Don't Let Your Grief or Loss Turn into Depression

Very often, I work with people who have recently suffered some type of important loss in their life, usually a spouse or significant other.  The loss can be through death, divorce, or the break up of a relationship.

This process is almost always painful, but it is important in these situations to separate out the necessary pain from the unnecessary pain.  The necessary pain is the grieving.  Grieiving is the way that the mind detaches from someone with whom the grieving person has bonded.  Grieving hurts badly, and I wish that it was not necessary, but it is.

On the other hand, depression is not necessary.  Depression is more severe, more pervasive, more disabling, and to some degree has a different symptom picture.  "Uncomplicated grief" is different from grief that develops into depression:

• In grief, the negative thoughts tend to be more realistic, such as "I will miss them terribly," or "they were unique," rather than "I will always be alone" or "There is no one else that I can be happy with."
• Similarly, feelings of worthlessness are not part of grieiving.  To the degree that guilt is present, in grieving the feelings are limited to specific incidents regarding the deceased; in depression, it may be more pervasive or illogical.
• In grief, suicidal thoughts are usually not present.
• In grief, there is usually not the intense psychomotor slowing (slowed thoughts and movements).
• In grief, there is usually not too much work impairment.
• Depression tends to be more pervasive, and nothing may lead the person to feel much better, whereas in grieving, the support of friends and family is more likely to help the person.

There are probably at least four pathways by which grieving becomes depression.

Pathway #1.  Negative thinking.  In this pathway, the person doesn't simply miss the person that has died or left them; they attach very severe negative interpretations to it.  "I'm a loser; I will never find anyone else; I'm ugly; it is my fault that he left me; I'm being punished by God by Him taking my husband away."

Pathway #2.  Excessive withdrawal from life.  Many of us have a tendency to withdraw and "lick our wounds."  To some degree this is normal.  However, it is quite possible to withdraw so much that we interrupt the flow of our daily lives.  We pull back from life so far that we cannot recieve any social support.  We may pull back from pleasurable experiences in general.

Pathway #3.  Triggering an underlying genetic tendency towards depression.  For some people, the depression is not due to what they are doing or thinking but to the way their brain responds to stress.  They may have already experienced major depression in their life.  In this case both medication and therapy may be needed.

Pathway #4.  The triggering of old memories.  The loss of someone in adulthood may trigger painful, unresolved feelings from some event very early in life, such as the death of a parent.  Again, therapy might be helpful in this situation.

In general, when I am helping someone who is going through this process, I try to allow them to grieve in whatever way is comfortable to them, but within limits.  I try to keep them from falling into the trap of excessive negative thinking, or from pulling back so much from life that they have no enjoyable experiences.