Veronica Rex is no stranger to grief. She lost her daughter and son-in-law in separate murders in 2009, and her son in another murder in 2018 — leaving 10 of her 15 grandchildren missing a parent.

When she heard that a mass shooting on South Street last weekend had killed 3 and injured 11, a fresh wave of grief consumed her. She kept thinking about how many families were shattered and thrown in disarray in a day.

“You become lost, and when I say lost, it’s like days, you don’t want to get up,” she said. “I was broken.”

Her work in her community trying to help with issues like the opioid crisis has helped her to move forward. But the constant news of gun violence — in the newspaper, on television, filling her Facebook page — triggers painful memories.

The field of psychiatry recently created a new diagnosis to help people who remain immobilized by grief for unusually long periods of time. Such changes come as the coronavirus pandemic has compounded the usual burden of grief and mourning, and Philadelphia in recent years has experienced some of its bloodiest on record for gun violence. So far this year, nearly 220 people were murdered in the city, each leaving behind a circle of grieving individuals.

With so much loss, there is always someone grieving in the city.

» READ MORE: South Street shooting victim Alexis Quinn remembered as a loyal, loving daughter who ‘brought people together’

The Uplift Center for Grieving Children provides services to bereaved children and their family members. About half of the youth that signed up for their school or family grief groups have lost a loved one to homicide — but that doesn’t mean a murder is the only death that has impacted them.

Racial inequities in health and safety manifest in how mourning is experienced by the clients of the organization, which primarily serves Black clients.

Kevin Carter, Uplift’s clinical director, says the center works with many youth who are grappling with multiple deaths — whether from violent crime, COVID, or health issues such as cancer.

“What we want people to do is to see grief as a normal, natural, necessary part of living and being human,” Carter said. “We are trying to help people process their grief so that it doesn’t get stuck inside them.”

‘Stuck-inside’ grief

The notion of grief getting “stuck inside” was recently formalized by the psychiatric community with the addition of “prolonged-grief disorder” to the Diagnostic and Statistical Manual of Mental Disorders — sometimes referred to as “psychiatry’s Bible” — earlier this year.

“There is a course beyond which grief becomes problematic,” said Nadine Melhem, an associate professor of psychiatry at the University of Pittsburgh. Her research on grief helped to inform the decision to add prolonged-grief disorder into the DSM.

The diagnostic criteria of prolonged-grief disorder is intense grief that persists six months after children experience a loss and one year after a loss for adults.

Melhem explained that prolonged-grief involves intense yearning for the deceased, preoccupations with the deceased, thoughts of the deceased, and inability to accept the death over a long period of time.

» READ MORE: In their own words, seven moms whose children were killed by gun violence share what they’ve lost.

Prolonged-grief is associated with clinically significant impairments for school-aged kids, such as diminished social interactions and educational struggles.

Therapists and access to supportive services alone are not enough to give people a sense of safety in communities that frequently experience shootings. And access to mental health resources has been a challenge for many throughout the pandemic.

Erica Wilkins, a licensed therapist and the director of the couple and family therapy program at Thomas Jefferson University, says that the persistence of gun violence makes processing grief all the more difficult, especially in communities of color that are disproportionately affected.

“There’s triggers, always,” Wilkins said, adding: “We in Philadelphia for a very long time lived with the daily trigger of news reports of people being killed.”