The next stage is the depression, reflection and loneliness. This is where I think we are as a community, as the reality of it has set in the shock aisle, the pain of it, the anger we felt and were, we're settling, was feeling a little down, a little lonely. Uh, and this again is this the stages that I'm going through, Justin are all normal and natural part of the grieving process. At some point we will feel like we're reorienting our lives around this new reality, uh, physical distancing and whatever else is impacting our lives in terms of, uh, as you said, the school routine,
Speaker 3:
uh, the, the uh,
Dr. Scoggin:
decrease in gatherings of large groups of people. Uh, we saw a re reorient re or you're orienting ourselves around that and um, we start working through it kind of the last phase is we fully accept this new reality, these that are coming, this new reality, and we start getting hopeful about what our new lives will look like. There's no returning to normal. People use the word new normal, I call it business as unusual.
Host:
Hm.
Dr. Scoggin:
So that's, that's a process that all of us at different levels are going through because we're, we've lost something. We're not going to return to anything that that was familiar to us. It's going to look different and to get a little depressed, lonely about that angry. That's all normal. So that's kind of the equate version of the grieving process.
Host:
Yeah. That's, um, I'm sure several people listening can relate to at least one, if not the multiple stages. That's a really good breakdown of maybe from a community aspect what we're going through and, and how we're gonna get through this process. Um, I, I did like that, that at the end of it, there's, you know, you could kind of talk about it as there's a light at the end of the tunnel or no, we don't stay in the be lonely depressive or angry part forever. Correct.
Dr. Scoggin:
Well, yeah, you can think about again, the loss of a loved one in death. Yeah. That is the frame for this. Hopefully at some point as you miss them as you are, are, are getting angry that they're no longer there, that their lack of presence in your life has changed your life. You get down about that and feel a little lonely without their presence and you start moving out of that and the reality of living life without them.
Host:
Yeah.
Dr. Scoggin:
You get hopeful if you get stuck in any one of those phases and kind of stop living your normal life, that's when we call, we say that grief becomes more complicated. Like when you stop eating it, interrupt your sleep. Yeah. People can confuse that with depression or anxiety. It's really that you haven't fully agreed and you gotten stuck in your grief.
Host:
You mentioned earlier, a minute ago about a new normal, you know, there's talk about, you know, we've in this region here around where wake forest Baptist health is, you know, dr Chris, all our infectious disease expert, he's, he's kinda described it as we've, we've, we're kind of, we've Crested onto this Mesa, uh, so it's not a sharp mountain, but it was a, it's a Hill and then it may side, that's kind of a plateau, uh, that we might be on this, this smaller plateau for a little bit and it's not a mountain. Uh, and as far as, uh, the clinical cases and hospitalizations and all the updates that doctor dr old gives. So, you know, there's been talk about, um, reopening certain facets of, of business operations and government operations. But it is going to be a new normal. As you mentioned earlier, what you know, if, if we're kind of saying, okay, we can see the light at the end of the tunnel, the worst in this area might be, might be close to behind us. Um, or we're just now turning the curve possibly. How is this going to impact or how might this impact people's mental health as we, we kind of go around the corner and we're on this plateau, this Mesa and you know, there's talk of, of opening certain things at some point in the near future. What do we, what do we, how do we go through the grieving process to get to this new normal and what does that look like?
Dr. Scoggin:
Yeah. Justin, I think the, the reality of the past five weeks is that our nervous systems has been highly activated in sometime some way our nervous systems have been on fire and dysregulated. I think we're starting to see a promote a mental health standpoint. People's nervous system starting to come a little bit back to what we would call a new normal. And the way I'm experiencing that as people are, are, it's kind of a let down reflex that your nervous system is not on high alert anymore. And we're in that phase of kind of the depression, loneliness, uh, as people are really just exhausted right now. So if you're feeling very fatigued and exhausted, that's, that's really part of a grieving process when you're kind of, you're absorbing the reality of what has happened, starting to process what that means for you to be a little depressed, reflective and feel a little lonely as normal. But I've also noticed that people are starting to feel some possibility of hope again and living their lives, getting back to a life that they once knew. And I think that's kind of where we're at in the grieving process that we're at that kind of tired, exhausted, depressed, lonely, reflective stage. But is we get signs that things may be opening up a, you'll start to see people's nervous system settle out, become a little bit more regulated. Uh, I've started hearing the department today and people smiling a lot more.
Host:
[inaudible]
Dr. Scoggin:
so I think there is some, some hope that is setting in and some beginning to accept, okay, this is, this is a unprecedented, but, uh, there is, as you say, light at the end of the tunnel.
Host:
Yeah, that's a, that's a good word. Dr Scoggin and I appreciate you kind of walking us through this idea of a grieving process of how we worked through the different stages of, of just how much our lives, our lives have been, have been disrupted and looking at, uh, what the future might hold ahead of us. Um, now, uh, you know, I've heard a term, um, uh, psychiatric pandemic and, uh, I've seen that maybe a couple of times out on the internet and, um, what do we, what are we looking at with, with what that means? Uh, what, what is maybe to come, is there, is there a kind of a wave to follow after this major disruption of our lives? And as we try and get back to, um, a new normal, the psychiatric pandemic, you know, w we recently saw that the Forsyth County government, they, they allocated a hundred thousand dollars for, for local mental health services. Cause I think they see a need coming or rising, uh, here locally. Um, can you explain that to us a little bit and, and what we can maybe be expecting and are we ready for this?
Dr. Scoggin:
Absolutely. Justin. We, we know from the, uh, disaster psychiatry literature that's been researched after natural disasters that really following something catastrophic like this, you know, people kind of gear up to, to manage it and to live. But once that's in, in, in the rear view mirror, so to speak, the, the mental, uh, and bodily impact of that really sets in with folks. And so what we're planning for is this pandemic. Yes. Of the psychiatric needs. They will follow kind of flattening of the curve at this COVID at 19. There's really four groups that I think about when I think about the psychiatric pandemic that's to come. The first group are those who just by the nature of their constitution and um, psychological makeup have been pretty resilient through this and will not really demand a lot of the psychiatric, mental health care. Their, their lives will proceed if you will, somewhat normally.
Dr. Scoggin:
The second group, I'm going to term the worried, well these are folks who uh, you know, they, they functioned pretty well. This has kind of activated some, some anxieties and concern, a little support during this time and following, uh, but, but they over the next six months will kind of snap back to a more regulated state. The third group really are, is, is the group that's been highly impacted by, by this psychologically. This group probably had some vulnerabilities prior to this, both social emotional and they will become, if you will, kind of newly diagnosed, uh, uh, consumers of, of mental health. And we will see a rise in that. I know that, uh, last month the prescriptions for anxiety called benzodiazepines went up 34% and our entry, so we know that anxiety is certainly on, on, on the rise in our country. And this third group will be ones who will become, uh, kind of the new consumers, if you will, of mental health services. Gotcha. Fourth group is really those who already were suffering with mental health and substance use issues and their, their conditions will, will worsen post COVID and they will need more attention and treatment. So that's that we'll extend this pandemic will extend really for six months to two actually years. That will be the after effects of this kind of catastrophic, unprecedented, uh, viral pandemic.
Host:
It's interesting, dr Scoggin. Uh, so as we see this mental health need coming, um, for the next several months, you know, uh, you know, I've heard dr crystal, uh, use national disaster analogies and I've heard you referenced them as well. And I think that's a good reference point for people to help understand kind of where we are. And, and you know, we've experienced though, if it's a hurricane or a tornado or a flood before, and this is, you know, the, the feelings that we are experiencing are not dissimilar from going through something like that. A major disruption in your life. You know, as we go through this and I appreciate you kind of helping us talk about identifying how would that we aren't in grieving process and then we can help us work through the steps. Um, so if someone, you know, com talks to you or you're in clinic with someone and they're presenting with this, uh, situation, doctor Scoggin, what, what do you tell them? How do you, how do you reassure them that this is, uh, going to, going to get better? Or how do you walk them through making progress to, to get to the, the other side, if you will?
Dr. Scoggin:
Well, one, one thing that I do, uh, Justin is just to, uh, try to help them name, uh, what they're feeling and to normalize that. Yeah. If you've never gone through this and you're, you start feeling differently and having experiences that you hadn't had before, sometimes just to put it into a frame that normalizes it helps, helps people. Some people will say, I feel like I'm going crazy. And I'd say, no, you're just, you're just grieving. And that's very normal. So normalizing is one of the things that I certainly try to do and help people name and label what, what's going on with them and to encourage them to take regular pauses when they start feeling a certain way that concerns them. What do I mean by pause? Kind of goes back to actually another podcast to do that, that dive deep diaphragmatic breathing to pause, to name what you're feeling and then actually just let it have its way. What, what we're, what we resist persists as Carlyon taught us many years ago. Resisting what you're feeling and not being able to name it can cause further complications. Yes.
Host:
Uh, well I like that information, dr Skogen. I think hopefully the people listening will find this useful. You know, as we wrap up this podcast episode about grief and the grieving process and, and working through that, um, you know, not dissimilar from, from maybe someone has experienced the loss of a loved one or gone through a natural disaster. You know, is there a kind of a closing word of encouragement that you would like to offer to people listening, um, you know, that have experienced, you know, a heightened level of stress or anxiety or, or maybe, you know, as they're listening to this, they're identifying that, you know, at, I've been going through this grieving process and I, this is, this is helping me, that I'm identifying this and naming it, you know, what do we, what do we, what can we look forward to? Dr Skogen is as we go through, um, hopefully work through, um, coming back into some of the, um, quote unquote normal functions of our lives at some point in the near future. You know, even even if it is a new normal, um, you know, at least either there's change on the horizon for us once again as we try and, um, integrate some of the more traditional processes back into our life. What, what is, what, is there a closing word of encouragement you have for us to help us stay focused?
Dr. Scoggin:
Certainly Justin. Thank you. The first thing I would name is the worst thing is never the last thing. So we can, we can certainly get caught up in this being a horrible shift in our lives and the impact it's having. Yeah. But remind yourself that those times when it felt like your life was coming apart and that you'd never recover. This is horrible. Remember those times where you recovered and it was not the last thing that that hope came again, you started living your life again. Because we've done that all of our lives. We just forget that the small things where we've been maybe majorly disappointed, hurt, but we found a way to recover. Life always has a way. So the worst thing is never the last thing important relative to the topic today. Give yourself some, some grace and patience to go through this normal process. Yes. And if you find that it's interrupting your life in terms of, as I said, sleeping, eating, you can't concentrate, well then you may need to reach out and get some, some more focused and professional help. But if you're just in this kind of lonely, depressed place or angry place, that's normal. You're grieving. We're all, we're all grieving at multiple levels, losses that we feel right now.
Host:
Well that's very helpful, dr Scoggin and as we wrap up, I just want to thank you and just helping us to realize that, um, it's okay to recognize and name BZ emotions, feelings, um, things that we're going through and to normalize them and validate them. Um, hopefully people listening will find this very helpful. Um, and hope you come back and join us again in the near future and um, we can talk about, uh, another, another interesting topic. So I know you're busy, but thank you for taking the time to join us today on this best health episode.
Dr. Scoggin:
Thank you for the opportunity, Justin.
Host:
Yeah, and as a, as we're wrapping up, I just want to invite everyone listening. Um, this podcast will be posted on, on the podcast page and in the, uh, in your podcast store along with all the other podcast about best health has done all the different episodes and it's also available on the wake health.edu/Coronavirus website along with all the other covert 19 related podcasts we have done, um, for additional resources. So, um, if people have um, questions or, or they listen to this podcast and found it useful or insightful and they want more information or maybe someone to talk to, you can definitely go to wake health.edu and, and get more information about how to contact us, um, to talk to someone. You can also call at three, three, six, seven, one six. Wait, um, faith health and see is another resource here locally that people can utilize. Um, if they, if they want to learn more about this or, or talk about this with someone. So dr Scoggin appreciate everything. Um, I hope you stay well and everyone listening until we talk next time, please be well,
outro:
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