Wednesday, March 21, 2012

A personal perspective on grief and clinical depression

Ivan Kramskoy- Unconsolable GriefIvan Kramskoy- Unconsolable Grief (Photo credit: Wikipedia)

There is no excuse for the lack of compassion...

First of all, lets get the terminology out of the way, just to know that we are standing on firm ground:

Depression is defined as "a biological-based mental illness that can have lasting emotional and physical effects, such as feelings of worthlessness, guilt, or indecision; difficulty concentrating; change in appetite or sleep habits; loss of energy, interest, or pleasure; loud, violent, troubled, agitated, slowed, or anti-social behaviors; drug or alcohol abuse; and difficulty with interpersonal relationships."

A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Symptoms of depression include:

  • Feelings of hopelessness, pessimism.
  • You feel that life is/has been "passing you by"
  • You don't want to see people or are scared to be left alone
  • Social activity may feel hard or impossible
  • Feelings of guilt, worthlessness and helplessness
  • Persistant sad, anxious or empty mood
  • You feel exhausted a lot of the time, with no energy
  • You feel as if even the smallest tasks are sometimes impossible
  • You spend a lot of time thinking of what has gone wrong, what will go wrong or what is wrong about yourself as a person.
  • Loss of interest in previously pleasurable activities
  • You feel a burden to others
  • You sometimes feel that life is not worth living
  • You feel no confidence in yourself
  • You have difficulty sleeping or waking up
  • You have changes in weight, significant loss or excess gain
  • Restlessness, fatigue
  • Physical aches and pains, sometimes with fear of being seriously ill
  • Thoughts of death and suicide
  • Increased Heat beat
  • Poor concentration, memory or attention

Grief, on the other hand, is the internal process we go through after a loss.

It is the internal part of loss, how we feel. The internal work of grief is a process, a journey. It does not end on a certain day or date. It is as individual as each of us.

Grief is real because loss is real. Each grief has its own imprint, as distinctive and as unique as the person we lost. The pain of loss is so intense, so heartbreaking, because in loving we deeply connect with another human being, and grief is the reflection of the connection that has been lost.

It does not have a clear beginning or clear end. It is a reflexion of feelings surrounding the loss. As we don't get over the loss of someone, we have to learn to live with that loss. Eventually, we will be able to remember and honor our loved one without feeling pain.

We shall grief as long as we need to.

The difference between mourning and grief is that the first is the external part, the actions we take, the rituals and the customs we have when someone dies. Grief, instead, is the internal part of the loss.

Ok, now why are all these people - including annoying me - raising their voices and filling your FB, Twitter, email and another way of communication, with words such as "DSM", "APA", "Bereavement Exclusion", among others?

The crux of the matter is that the members of the APA (American Psychiatric Association) are revising the DSM, which is the catalog of mental illnesses and disorders and are seriously considering getting rid of the bereavement exclusion.

Up until today, a physician would wait to diagnose someone with clinical depression if their patient had suffered a loss. That is what is called the "Bereavement exclusion".

The proposal to the new edition of the DSM, its 5th, indicated that a person should be treated as clinically depresses just after TWO WEEKS, yes that is correct, just FOURTEEN DAYS following the death of a loved one.

Remember the differences between mourning and grief? It might be the case that the DSM V committee confusing both… That is something to consider.

Now lets get to my story... The story of my illness and my personal and professional experiences with death and loss and the bereaved, so you may get why I chose to use the words "personal perspective" on this post:

When I was eighteen years old, I was diagnosed, for the first time in my life, with clinical depression, or "major depressive disorder" as it is listed on the DMS IV.

Sadly, it is a trade that I share with several family members and thankfully, I had received the appropriate treatment since then.

I was taught, back then, to accept my depression and to learn to live with it. I have been living with my illness as any diabetic lives with his/hers. I am not different from anyone. I just need to be careful with my mood swings and my energy level.

I have consulted many, many doctors over the last twenty three years of my life. I have been lucky enough to find the right psychiatrist at the precise moment of my life. I am grateful beyond words for them and the use of their knowledge to help me deal with my depression.

Let me tell you something more about my illness:

My symptoms at one time or another, had included each and every one of those enlisted above... yes, I did contemplate committing suicide at one point.

Extreme fatigue is the symptom that dominated my depression. It is still my depression demon.

When I was not treated, just getting out of bed and brushing my teeth, took away all the energy I had and still, I inevitably, had the rest of the day ahead of me. The effort of daily activities put me in a foul mood, not because I was angry at anyone, simply because I lacked the internal battery I needed to fulfill them.

The medicines I have taken over the years, had been extremely helpful in balancing my energy level, remember my diabetes - depression comparison?

Of course I get tired, but I am able to get throughout the day and the rest I get at night is enough to charge my batteries as a healthy person does.

When I was in my late twenties, my husband and I lost three children prior to their birth due to a balanced maternal translocation. In just two years, we had to deal with their deaths.

At that moment in time, I was already in psychiatric treatment, getting the antidepressants that I have needed to treat my symptoms, do you remember me telling about extreme fatigue as my depression demon? That is what I am referring to.

My psychiatrist was compassionate enough not to treat my grief as clinical depression, she still is. She knew well enough that I had reasons for feeling as I was.

She never medicated me to make me feel numb. She never urged me to get over the intense pain I felt over the death of my children. She sat down with me, twice a week and listened. She is a good example of what a doctor should be, according to the Hippocratric Oath she took when she became one.

After a couple of years and working very hard though my grief, both within the MISS community and with my psychiatrist during our therapy sessions, I began volunteering for the MISS Foundation.

By then, I was able to reach out to other bereaved parents. I got certified as Support Group Facilitator and working with the bereaved was the reason behind the Masters in Family Science that I earned at the beginning of the century.

I have been honored to walk along with many, many bereaved parents through their grief journey and to know their children through their loving eyes. It does not matter the cause of death or the age the child had when he/she died.

I have met and worked with bereaved parents under medication, given just after the death of their child. Do you want to know what happens to them?

Their grief gets relegated to be dealt with for a later time. The medication they get is unnecessary.

Why? Because they are grieving, they are not depressed!

They have to work through their feelings, emotions and thoughts, they have to reconsider the plans they had for their life, they have to live with the daily reality that their child has died and will not come back.

They have to understand that there won't be kisses and hugs, long talks and arguments, graduations and weddings, nor will there be grandchildren from that particular child.

Do see the depth of their situation? Can you understand the magnitude of their suffering? Do you truly believe that medication will integrate the death of their child?

Bereaved parents, as any bereaved person, need time. First, to let the reality of the tragedy sink in on their brains. That takes between three weeks and two months.

Then, the grief process really starts... Its continuum is a roller coaster of emotions and feelings and thoughts, which may appear similar to some symptoms of depression, but are not. They are normal and natural and expected within the grief journey these parents embarked without their will.

“Compassionate Human Contact is what they need, not medication!”

How do I -and every HOPE mentor, Support Group Facilitator and Online Support Group Moderator with in MISS- work with these families?

Well, I give them my time, freely. As I will never get it back, I know how important every minute I am before a grieving parent is. I am willing to listen and sit with them as close or as far away as they need me to be.

I am willing to sit along with them in that dark, pit hole grief takes us once in a while and wallow with them, and then, holding hands get out to the world again.

Was I able to explain the difference between grief and depression?

Was I able to make clear the difference between compassionate care - from you physician, your social worker, your clergy person, your family, your friends, your support group - and medication?

I hope I had... After all, I am not in the mental health business, I am a lawyer!

I have said what I needed to say.

Please think about what you have read, and let me know what your thoughts are.


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  1. Touching, brilliant and well documented. Entries like this one should be mandatory reading for members of the APA.

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