Author Topic: Grief is the same as depression?  (Read 4032 times)

Dr. Richard Grossman

  • Moderator
  • Hero Member
  • *****
  • Posts: 858
    • http://www.voicelessness.com
Grief is the same as depression?
« on: August 15, 2010, 08:58:45 AM »
Hi everybody,

There's an interesting op-ed piece in the New York Times today--"Good Grief" by Allen Frances--about viewing grief as depression--the new DSM is currently leaning in that direction.  It raises the question:  in what circumstances is depression appropriate and for how long?  Also, should grief be "treated"?

http://www.nytimes.com/2010/08/15/opinion/15frances.html?th&emc=th

Hmmm, can "A Brave New World" be far behind?  Soma, anyone?

Richard

« Last Edit: October 24, 2010, 11:36:48 AM by voicel2 »

sunblue

  • Sr. Member
  • ****
  • Posts: 333
Re: Grief = depression?
« Reply #1 on: August 15, 2010, 11:53:11 AM »
Hmmmm....equating those who engage in normal stages of grieving with those who suffer from major depression, in my view, is not beneficial to individuals in either category.  Unless grieving occurs for an extended period of time and prevents the individual from functioning normally, it's not the same as major depression.  Labeling it as such can be harmful to the person grieving.  Also, what message does this send?  That anyone who experiences feelings of genuine sadness--whatever the reason and for whatever length of time--is depressed?  It serves to minimize even further major depression as an illness and those who suffer from it.  Grieving is a healthy state and a stage one must go through to move past a traumatic experience such as death or a major loss.  It's not the same as being depressed.  I think they're confusing feelings of sadness with depression.  Deep sadness is but one symptom of depression.  And sadness is a normal feeling that everyone experiences to some degree.  It is the degree that defines whether it constitutes mental illness or not.

Makes me wonder what's really behind this new definition?  Why are they looking now to extend major depression into those who grieve?  Do they really want to send the message that grieving is not "normal"?  Would a psychiatrist then treat and prescribe for someone suffering from "grief" in the same way as those with major depression?  I sure hope not.  As one who's suffered from depression my whole life, I know the difference between grief and depression.  It's not the same.  I would hate to see someone going through the normal stages of grief as being defined as having a mental illness.  Has our society become so fearful of the feelings of pain and sadness that we refuse to acknowledge they are "normal" parts of living...and instead a mental illness?
Hope the DSM5 hasn't gone to print yet!  LOL

Dr. Richard Grossman

  • Moderator
  • Hero Member
  • *****
  • Posts: 858
    • http://www.voicelessness.com
Re: Grief = depression?
« Reply #2 on: August 15, 2010, 01:48:26 PM »
Thanks, Guest and sunblue for your responses.

Maybe Big Pharma should invent a pill to keep people from making those damn attachments in the first place.   Preventive medicine...:wink:

More on this in a serious vein later,

Richard

Izzy_*now*

  • Hero Member
  • *****
  • Posts: 1688
  • Beer is living proof that God loves us
Re: Grief = depression?
« Reply #3 on: August 15, 2010, 08:58:39 PM »
It's the New World Order at work--- everybody's gonna grieve sooner or later; they get the special de-grieving pill; it's poisoned and helps with the depopulation!  :D  :D  :D
"The joy of love lasts such a short time, but the pain of love lasts one's whole life"

sKePTiKal

  • Hero Member
  • *****
  • Posts: 5441
Re: Grief = depression?
« Reply #4 on: August 16, 2010, 08:28:41 AM »
Quote
Has our society become so fearful of the feelings of pain and sadness that we refuse to acknowledge they are "normal" parts of living...and instead a mental illness?

Yes, I think it has. And we can add aging and death to the list, also. There is - and has been - for quite a while - a progression in societal attitudes to avoid, deny, minimize and discount "bad" feelings... as if there were no functional reason for those feelings. And as if those those feelings were a "malady" that isn't just a normal part of the human condition - the result of living life... and adapting to it.

Way too much of "health care", in my opinion, is focussed on pharmaceutical, surgical, and other extreme medical means to deal with what are normal life cycle changes. There is a pill for EVERYTHING these days... even if only a small percentage of the population actually needs the pill to maintain or improve their quality of life. The trend I've noticed, is that normal life "changes" need to be resisted and corrected at all (absurd) costs. Mass marketing of these drugs only serves to make normal people wonder if they themselves need this drug - if the normal stuff they're experiencing means they have this "disease" or "malady" that needs to be corrected with the pill. As if the marketers are trying to encourage everyone to become a hypochondriac! I really think that those ads should be banned - just like alcohol & tobacco ads were - because people are being persuaded that they need a drug for a symptoms that only a doctor could a.) diagnose as a serious condition and b.) possibly isn't out of the normal range and c.) could easily be reversed, corrected or adapted to with simple lifestyle changes. Now, there's even a drug to take if your normal anti-depressants don't make you happy as a lark!! (and no, I'm not anti-drug for the people who really need them... without penecillin I probably wouldn't be here writing this.)

Where did the idea come from - and what validity does it have - that normal people are giddy with happiness 24 hours a day? That there aren't challenges, obstacles, difficulties to deal with that irritate us, annoy us, make us angry or sad or even feel hopeless to change? That we can control everything... and that it's a desirable goal to control everything so that life's a party continuously. Without the "bad" feelings... how would we ever know we felt "good"? (Sorry for the soapbox rant - I've wondered these things for 40 years; it came out of trying to figure out what was wrong with my mom and why she was so afraid of people who were normally happy and enjoying their lives... as if that were a direct attack on her, you know?)

Blurring the lines between the criteria for a definite "mental illness" and the type of therapeutic treatments necessary to help some people adjust to changes in their life - a temporary situation - just isn't helpful, except to perhaps "mainstream" the idea that we're all mentally ill and there's a pill for that. Is there a pill for people who are delusionally happy all the time with no life problems? Is there a pill for N's, BPD, or just plain old stupid mean abusive people? (uh-oh... maybe I just suggested a new market!)

It does sound like Soma... but I'm keeping my fingers crossed that it's still a free country and we each have a real choice in the matter.
Success is never final, failure is never fatal.

Dr. Richard Grossman

  • Moderator
  • Hero Member
  • *****
  • Posts: 858
    • http://www.voicelessness.com
Re: Grief = depression?
« Reply #5 on: August 16, 2010, 08:45:24 AM »
Amen, PhoenixRising.  Thanks for your terrific post.  In labelling normal reactions to hard times as depression , we run the risk of medicating meaning--or the pursuit of meaning--right out of our lives.  And that would be a world I would have serious doubts about living in.

Richard

« Last Edit: August 16, 2010, 12:06:40 PM by Dr. Richard Grossman »

sKePTiKal

  • Hero Member
  • *****
  • Posts: 5441
Re: Grief = depression?
« Reply #6 on: August 16, 2010, 03:02:23 PM »
aw... gee... thanks!  :oops:

I still feel as though I'm sticking my neck across a guillotine making statements like this. But I sure think a lot of these things. I recently made a political statement to someone and immediately covered it with "but of course, no one cares what I think and it's probably considered politically INcorrect". Guy I was talking to, said: who cares what someone else thinks about what you think?

It was a very good point he made.
Success is never final, failure is never fatal.

Dr. Richard Grossman

  • Moderator
  • Hero Member
  • *****
  • Posts: 858
    • http://www.voicelessness.com
Re: Grief = depression?
« Reply #7 on: August 16, 2010, 10:50:25 PM »
Grieving is a healthy state and a stage one must go through to move past a traumatic experience such as death or a major loss. 

Hi sunblue,

Great post.  I agree entirely with what you say.  People who are grieving are likely to get high scores on the standard tests for depression (Beck Depression Inventory, etc.)  Pessimism, social withdrawal, insomnia, fatigue, appetite, loss of interest in sex, etc..  If it was left to Big Pharma and many psychiatrists, these would be signs of depression that should be treated, rather than allowing the natural grieving process to take its course.  Luckily, there is still time for the people responsible for DSM to re-consider their position—publication date is May of 2013.

Richard

P.S.  Many years ago at MGH I was asked to do an evaluation of a woman whose husband had recently died.  She wanted a face lift to help her move on with her life, but her children were concerned/angry that she had not grieved properly or long enough.  I did not tell her:  “no facelift, you should be grieving”.  There was nothing “wrong” with her—she had done whatever grieving was necessary and was ready to go on with her life.  Everyone is different, and certainly those differences should be respected.     

Meh

  • Hero Member
  • *****
  • Posts: 2740
Re: Grief = depression?
« Reply #8 on: August 19, 2010, 02:54:41 PM »
I know the point of the article is a little different then what I get out of it personally---

If grief = depression,
then,
depression = grief,

So depression could be see as prolonged grief. This makes a lot of sense to me. A LOT. And I don't think even one of my therapists ever told me that depression is the same as prolonged grief. And maybe therapists don't think that it is and that is why they don't say it.

Grief comes from a type of loss. If one is always at a loss for love and family and connection and acceptance then wouldn't that create prolonged grief and not be due to a mental illness?

I mean what if someone goes through pain and loss that is never healed, then that would make them "depressive".
I almost think that labeling someone as "depressive" is unkind because it says that there is something defective with a person- when the person may be living in a defective life.

Personally the idea of having prolonged grief due to life's circumstances instead of a "mental illness" makes sense to me and I would think this a kinder description of a problem.

I would like to add that the few times I have felt accepted in a family-like situation the result was I felt less depressed because the sense of belonging is pretty significant.

I know that there are supposedly gradations of depression and that makes me wonder if I have been uncarefully diagnosed with depression when I should be diagnosed with a form of prolonged grief. ?

Isn't (depression/grief) just mincing words. Isn't grief the period that people can tolerate another persons sadness and then "depression" begins when people around can't tolerate the grieving person any longer. Even animals in the zoo and experiment animals are depressed. So they are in prolonged grief because they have had to live such an unnatural life. I guess I have my own personal frustration with the term "depression" because depression itself becomes the root problem and the term seems to take away the cause and effect or situational element.




« Last Edit: August 19, 2010, 03:13:30 PM by Muffin buster »

sKePTiKal

  • Hero Member
  • *****
  • Posts: 5441
Re: Grief = depression?
« Reply #9 on: August 20, 2010, 08:37:15 AM »
You are RIGHT ON - muffinbuster!

Once I was able to see that I'd suffered many losses (in therapy) - and not been able to, allowed to, believe in my own right to grieve those losses... and consequently began doing the delayed grieving... the "symptoms" of depression and anxiety started to subside and abate - practically on their own, as if by "magic". That's why blurring the lines between these two definitions - clinically - is, in my opinion a bit mistake.

Edit in: I meant to type a BIG mistake... but my fingers weren't connected to my brain.

Furthermore: I wonder - if the DSM even takes into consideration this wide and varied category of "us - the voiceless for whatever reason caused it" - with all our symptoms - and recognizes that it is possible for us to heal - i.e., be cured - of what "ails" us, with compassionate therapy. And if not - why not?????? We're hardly "mentally ill" (despite the symptoms that masquerade as common recognized illnesses), most of us have simply been very badly parented and have integrated less successful life strategies for coping with that huge loss. Once we grieve, develop some new skills and new life strategies - we are no different than that the people who get labelled the "worried well", who occasionally need external support to get through major life transitions or challenges.

Sadly, I think our numbers will grow due to the stresses on families - both inner and outer - these days.
« Last Edit: August 20, 2010, 08:55:06 AM by PhoenixRising »
Success is never final, failure is never fatal.

teartracks

  • Guest
Re: Grief = depression?
« Reply #10 on: August 20, 2010, 11:13:14 PM »





PR,

Wow, I wish you sat on the DSM board (or whatever they call it) with Allen Francis.  Since his name came up here, I've read a little about him.  It appears that at the least, he is willing to acknowledge that the DSM guidelines are sometimes misguided.   I don't know exactly how the APA is structured when it comes to writing and updating the DSM, or whether they would consider a huddle or two with 'the other side'.   You said all that so well PR. 

tt

   

sKePTiKal

  • Hero Member
  • *****
  • Posts: 5441
Re: Grief = depression?
« Reply #11 on: August 21, 2010, 10:58:49 AM »
Part of my mind has been chewing on this topic, probably for longer than I realize.

In one way or another - I imagine that all of our stories here can be seen from the perspective of dealing with grief and loss. Current life, ancient history, addressed and unaddressed, conscious and unconscious. The things we struggle with and continue to refine and evolve and change for ourselves, too. Ways we've found to cope and to go on living. The old saying that the unavoidable things in life are death & taxes could also include grief as an unavoidable aspect of living. Like the Buddhist saying, that Life is suffering - perhaps it's meaning makes more sense if we rephrase it as Life involves Loss that is experienced as Grief. Grief is ancient and is an inherent human emotion - like love - and is NOT A MENTAL ILLNESS.

By the time I was 12-13, I was pretty well acquainted with death, loss and grief - both in my own loss experiences of people who substituted as parents; people I truly cared about and who returned the favor and through the difficulties posed by my mother's unaccepted, unprocessed, and unresolved grief over her mother's death, when I was 6-7. In losing my grandma, I lost the nurturing maternal attachment in my life - and part of me had to accept (kicking and screaming) that my mom wasn't ever going to be up to the task of providing this. I formed other relationships that served the same purpose with teachers, a neighbor, and an aunt to fill that need. I lost those relationships too, through moving house and death. I lost my dad through abandonment and divorce - and alienation of affection, which is a technical term for what I called my mom's brainwashing campaign to make me fear and loath my dad & support her instead. I even lost a huge part of my Self during that time period. I was only semi-aware of this and what a burden it was to try to carry it all by myself. Other people, especially people my age, didn't have to face this or deal with it - or if they did, their parents were right there caring for and help them along. There just wasn't anyone around to tell me that these kinds of losses - the grief that one feels as a result - and even my own loss of self (as a result of the rape) was freakin' normal... that they would pass... and that there wasn't anything wrong me, that wouldn't get better.

But many, many people in the world face this or worse every day. Like I said, this seems like an unavoidable part of life even though some people don't face it until they age or maybe have enough resources that they never face it alone. I needed help facing my grief and all my losses, consciously. It was a lot of stuff to process and I hadn't acquired the skills to do it solo - nor did I have enough resources and connections in my life - nor the awareness of the fact that this is what my burden consisted of, even. Without the process of therapy and the patience of my T as I went through approaching and then avoiding, then approaching from another direction... the actual content of the burden - my "dancing around the bush" stage - I came to appreciate that it was perfectly OK for me to need this kind of help. I simply couldn't ask any one other person in my life, to take all this process on - it really wouldn't have been fair to them. What she taught me, was that there is nothing to fear in loss and grief - these emotions can exist without "going crazy", like my mom did - never fully recovering.

She taught me that the burden of grief/loss I was unconsciously carrying was behind my feeling of being a fraud - I was reasonably success in life, on my own merits - yet I felt lower than slime and unworthy of stating the fact that I had needs, much less asking to have them met or meeting them myself. She taught me to be kind to myself - how to do this and what kindness is - and that adults need this too; not just kids. And she also taught me that total terror, abject grief, and even the despair of multiple losses all eventually subside and pass, but that it's not possible to make this conform to timelines, deadlines or schedules. I didn't learn this or discover it on my own - it's wisdom that needs to be passed from generation to generation, person to person. Eventually, after finally processing all those old, stashed away feelings - lo and behold - one day that burden (and all the associated crap that, like barnacles, attached to it) started to lift and blow away like fog or storm clouds. There are still barnacles around to clear away - but way fewer than when I started.

And it's just not possible to create a "one size fits all" treatment plan or way to process grief. Each person's situation and experience is different. It's absurd to call a temporary state or emotion a mental illness - simply because it can persist unaddressed, unprocessed and un-let go of - for a lifetime. In my case 40 years. And if I'd been treated for depression instead - the grief would still be unprocessed; still festering in my psyche - still a problem. And yes, in my experience, carrying this unrecognized burden of grief interfered with my life and even how I functioned and coped and grief was responsible for my low tolerance to stress and my self-sabotage style of coping. Yes, therapy was the answer and the path to well-being... but grief therapy - not therapy or treatment for depression.

To say that Grief needs to be included in an encyclopedia of mental illness diagnoses - simply because some people don't have the resources to resolve grief by themselves or to process it in a "timely fashion" (according to what model??)... and that they can be helped by compassionate therapists using the same techniques as in actual depression treatment, is what they call in economics a "moral hazard". It's a moral hazard, because what's next? Adding love & empathy & compassion to the DSM and suggesting using the treatment for bi-polar illnesses or schizophrenia to relieve our delusions and manias?

Being human and sometimes having human emotions - and not having learned how deal with emotions - is not a mental illness that needs life-long treatment.

OK - I think I'm starting to rant. I didn't realize I had so much to say about this - and I didn't know what I was going to say until I started. (EGADS!! what is that a symptom of??? LOL) Glad you're enjoying it tt! Is there any kind of lobby for the DSM committee? Any way to get clients' voices heard? Or will the "experts" decide to discount our opinions on their topics of expertise? After all - we go to them for help; I don't expect many of them to be willing to accept my point of view. And besides, I'm starting to take myself too seriously; I need to start looking for the absurd in this... the pure silly. Because it's surely there.
Success is never final, failure is never fatal.

teartracks

  • Guest
Re: Grief = depression?
« Reply #12 on: August 21, 2010, 10:22:31 PM »


About grief, if a young child experiences a grievous event and there is a caring person  to help the child understand that what they are experiencing (if indeed the child shows signs that they are grieving) is called grief (and that it has a beginning, a middle and an end, in other words they give the child a reasonable and honest age appropriate, loving explaination), then as an adult wouldn't the child, now adult have a reliable way of distinguishing feelings of grief from depression or melancholy that has no identifiable correlation to a greivious event?  

Edit in:  Some who have studied grieving, say that if a person (talking adult now) is healthy and well adjusted, they may not grieve at all.  I have a friend who nursed her husband through a long illness that ultimately took his life.  She started dating within days of his death.  This caused a rukus in her family.  She confided to me that her grieving had been done during the years she nursed him through his suffering.  I get that, but I'd have a hard time accepting that not grieving a loved one is normal.  

tt



« Last Edit: August 22, 2010, 01:36:49 AM by teartracks »

sKePTiKal

  • Hero Member
  • *****
  • Posts: 5441
Re: Grief = depression?
« Reply #13 on: August 22, 2010, 12:42:53 PM »
tt:
I'd say your friend did a lot of "pre-grieving"... in other words, dealing with the grief process, before the fact. I see my SIL doing some of this, in regards to her mother - the MIL who lives with me & my hubby. Your friend knew what the inevitable result of her care-taking would be and began rehearsing - in reality, dealing with all the emotional content of accepting that fact - prior to death actually taking place. Wonderful thing - our imaginations - in that respect. We can "experience" something that we haven't actually experienced yet. And then, when it does become reality it's possible to find that all the "work" is already done.

Example, is my Dad. By the time he died, I'd already done quite a bit of grieving for him and processing that loss. I'd had practice, you see. When he left the family: loss. When he had a stroke and the aphasia interfered with communication - loss. As he withdrew into his multiple illnesses and physical pain and didn't really want me to see him in that state - loss. When my mother tried to demonize him and turn me against him (with some success) - loss. My own fear of him, hesitation, reticence and reluctance about becoming entangled in the delicate balance of trying to have some sort of adult relationship with him - without triggering more fallout from my mom - loss. I had done a lot of the work - the heavy emotional lifting of processing that loss - before he died. Feeling the feelings, in one way or another. Rehearsing.

But then too, I realize that I will continue to process that loss for quite a while yet. It's not grieving per se. It's accepting my own actions, decisions and responsibility - and chipping away at a chunk of regret at things that might've been different; things I could've said and done differently, if I hadn't been saddled with a bigger grief that I was unaware of. I had a bit of a discussion with my T about the difference between grieving and mourning during the early days of my inner child work, with Twiggy. One day, I announced that Twiggy was done grieving. The time period was relatively short, surprising my T. But I qualified that, saying that Twiggy had moved on to mourning. I couldn't distinguish the two to my T's satisfaction at the time. In retrospect, I do know what I meant, though I think this meaning only relates to my personal experience and maybe has no relevance for anyone else.

In the context of Twiggy having experienced so much loss and grief so young, she became more well-versed in her own ways of dealing with it. So, when through therapy, Twiggy and I together faced the greater, global losses and grief of that whole time period... it didn't take that much time. Grieving, for me, is the emotional flood of total experience of pain & loss. It's looking into the depths of the hole that is left in me when someone is gone; the lonliness and void in emotional connection. It is intense, to say the least. And the only way to express it, as Guest suggests is: weeping and weeping. I've done my share of weeping in my life - usually for no apparent reason. It was mysterious and unconnected to anything in my current life. When I tried to meditate, for example. I would often awaken, with tears streaming - and no recollection of a dream whatsoever. During movies, when something would evoke my own old, buried experiences. When reading. And just out of the blue. And lastly - when I finally heard in Twiggy's words, what had happened to me. I finally grieved for my abject lonliness and abandonment and emotional abuse experienced in my Twiggy years in about 2 weeks. I'd been carrying it around and unconsciously grieving it for 40 years, you know?

But that simply meant that I was shifting into the mourning phase now. Acceptance of the facts; reality. Integrating the emotion into the whole of my experience of myself. Creating narrative and context so that the emotion finally made sense and wasn't an anomaly in my experience of life & me - a leftover, long avoided or prevented from attending to, task that interrupted a smooth, continuous (albeit ugly in parts) experience of my self. Adapting. And moving on - back out into life - more whole than when I had no clue about the giant grief that sat just behind my left shoulder and unbalanced my whole being. And that's a whole different process or experience for me, than grieving even though it does contain some sadness.

In answer to your question, tt: I don't know. It's easy to say yes, that learning from an adult how to process grief means that the individual will be able to identify it later, in comparison to depression. In my case, I didn't know if I was depressed or not. I didn't know WHAT I was. But I do know that a lot of the laundry-list of "evil" things I experienced at my mother's hands was a direct result of her absolute terror of grief. Her experience of this, when my grandma died and the consequent hospitalization for her "nervous breakdown" was applied to me as "what would happen" to me, if I didn't exhibit relief and happiness (and completely avoid grieving the loss of my school friends, my support network of teachers and my dad and the destruction of the whole life I built for myself outside of the sick FOO).  Because of course, in her mind, I was "just like her".  And I wasn't allowed to, or able to speak for myself - and be heard or believed - by her. When my grandma died, I wracked my brain to find ways to comfort my mom... to help get from grief to mourning. I tried and failed. But then, I was 6-7. I don't know how I knew how to do this, but I did. It seemed to me, that love and kindness and patience and nurturing were the right "first aid" for grieving. I guess that was my way of recognizing what my own needs were????
Success is never final, failure is never fatal.

teartracks

  • Guest
Re: Grief = depression?
« Reply #14 on: August 25, 2010, 12:48:28 AM »
My thoughts are incomplete on this.

My interpretation of grief includes the loss of a loved one, but also an event - something that caused a part of us to die inside  at the hands of another.  I also, expect it is well possible for grief to come live in us if we violate a deeply held standard, perhaps spiritual requiring repentance and confession.

When grief lives in us, as soon as it is recognized (sometimes it's there, been there for a long time. and we haven't acknowledged it, or it hasn't surfaced), it deserves honor, that process, procedure that brings 'closure' (closure seems like an incomplete description, but it's what comes to mind).  

Sometimes, because of the nature of the act that caused the grief, you may choose not to share it publicly, because of the hideousness of its cause or because making it public might bring attention to a despicable set of circumstances or a hideous person who might find glory in the attention brought to them.   It is also possible that public mourning may harm to others who sufffered deep injury/loss/grief in the same event that caused your grief.  

Sometimes honoring grief requires public mourning. There are a number of traditions for public mourning, wearing black, withdrawing from social events, etc.  You'll know what is right for you.

Sometimes when grief lives inside us, we can honor both the grief and its tragic cause (the thing or the one who caused it).

Sometimes when grief lives inside us, the thing or the one who caused it cannot, must not  be honored because of their despicable nature and what they did.  

Quote
Grieving, for me, is the emotional flood of total experience of pain & loss.
Regardless of what caused any grief that lives in us, it should be in my opinion,  recognized/acknowledged and honored in a way resembling a funeral.

These are some of the thoughts I've had trying to distinguish how grief and depression could be separated at least in certain aspects.  It  seems to me that grief is  always linked to a grievious event.  Depression/melancholy on the other could conceivabley overcome a person and not necessarily be linked to a grevious event.  Make any sense?  Please share your thoughts...

tt




 
« Last Edit: August 25, 2010, 01:41:19 AM by teartracks »