Differentiation between the Healthy Process of Grief and Depression

This information is lifted off the Diagnostic and Statistical Manual of Mental Disorders ( DSM 5).  Interestingly, this passage, which I consider to hold very important information, is written as a footnote on page 134 of the Manual.

What is the difference between grief and major depression, anyway?

For one thing, grief is a natural, healthy reaction to loss. It is an emotional response to something that has happened in our lives. We cannot escape encountering losses, and we cannot escape feelings of grief when it happens. Just because one feels terrible in a state of grief, does not mean that one has a mental / psychological disorder.

My reason for highlighting this, is with the hope that in grief, one one learns to find the right kind of self-support: find someone to talk to, try to not be alone, cry, find creative outlet and let time heal the wound (although it may leave the scar).

A potentially detrimental method of avoiding grief is to turn to drugs or narcotics, blame the self/self judgement for feeling bad, or any kind of harming the self or others.

grief and depression psychotherapy
Grief vs. Depression

Here’s what is written in the DSM-5 footnote:

“In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief the predominant affect is feelings of emptiness and loss, while in a MDE it is persistent depressed mood and the inability to anticipate happiness or pleasure. The dysphoria in grief is likely to decrease in intensity over days to weeks and occurs in waves, the so-called pangs of grief. These waves tend to be associated with thoughts or reminders of the deceased. The depressed mood of a MDE is more persistent and not tied to specific thoughts or preoccupations. The pain of grief may be accompanied by positive emotions and humor that are uncharacteristic of the pervasive unhappiness and misery characteristic of a MDE. The thought content associated with grief generally features a preoccupation with thoughts and memories of the deceased, rather than the self-critical or pessimistic ruminations seen in a MDE. In grief, self-esteem is generally preserved, whereas in a MDE feelings of worthlessness and self-loathing are common. If self-derogatory ideation is present in grief, it typically involves perceived failings vis-à-vis the deceased (e.g., not visiting frequently enough, not telling the deceased how much he or she was loved). If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about “’joining” the deceased, whereas in a MDE such thoughts are focused on ending one’s own life because of feeling worthless, undeserving of life, or unable to cope with the pain of depression.”

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Experiences of Grief after a Loss of a Loved Person

What does a person go through when he/she loses a very dear person? This person could be a parent, spouse, child, friend or even pet.  Every person’s experience is unique, because every relationship is unique. In order to understand what people may go through after the death of someone special, here is a questionnaire that I found.

How is the experience of grief described?

This is a set of questions that one can reflect upon when accessing the grief experience.

Since the death of your loved one, how often did you:

      1. Think that you should go see a doctor?
      2. Experience feeling sick?
      3. Experience trembling, shaking, or twitching?
      4. Experience light-headedness, dizziness, or fainting?
      5. Experience nervousness?
      6. Think that people were uncomfortable offering their condolences to you?
      7. Avoid talking about the negative or unpleasant parts of your relationship?
      8. Feel like you just could not make it through another day?
      9. Feel like you would never be able to get over the death?
      10. Feel anger or resentment toward your loved one after the death?
      11. Question why your loved one had to die?
      12. Find you couldn’t stop thinking about how the death occurred?
      13. Think that your loved one’s time to die had not yet come?
      14. Find yourself not accepting the fact that the death happened?
      15. Try to find a good reason for the death?
      16. Feel avoided by friends?
      17. Think that others didn’t want you to talk about the death?
      18. Feel like no one cared to listen to you?
      19. Feel that neighbors and in-laws did not offer enough concern?
      20. Feel like a social outcast?
      21. Think people were gossiping about you or your loved one?
      22. Feel like people were probably wondering about what kind of personal problems you and your loved one had experienced?
      23. Feel like others may have blamed you for the death?
      24. Feel like the death somehow reflected negatively on you or your family?
      25. Feel somehow stigmatized by the death?
      26. Think of times before the death when you could have made your loved one’s life more pleasant?
      27. Wished that you hadn’t said or done certain things during your relationship?
      28. Feel like there was something very important you wanted to make up to your loved one?
      29. Feel like maybe you didn’t care enough about your loved one?
      30. Feel somehow guilty after the death of your loved one?
      31. Feel like your loved one had some kind of complaint against you at the time of the death?
      32. Feel that, had you somehow been a different person, your loved one would not have died?
      33. Feel like you had made your loved one unhappy long before the death?
      34. Feel like you missed an early sign which may have indicated to you that your loved one was not going to be alive much longer?
      35. Feel like problems you and your loved one had together contributed to an untimely death?
      36. Avoid talking about the death of your loved one?
      37. Feel uncomfortable revealing the cause of the death?
      38. Feel embarrassed about the death?
      39. Feel uncomfortable about meeting someone who knew you and your loved one?
      40. Not mention the death to people you met casually?
      41. Feel like your loved one chose to leave you?
      42. Feel deserted by your loved one?
      43. Feel that the death was somehow a deliberate abandonment of you?
      44. Feel that your loved one never considered what the death might do to you?
      45. Sense some feeling that your loved one had rejected you by dying?
      46. Feel like you just didn’t care enough to take better care of yourself?
      47. Find yourself totally preoccupied while you were driving?
      48. Worry that you might harm yourself?
      49. Think of ending your own life?
      50. Intentionally try to hurt yourself?
      51. Wonder about your loved one’s motivation for not living longer?
      52. Feel like your loved one was somehow getting even with you by dying?
      53. Feel that you should have somehow prevented the death?
      54. Tell someone that the cause of death was something different than what it really was?
      55. Feel that the death was a senseless and wasteful loss of life?

Finding the Answers

The questions, answered in the affirmative within the first 2 years of loss of a loved one, reflects the natural response of grief. After a longer period of time, the feelings should subside. If feelings of grief develop into depression, seeking counseling can be a life saver.

Seeking a balance in allowing oneself to grief, and then to slowly move on with living a life without the loved one is an act of taking responsibility for one’s own survival. That is a matter of individual choice, and freedom. Finding resources to survive loss is part of the act of responsibility. A good resource one  can achieve for oneself is to find someone who would listen. This person may be in the form of another family member, friend, counselor, priest or psychotherapist.

Bibliography

Barrett, T. W., & Scott, T. B. (1989). Development of the grief experience questionnaire. Suicide and Life-Threatening Behavior19(2), 201-215.