When Does Grief Become Depression?

Loss of any kind brings with it a lot of feelings. Loss of the pet rabbit for a child is still grief (and a useful experience for later life) as is the death of a close relative. But loss comes in many forms, such as the loss of a job or the sudden end of a relationship.

Our reaction to a loss of any kind is significantly relative to the value each individual attaches to the thing or person that has been lost. So when we experience a loss ourselves or witness the loss someones else has suffered, we should not be quick to judge.

I’ve experienced a heart-rending loss myself, with the death of my mother and also the suicide of a work colleague. I’ve also watched numerous friends and relatives who have also lost close family and friends. Perhaps the most pertinent experience I’ve had with loss and grieving is as a therapist.

Working for many years taking referrals from G.P.’s (Family Doctors) has brought me many people who are struggling with grief. The referral I usually got went something like:

“Mrs Suchabody is depressed after the death of her husband “X” years ago”

While in my early career I took the referrals at face value, experience and some extra studies have taught me, that grief is a process all unto itself and should be treated as such, rather than presuming some sort of mental “disorder”.

What is Grief?

Grief is a whole set of emotions that comes with the loss of a loved one (I will assume this for the purpose of this article). Those feelings are going to be huge and the effects catastrophic.

But we need to know that grief is the emotional aspect of bereavement, which is a process. As I’m sure you are aware, a process is a development of events, one after the other, usually in a specific order, which culminates in a finished “product”.

It’s a little like a novel, with a beginning, middle and an end, except that the chapters of the bereavement process can be in a different order for different people.

The bereavement process is always a long one. The length of which is different for everyone, dependant upon personality and circumstances. It can change us, at least temporarily, and always takes a few years to come to terms with.

The Bereavement Process – in Brief

The purpose of this article is not to discuss the bereavement process per se, but rather about trying to identify when something is happening that is beyond the natural process. To do that we need to at least acknowledge something of the process itself.

There’s been some excellent work done in this field over the last 50 years. One pioneer in this area was psychotherapist Elisabeth Kübler-Ross with her book “On Death and Dying” (1969). Her work provided a much more clear understanding of the bereavement process, which she identified as:

  • Denial & Isolation
  • Anger
  • Bargaining
  • Depression
  • Acceptance

….which obviously became known as “The 5 Stages of Bereavement”. If you would like to learn more about the process itself, then I would point you to David Kessler’s website.

There have been other ideas about this process, some adding more stages, such as the 7 Stage Process discussed by Jennie Wright (2011) which you can see on her website HERE.

For our purposes, it’s important to note that “depression” features prominently in the process (as you might expect). It’s this part of bereavement that is often the point where someone is more likely to present to their doctor for help. Let’s take a look at how this can happen.

Depression….or Not Depression?

Rather than try to re-invent the wheel, let me quote from Jennie Wright’s website about what you might expect from the depression stage of bereavement…

“Just when your friends may think you should be getting on with your life, a long period of sad reflection will likely overtake you. This is a normal stage of grief, so do not be “talked out of it” by well-meaning outsiders. Encouragement from others is not helpful to you during this stage of grieving.

During this time, you finally realize the true magnitude of your loss, and it depresses you. You may isolate yourself on purpose, reflect on things you did with your lost one, and focus on memories of the past. You may sense feelings of emptiness or despair.”

As you read the above quote, you should be able to recognise that Jennie implies a natural shifting or movement through the “depression”. The idea being that as time progresses, natural thought processes occur that gradually bring the bereaved person to a point where they can almost step out of the loss and into a muted acceptance.

But what if they can’t? What if this stage just drags on and on, a year? Two years or even more? When does this so-called depression end? Is there some kind of yard-stick with which to measure this horrible stage?

Unfortunately, there’s no template for this other than a vague understanding that natural grief should take us through to the final stages of acceptance. This is the hard part. Simply because there is no “one size fits all” then it’s often during this stage that the bereaved will visit their doctor and ask for help.

If you’ve done some reading on this subject (or just related back to your own experiences) then you will know that feeling flat and down, crying and a variety of other feelings are all part of the loss you feel. But strangely, even in the early stages of these feelings, some people will head straight for the doctor for some help. Maybe they expect taking some tranquillizers or anti-depressants will make it go away? Yes, I’m sure it will help…. help to prolong (or even freeze) the natural process of emotional healing.

There’s a time for drugs, but it’s certainly not yet!

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The bereaved may have been feeling the depressive stage for (let’s say) 6 months. Then he goes to the doctor because “It’s unbearable” he says. Is now the time for those drugs? Are 6 months long enough? How can the doctor know, especially if she only allocates 10 minutes per patient? In all likelihood, the bereaved will come away with a prescription for an anti-depressant. Oops. We’ve just added chemicals into the mix of a natural process.

I’ve worked with a lot of doctors over the years. As a result, there’s a couple of things I have become acutely aware of, the first of which is that family doctors are not mental health specialists. In fact usually, they aren’t specialists in any field of study. Typically you might say, they follow the adage of being “jack of all trades, but master of none”.

Then there are the issues of experience and attitude. I will let you fill in the blanks there. I will just say that I have had the displeasure of having had a family doctor in the past who was “less than wonderful”.

The picture I’m painting may sound rather negative, but the fact is, few people know anything about the grieving process and that includes doctors.

So is the “depression” stage of grief actually a clinically diagnosable condition? Well, no it isn’t. Until it is! Sorry I know I’m talking in riddles. I will explain.

The naturally occurring stage is most definitely not depression as understood by psychiatrists etc. Often times, the bereaved will gradually notice they have less unpleasant thoughts. Some days are better than others. Gradually. Then one day he notices that he feels different somehow. Basically, that’s how it goes with the natural process of bereavement. If after an extended period of time, these things don’t happen at all, there are no better days or in fact, there is a shift toward becoming entrenched in typical depressive symptoms, then it’s likely that something has gone wrong.

But to be able to recognise the difference, we must not only have an understanding of typical depressive symptoms but also of the process of grief too.

When Bereavement Goes Wrong

So why does bereavement go wrong? Is it that a person just has too much love for their lost loved one? Well in some instances that may be true. I’m sure we’ve all heard of very elderly couples dying within short periods of each other. My own great-grandparents died within 6 months of each other. I knew they had been together since the late 1910’s, being married just after he returned from the trenches of WW1.

This kind of event is hard to explain in any scientific way. It’s easier to simply say that the surviving spouse just gives up their life, not feeling the strength to carry on.

This isn’t the kind of problem I’m referring to though. So what is it that causes a person to get stuck in one place in the process of grief? I guess the exact answer to that is as numerous as there are humans on the planet. So to try to answer the question, I’m going to have to generalise.

Something “abnormal” has happened.

Abnormal? Yes. As in “something out of the ordinary for a natural grieving process”.

Let’s not get carried away and start talking about mental illness.

Let me give you a hypothetical example. The wife of a couple has a serious road traffic accident and is killed. The husband is mortified and after 18 months finds himself heading deeper into depression. He keeps his wife’s clothes around and has pictures of her all over the house. He sits for hours just watching their videos or sitting in silence as he thinks about their life together.

This is typical behaviour for a person who absolutely refuses (through a conscious act of will) to let his dead wife go. The longer this goes on, the more likely he is to become clinically depressed (a diagnosable depressive condition).

The problem with the man in my hypothetical example is something to do with his own deep need to hold on to not only the memory of his wife but her physical existence. To the rest of us, that seems quite unrealistic, but to this grieving man, it seems to make perfect sense. He holds on to her and so he feels some comfort in that. To let her go would mean more pain than he could bear. So this is his method of survival.

Once or twice as a therapist, I have worked with clients who manifest the appearance of the physical form of their dead spouse as a “ghost”. However, working through the issues, the “ghost” stops appearing as they gradually come to accept their loss. In essence, what they experienced were hallucinations as part of a psychotic episode, brought on by the extreme stress induced by their feelings of loss.

As any psychiatrist will tell you, psychosis (slipping into an alternate reality and interacting as if it were real) occurs for only some people, whose ability to cope with extreme mental stress is such that they are more prone to enter the condition. It doesn’t happen to everyone.

Usually, depression during bereavement is the result of the bereaved person being unwilling or unable to deal with some aspect of their situation. It may be an unwillingness to accept the circumstances of the death, such as a murder where the perpetrator is still at large. It could be any unresolved issue surrounding the death.

It is also just as likely that the bereaved person has had little or no experience in the past, of dealing with emotions in any significant way. This could be as a result of personality problems, or simply never having had to deal with the strong emotions that naturally come as a result of the trauma associated with the loss of a close relative or friend.

In my experience in working with bereaved clients, I have never had a client who was not able to move on from the stuckness they feel in their grief. That’s not me “blowing my own trumpet”. Rather it speaks to the fact that people can get stuck in grief and to move on, sometimes they need to be able to examine themselves and their situation in order to find that sequence of thinking or put things into better perspective, so they can get back on track, that being the natural process of grieving.

So to round this article off, yes clinical depression can become an element of bereavement. It usually starts as a result of some kind of “stuckness” in the process and if that happens, then it morphs from the bereavement form of feeling down (which I realise is an understatement) into full-blown depression.

I suppose as an ex-therapist I am bound to say this, but I really mean it when I say that the best way to become un-stuck, is to find a really good bereavement counsellor and be prepared to cry…a lot.

Further Reading:

David Kessler – The 5 Stages of Grief (website)

Jennie Wright – The 7 Stages of Grief (website)

If you like what you have seen here then please take a look at my book “The Whole Family“.

Click the photo to go to the page to learn more:

Buy paperback or eBook on Amazon
A book to make your home life a happy one – by Steve Chriscole

 

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stevechriscole

Steve Chriscole is a former Counselling Therapist (Psychotherapist) turned teacher and freelance writer for hire on a wide variety of mental health matters. Both in person and in his writing, he is passionate about raising awareness of anxiety and depression in particular, as well as growth in self-awareness and self-confidence in order to help people lead happier and more productive lives.

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