This is the fifth of six blogs focused on “The Stages of Grief”. In this one, we will be looking at depression, which can create a great deal of confusion for grievers.
For those readers who have yet to read the previous blogs in this series, once again it is important to understand that in no way are we saying that “the stages of grief”, as proposed in “On Death and Dying”, do not have application as they were originally noted as related to those diagnosed with a terminal illness. Our concern is when they are applied to all of the many emotional losses which can bring grief into people’s lives. Every major change in life brings with it elements of grief.
Most people have little or no training in dealing with loss.
The problem for grievers is that the majority of them have had little or no training of any value regarding how to handle their grief. While they may have had a lifetime of experience with how to accumulate new things, they have very little education on how to deal with the emotions associated with loss. When they are suddenly faced with a grief causing experience, they are lost.
Some friends will respond to grievers with cliche ridden advice about keeping busy or suggestions why they should not feel sad. These suggestions may seem logical, but grief is hardly logical. It is emotional. No amount of logic can truly overcome emotional pain.
Eventually, some well-meaning, but not professionally educated, friend will mention the stages a grief, including the stage of depression, as a way of defining what a griever must experience. Most grievers are so desperate to feel better, that they never question the viability of this model as related to their particular situation. What they hear is that they must go through each step, in the order presented, to recover.
How people gather information has changed dramatically over time.
The world of obtaining information has changed dramatically since Elisabeth Kübler-Ross first proposed this model in her book. At that time, in order to be exposed to new research, one had to go to a bookstore or library to find the source material. This meant that the reader had read the entire study. New ideas were carefully researched and edited before they went to print.
The first place most people depend on today, when they discover that their friends’ suggestions on how to cope with their loss does not seem to make things better, is the internet. Since most grievers suffer from a reduced sense of concentration, they are not looking for extensive studies, but rather short and simple answers.
If they search the word “depression” on the internet, one of the first things they will encounter is “clinical depression”. Grief is the normal and natural reaction to any change in our lives. It is normal reaction, not a mental illness. The griever does not understand this distinction, however, and may self-diagnose themselves as clinically depressed on some level.
Most grievers do not think to seek out a “grief professional” for help.
It is understandable that grievers do not understand the difference between true depression and the overwhelming feelings of loss associated with grief. They simply know that something is not “right”, and will often call their regular physician.
Sadly, while general practitioners and internists have extensive training in medical issues, most have very limited knowledge concerning grief and loss. It is highly likely that the stages of grief concept was presented at some point in medical school, but it is equally likely that they never fully explored this subject unless they went on for advanced studies in psychiatry or mental health.
When I was young, our family physician knew us both socially and professionally. He knew what was happening in our lives beyond just our medical needs. He inherited us in his practice from his father, who had been our family doctor before he retired. It was not unusual for him to spend thirty minutes to an hour visiting with us prior to making any diagnosis or prescribing any medication.
That is not always the case today. In the world of modern medicine, we normally visit with an assistant first, who takes our vitals and notes our presenting symptoms. When the doctor comes in, he or she will look at the notes, ask a few questions and then offer a treatment plan, often within a matter of minutes. That intimate knowledge of our exact situation and the extenuating circumstances may not be something of which they are aware. The number of patients that they are required to see in their daily practice does not allow the average physician time to delve deeper into our lives. (I am very fortunate in that I have found a doctor who, while rarely on schedule, always takes the time to visit and gather details, but she is an exception).
Problems arise when grievers are treated for their symptoms, rather than the underlying problem.
The symptoms of grief are similar to that of depression and other medical issues. Grievers have a reduced sense of concentration and often have trouble focusing, suffer sleep related issues, find completing tasks difficult and are easily upset. It is also not uncommon for them to self-identify as being depressive, since they have been told by others that this is a “stage of grief”. Given the shortage of time most physicians face, and the desire they have to treat what has been presented to them as a medical issue, it is not uncommon for them to prescribe a mood altering medication.
Doctors may even prescribe antidepressants when they are fully aware of all of the details. I cannot begin to count the number of times that I have met with a family to make funeral arrangements where I was told that their family doctor had placed them on medication to help them through their loss.
This is not intended in any way to be a blanket indictment of the medical community. These physicians are trying to help in the best way they know how. Dealing with the intricacies of grief is not necessarily in their medical training. When that grief becomes prolonged, the DSM-5 actually mandates medication with major depressive disorders, including bereavement. The problem comes in when they are treating the presenting symptoms, without dealing with the underlying issues of what is causing the pain of the emotional loss.
Labeling a griever as being in a stage of depression can have negative consequences.
The emotional pain of any loss can be intense. Whether we try to deal with this pain by hiding our feelings or by medicating them, to make them less intense, still does nothing regarding processing them. At the end of the day, that pain is still there if we take no substantive action.
Telling a griever that, in the stages of grief, depression is a step that may or must be experienced, simply gives them a label for these feelings. It may not even be an accurate one. It does nothing to help them move beyond those feelings. It actually may serve as a stopping point to their moving forward, since they can now just tell people that they are in a stage or state of depression, and since it was due to a loss, there is not a cure.
Emotional loss is exacerbated by unfinished business.
Grief is not, in and of itself, a medical condition. It cannot be cured in a medical sense. It can, however, be something through which we pass if we are willing to realize that it is directly related to the unfinished business with the relationship lost.
If the griever is willing to take action to identify this unfinished business, and take additional action to deal with that business, there is hope for a better and happier tomorrow. A permanent solution cannot be accomplished with a pat on the head or a pill, but rather requires honest work in dealing with these feelings in their rawest form. These needed actions are the focus of The Grief Recovery Method.