Depression in Grief

Jackson, Parkes, Kastenbaum, Lindemann, and even Sigmund Freud all associated depression as being a constant and universal symptom of grief.  These grief thinkers might have added and subtracted other symptoms from their theories, but they all agreed that depression was an emotional constant which every grieving person will experience.

 

WHAT IS IT?

Well first off depression is NOT a blue mood.  Depression literally affects millions of people each year, and it is not a pleasant or desirable mental condition to find yourself in.  Depression is a disorder that can be described as a “whole body” illness.  Depression involved the body, moods and penetrates our very thinking.  Depression affects the way a person eats, sleeps, feels about him or herself, how they treat other people and how they generally think about life.  As mentioned before depression is not a blue mood.

 

The origins of depression are so complicated and at times illusive that it is not possible in the scope of this work to cover them all.  However much evidence suggests that childhood experiences which were highly unpleasant and mentally traumatic is a predictable contributory cause.  The loss of self-esteem at a young age, the loss of confidence at a young age, the loss of a significant person in the young persons life – all these and a myriad additional loss situations can and do contribute to adult depression.

 

Depression might appear to be a sign of personal weakness or a condition that can be willed or wished away, but this is not true.  Depression is not a sign of personal weakness, no matter how weak the depressed person appears.  People experiencing a depressive episode cannot merely “pull themselves together” and get better on command.  Depressive disorders take time, and in some instances medication.

 

Depressive episodes can last for weeks, months or years.  With action, attention and love depressive symptoms can be alleviated with remarkable speed.  Grief depression is normal and should be expected.  However in our artificial, shallow, fast-paced lifestyle this extremely normal symptom of grief is often times viewed as being abnormal.  This is extremely unfortunate.

 

Statements like “Snap out of it,” or “Oh come on you have so much to be thankful for,” or “Gee-whiz, you child has been dead for 6 months, get over it,” or “Man, you’re no fun!”  These examples and a million other meaningless and cruel remarks are usually tolerated by a grieving and depressed person.  As care providers to the bereaved this attitude of eat, drink and be merry is not only offensive it is stupid.

 

DIFFERENT FORMS:

Depression comes in different forms just as do other alternating mind moods.  There are three types of depression which can manifest.

 

1. Major Depression

Major depression is manifested by a combination of symptoms that interfere with the ability to work, sleep, eat and enjoy once pleasurable activities.  These disabling episodes can occur once, twice or several times in a lifetime.  They involve temper tantrums, the need to be right on every subject, mood swings, social distance and isolation – in other words this is a mental mess.  This type of depression is normal in the grief process.

2. Dysthymia

A less severe type of depression is dysthymia which involves long-term chronic symptoms that do not disable, but keep one from functioning at full steam or from feeling good.  Sometimes people with dysthymia also experience major depressive episodes.  Dythymia is also a normal part of the grief experience.

3. Manic-Depressive

Another type of depression which is not generally associated with grief is manic-depressive disorder – also known as bipolar depression.  Not nearly as prevalent as the other forms of depression, manic-depression involves dramatic and pronounced cycles of depression where the person is almost unable to function to dramatic and pronounced cycles of elation or mania where the person does just the opposite.

 

At times the mood switches are dramatic and rapid but most often they are gradual and only a well experienced person familiar with bipolar symptoms can catch the signals.  In the depressed cycle one can have any or all of the symptoms of a depressive disorder.  Mania often affects thinking, judgment and social behavior in ways that cause serious problems and embarrassments for everybody.  For example unwise and disastrous business and financial decisions made while in a manic phase can prove catastrophic.

 

THE CAUSES OF DEPRESSION:

Depression is an illusive phenomenon to pin down.  No one really knows why or how it happens.  Theories abound, but no one really knows why or how it happens. 

 

Some types of depression run in families, indicating that a biological vulnerability can be inherited.  This seems to be the case with manic-depressive illness.  Studies of families in which members of each generation develop manic-depressive illness found that those with the illness have a somewhat different genetic makeup than those who do not become ill.

 

However, the reverse is not true:  not everybody with the genetic makeup that caused vulnerability to manic-depressive illness has the disorder.  Apparently additional factors, possibly an inability to deal constructively with stress, or a stressful environment are involved in its onset.

 

Major depression also seems to occur generation after generation in some families.  However everyone regardless of genetic makeup will experience a major depression sometime in life, and almost universally a major depression will be associated with a personal loss.

 

Psychologic makeup also plays a role in one’s vulnerability to depression.  People who have low self-esteem, who are constantly insecure, who are constantly on the defensive, who consistently view themselves and the world with pessimism and who are readily overwhelmed by stress are prone to depression.

 

A serious personal loss, a threat to one’s security, chronic illness, difficult and unrewarding relationships, financial problems or really any unwelcome change or intrusion in the life pattern can also trigger a depressive episode.  Most often a combination of genetic, psychologic and environment factors are involved in the onset of a depressive disorder.

 

THE SYMPTOMATOLOGY:

The symptomatology of depression is standard but not everyone who is depressed or manic experiences every symptom.  Some people experience a few symptoms, some many.  Also the severity of the symptoms varies with individuals.

 

The following represent standard symptoms associated with depression:

  • Persistent sad, anxious or empty moods.
  • Feelings of hopelessness, pessimism.
  • Feelings of guilt, worthlessness, helplessness.
  • Loss of interest or pleasure in hobbies and activities that you once enjoyed including sex.
  • Insomnia, early morning awakenings or oversleeping; appetite and/or weight loss or overeating and weight gain.
  • Decreased energy, fatigue, being slowed down.
  • Restlessness, agitation, constant movement, irritability.
  • Difficulty in concentrating, remembering facts or making decisions.
  • Persistent physical symptoms that do not respond to treatment such as nervousness, headaches, digestive disorders, chronic pain.

 

DEALING WITH DEPRESSION IN GRIEF:

We began by proposing the idea that depression is a whole body condition involving the body, mind and spirit.

 

Medication, counseling, love, affirmation, listening all contribute in helping to alleviate the symptoms of depression, but one resource is readily and economically available to the bereaved which is sometimes not labeled or even identified as a form of treatment is  ritualistic activities and behaviors.

 

Ritual is the only type of help which incorporates all three whole body needs.

 

Our society surrounds the crisis of life with acting out ceremonies that we call rituals.  These are easily accessible and may well be the most useful resources for the bereaved to act our deep feelings such as depression that are too painful to put into words.  Remember:  When words fail people use rituals.

 

The need to do things at the time of depression and upheaval gently leads a person into a supportive relationship and forms a communication that he or she might not easily or willingly engage in unless the opportunity for rituals were provided.  Isolation can be deadly to a depressed person.

 

Lawrence Abt, one of my favorite thinkers, points out that every culture whether contemporary or primitive surround the low times, the depressed times in life, with acting out ceremonies.  At birth, adolescence, marriage as well as educational, political and historical events or at many other times in life, people act out their feelings associated with the event.  These acting our procedures have five things in common.

  1. They chare a common form of communication for everyone to understand what is going on.
  2. They usually centers round a formal or informal parade which has deep significance for all who are concerned.
  3. The rituals employ the whole body concept; in other words all levels of human response: body, mind and spirit.
  4. There is large muscle activity (carrying or walking).
  5. There is the expression of belief and an appeal to reason and the reasonable which can be invaluable to aid the depressed person in seeing life in a new manner.

 

In responding in a helpful way to depression during the grief process these five benefits of death rituals offer an authentic opportunity for healing depression.  Another great benefit is rituals are usually free.

 

A death ritual, well planned and carefully executed is one wise way to address the depression the bereaved are experiencing in the event of the loss of someone or something significant to their meaning of life.  Today, more than ever before we are aware (for personal and community mental health) in the wisdom of acting out our deep feelings.

 

Lawrence Abt also points out that when people are not able to wisely act out their feelings the feelings (such as depression) take detours and produce organic acting out (ulcers, respiratory ailments, etc.) or types of personality modifications that we call mental or emotional illness.

 

The final question is not if the depression within the bereaved will be dealt with, but rather how it will be dealt with.  Depression in grief is very much like a pressure cooker if the steam is not allowed to be released the entire appliance explodes.  Conversely if a little steam is released by following the instructions on how to reduce steam then the outcome is a wholesome meal which is ready to be enjoyed.

 

Death rituals provide us with those instructions on how to let the steam from depression escape carefully, wisely and effectively so the outcome is a human being who is whole and is ready to enjoy life.

 

 

About the Author: Mr. Todd Van Beck is one of the most sough-after speakers and educators in funeral service. He is the general manager of Forest Hills Funeral Home and Memorial Park, Memphis, Tennessee. He is also director of education for StoneMor Partners. He is dean of ICCFA University’s College of Funeral Home Management and is on the faculty of ICCFAU’s new College of Embalming and Restorative Arts.

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