There has been much loss over the last several years in the news. With the rise in mass shootings, many individuals have died. Left to mourn are relatives, other loved ones, and friends. However, we all have experiences of death and loss in our lives. In the last month our own family has started to cope with the loss of our beloved niece secondary to pancreatic cancer. Also, I have been working clinically with several clients who experienced the death of loved ones. The times elapsed since the death event have ranged from one month to one year. In all cases, the individuals have asked me a question I've heard repeatedly: "How long should grief last before I return to my normal self?" In each case, I have explained that there is no established time line for when you should be "over" grieving. Usually, the follow-up question is: "Am I experiencing more than grieving, am I depressed?" Now that is a question which is not always easy for mental health professionals to answer, namely, the distinction among grief, complicated grief, and depression.
So just what is grief? Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. The more significant the loss, the more intense the grief will be. Most people associate grief with the death of a loved one. This is often the most frequent cause of grief. However, there are other losses which can cause grief, such as: divorce; loss of health for self or loved one; loss of job; loss of financial stability; retirement; miscarriage, among others. The more significant the loss, the more intense or severe the grief. Though everyone grieves differently, grieving is a normal process. Yet, it can worsen your quality of life and sometimes involves more serious symptoms when it lasts for a long time. This often is referred to as Complicated Grief. Estimates are that 10-20% of people who suffer from grief go on to suffer from Complicated Grief, a more long lasting and severe form of grief. Studies of complicated grief even have indicated brain changes in several areas (nucleus accumbens and amygdala) having to do with reward and avoidance centers in the brain.
Symptoms of grief can include: an intense pain when you think of your lost loved one; a heightened focus on reminders of your lost loved one; an overall feeling of numbness; a feeling of bitterness when you think about your loss; a loss of purpose or motivation; a loss of trust in friends, family, and acquaintances; an inability to enjoy life. People experiencing grief frequently suffer sleep and appetite disturbances as well as feelings of regret, guilt, or lessened worth depending on the circumstances.
The above symptoms and the profound sadness associated with grief can look a lot like the sadness clinical depression brings. The similarity can create a dilemma for mental health professionals: When should someone experiencing the loss of a loved one be diagnosed as depressed? In our old diagnostic manuals, no one was diagnosed with major depression, a major clinical mood disorder, within two months of the death of a loved one. That has changed with the latest edition of the manual making it easier to diagnose and treat a grieving person with depression.
So I go back to the original title question. Are you suffering from grief or depression? In both forms of sadness, you can experience a loss of interest or pleasure in activities you normally enjoy, as well as changes in sleeping patterns, difficulty concentrating, fatigue and other symptoms. However, there are distinctions. Someone who is grieving typically focuses his or her thoughts on the person who has passed away and experiences intermittent waves of pain rather than the constant pain typical of depression. Research also indicates that in most cases the depression-mimicking symptoms associated with grief tend to lessen over time with the help of family and friends. The support and assistance of family/friends as well as the individual's responsiveness to the support often are contrasted with the isolation and withdrawal of individuals suffering from clinical depression.
In my clinical experience, mindset or beliefs about the loss event have much to do with differentiating between what will remain a grief process and what will turn into a chronic depression. I find that most people are in a crisis at the time of the loss. How they give meaning to it for and about themselves and their lives is crucial. People with more absolutistic thoughts/beliefs about the situation and their lives are at higher risk for clinical depression. For example, I have worked with numerous clients who have suffered the loss of a loved one and said: "I'm sad, I think about them, I miss them". That is grief. Other clients state: "I can't go on with my life without my loved one, I can't trust any more, I can't enjoy my life anymore". These are the clients at risk to be headed for or maybe already in clinical depression. I remember a particularly sad case some years back. A family had brought in their 70 year old grandmother following the murder of her 25 year old grandson approximately six months earlier. She reportedly was sad, withdrawn, not sleeping or eating well. In speaking with her, she told me that she no longer could get close to anyone, particularly the grandchildren, nieces, and nephews, for fear she would lose them too. I only had this one meeting as the family did not return with her despite my recommendations. I learned about six months later that she had died in her sleep. While I can not say with any certainty, the old phrase "died of a broken heart" came to mind complicated by her beliefs about this very sad event for her. My point here is that the beliefs we adopt in resolving our feelings about the losses leading to grief influence whether the reaction remains grief or turns into clinical depression.
In any event, there is help available. Use the support of family and friends. Take care of yourself. Allow yourself gradually over time to re-engage life under the changed circumstances at your pace. If your sadness persists and interferes with your participation in life, consider obtaining professional help. You may need assistance with a clinical depressive disorder for which therapy and/or medications can help. As always, your mindset and beliefs will be critical. If you would like to know more about how stress can interfere with your life, please see our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For other information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com.
Good luck on your journey. May all your thoughts be helpful ones.
Dr. Paul Longobardi
For information on related topics, please see my website at www.successandmindset.com.