A personal perspective on grief and clinical depression

Ivan 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.

References:

http://grief.com/questions-answers/on-grief-grieving/

http://www.npr.org/templates/story/story.php?storyId=128874986

http://www.depression-guide.com/dsm4.htm

"What we can mention, we can manage"

Image via Wikipedia

Regarding death, we, as a society, often refuse to even mention the "D" word.

Our inner selves believe that if we don't call for it, death won't touch our lives.

Again, I have terrible news for you: death will touch your life. Either because you WILL die, without any doubt; or someone you love will die.

When it comes to children and grief, we usually expect children to:

• Act and react as adults
• Disregard the death of a loved one because we think they "don't understand" what is going on.

Since 1999, I began working with the bereaved. I learned that if a child is old enough to love, he/she is old enough to grieve.

The child might not acknowledge the death of a close relative or friend, but s/he will recognize that those around him/her are stressed out. Depending the developmental age a child has when facing the death of a loved one, his/her understanding will vary.

I firmly believe that those who work within a school and interact with children, have to be prepared to face - and to offer support to - a grieving child.

If you have been working within the school system and have never had to face a grieving student, you have been very lucky. Or you haven't acknowledge that one of your students was grieving.

Grief is a natural response to a loss, it is not exclusively to death. It might have been that your student lost something material, that is not important to you. It might have happened that your student lost someone important in his/her life because that someone moved. Maybe your student lost the stability of a loving home because his/her parents divorced.

Have you thought of the pain that a certain situation has brought to your student? Have you minimized their grief because their loss is not important to you?

When you are facing the bereaved, the most important thing to remember is: IT IS NOT ABOUT YOU!

Your feelings, your emotions, your thoughts, your experiences do not matter. When you have to offer support to a grieving child, no matter the source of his/her pain, you have to be able to put yourself out of the picture and focus on him/her.

You have to recognize that you don't have the power to make him/her understand what happened, to take his/her pain away, to make things better. The only thing you can do is listen and be there.

I have lived by this principle for the last decade of my life: "There is no excuse for the lack of compassion, not whatsoever"

Ignorance, our own inability to face grief, our selfishness, our problems, the lack of time are no excuses in my book for the lack of compassion. When put in a situation of setting an example for younger ones, the crime is even graver.

It is true: if we can mention a situation, we can work through it and we'll manage. This is a paradigm that we have to learn to live with.

If we can mention death and pain and suffering and grief, we can work through all the feelings, emotions and thoughts they bring and we'll be able to manage.

If we can talk about death and grief with our charges, our students, we'll be able to help them through a trying stage in their lives and we'll manage.

In the case you are unable to mention the above, please, please have someone capable to do so.

There are thousands of resources for grieving children, your obligation is to know them. There is no excuse not to have them.

Please, I beg of you, don't let a child grief alone because you are unable to be a compassionate human being!

The title of this entry was taken from the text written by Linda Goldman, regarding how to help grieving children within the school setting:

http://www.mcdes.org/pdfs/L%20Goldman.Grief%20article.pdf

Facing our demons: Children and Death

Image via Wikipedia

On December 26th, a tragedy happened:

A family of four were enjoying their time together, when suddenly, the mom fainted. Everything was done to bring her back. Nothing helped: she died of a pulmonary embolism in the prime of her life. She left a loving husband and two beautiful daughters, ages 7 and 4.

I know of this tragic event, because one of my daughters is a classmate of the older girl.

As my girls attend a Catholic school, I thought things were going to be handled well. How wrong I was!

The first Friday after classes resumed, they celebrated a Mass in memory of this loving, beautiful wife and mom. Sadly, the school principal didn't consider necessary for the girls' classmates to attend. I understand the 4 year old children would be difficult to manage, but the 2nd grade students couldn't be there?

• Her excuse: the lack of space inside the school chapel.
• The truth: there was space enough for 40+ little girls to attend and learn how to be compassionate and caring towards a suffering friend, but someone was not facing their demons and their lack to be compassionate.

Last Wednesday's afternoon, I got an email from the school administrators letting me know that my little girl HAD - as it already had happened -attended a class with the school chaplain in which they talked about the tragedy that happen upon this beautiful family.

Now, let me get this right. I am not opposed to the fact that the school chaplain, which is a beautiful, compassionate, intelligent man spoke with my girl and her classmates about death.

What makes me mad beyond words is the fact that they did it without letting us parents know, beforehand, the nature of the class and its contents!!!!

I wouldn't be angrier if they spoke about pornography to my children without letting me know first. I wouldn't be more upset if they spoke about masturbation to my 8 year old girl!

How dare they violate my primary right, as a mother, to be the first to talk about this life-altering subject to my own child?

As many adults of my generation, I was brought up in a culture that thinks that because we do not talk about death, we can keep it at bay. A society that keeps death closeted in a sterile hospital and then in closed coffin and expects us to mourn and grieve in a "well-bread" way: avoiding others feeling discomfited because our open display of emotions.

We expect our children to understand it quickly and quietly and then, move on with their lives, happy and carefree as they were before the reality of life got the best of their childhood.

Well, let me tell you something: death is the only reality that we know, for sure, we will face. We tend not to think about it because we fear it. I do believe that we fear more the death of those we love that our own death, but still, we fear it all the same.

I have bad news for you: Death is a messy thing. Mourning and grief are messier. When a loved one dies, part of our own life dies as well. The loss might be unbearable; the pain, excruciating.

Our life changes radically: nothing will be the same as it was before. We need the time and space to face what happened, to work through our thoughts, feelings and emotions. Probably, our physical health might be compromised for a time being.

As we embark on our grief journey, we need all the help we can get, although we might not even be aware that we need it.

The grief we face after the death of a loved one does not resolve itself in a couple of months, or even in a couple of years. We need to be aware of this reality and make the best of it. This is what makes us stronger. As in the case of these little girls, they will revisit their grief over their loving mommy's death over and over, as they grow up and understand it in a different light and when significant events in their lives take place.

Now, I strongly believe that compassion is a learned human virtue. We are used to think that because we are human, we are compassionate. Well, I am sorry to disappoint you. Instinctually, we avoid pain. Even the one others suffer. When we see others in pain, we cringe inside either because it hurts us seeing another in pain or because it reminds us that it could be me the one that suffers.

Compassion has to be taught. The best way to teach it is with our example. It the case of the classmates of these girls, the school - being a Catholic school, staving to make good, virtuous women of all their student - lost a golden opportunity. They should have been present on that Mass. Lending their loving presence and strength to that friend that needed to feel surrounded by love and understanding.

Now, back to the other charge I lay here. Another golden opportunity was lost as well. I believe that trying to explain death to those little girls, considering their developmental stage and opening a trusting communication channel is an honor that should be cherished.

I confess I am a devout Catholic. This fact does not blind me to the need to understand things in a human, rational plain, and then elevate them to the theological point of view.

How easy is to talk about God's will when you are not in pain! How easy is to tell other to accept God's will when your loved ones are alive, happy and healthy!

I, as a parent, was wrongly deprived of my primary right to educate my girl about the truth of death. What is left to me is to pick up the pieces and try to make the best of it, and correct all the misconceptions my girl got last Wednesday, with all the lack of information I have because the school didn't gave us parents the content of that class and I have to work from what my 8 year old girl understood or misunderstood.

Even though, my area of expertise is parental grief, I do understand grief, as a 13 year old volunteer to The MISS Foundation.

I have read many, many books regarding children and teen grief.

I have had to work hard through my own misconceptions about death and my own complicated grief over the death of a beloved grandparent, as I did as society expected me to do at the time of his death and never got the chance of grieving his tragic death in a healthy way.

I have had the honor to walk along others through their grief journeys after the untimely death of their loving children. I have seen the consequences of bad death education and its repercussions in the grieving process, complicating the very difficult grief journey of a bereaved parent.

So, don't you think it is time to face our own demons in order to help others in need? Don't you think it is time to face yourself in the mirror and accept your limitations? Don't you think it is time to accept we can make mistakes, and even with the best of intentions, hurt others in need?

I urge all of you to look inside yourself. I urge you see if your incapacity to face pain and suffering is affecting others, is challenging your ability to educate and care for those you should teach how to be better.

I invite you to accept the reality of death in your own life. I invite you to face the fact that death will touch each and everyone of us, one way or another. I invite you to deal with your demons and be there, be really there, for those close to you that are in grief.

If, after looking inside yourself, you are brave enough to acknowledge that you don't have it in you to be there, please, I beg of you, look for someone who can lend the support you are unable to lend. It is nothing wrong with this. I applaud your honesty and bravery!

I wish, with all my heat and soul, that non of you were to feel the pain and grief of loosing a loved one to death. I wish, with all my heart, that I had the ability to shelter you from grief. Sadly, I know I can't.

If you have a moment, please say a little prayer for the family I told you about. Please say a little prayer for all the families that are going through the terrible tragedy of the death of a loved one. Thanks.