Am I Just Depressed or Did I Lose Something? The Difference between Grief and Depression. Leslie Bissell. Wheaton College.

Transcription

1 Did I Lose Something? 1 Am I Just Depressed or Did I Lose Something? The Difference between Grief and Depression Leslie Bissell Wheaton College Wheaton, Illinois April, 2001

2 Did I Lose Something? 2 Am I Just Depressed or Did I Lose Something? The Difference between Grief and Depression Meet Zoe. She is a new mom who brought her baby home from the hospital a few weeks ago. Although the baby is doing well, Zoe can not get herself to speed. She is tired all the time and doesn t even want to get out of bed in the morning. Her mood cycles from being incredibly irritable to a puddle of tears for no good reason. Although she and her husband had been waiting to have a child for several years, Zoe just isn t excited about taking care of her daughter. She feels as if her efforts are hopeless, that she will never be able to be the mom that she has always wanted to be. Meet Jack. As a man in his mid-30 s, he seems to have everything, the car, the house, a wonderful wife and 2.5 kids. But for the past month or so, Jack just hasn t been himself. He doesn t have much of an appetite and has lost quite a bit of weight. It has become increasingly more difficult to concentrate while he is at work and making even the smallest decision is a major event. Jack hasn t been sleeping well either. He tries to go to bed at a decent hour but he just lies there staring at the ceiling until 2:00 a.m. When he finally does sleep, it is only for a few hours. Although he wouldn t admit this to his wife, he has even thought about taking his own life, not so much because he really wants to die, but because he wants the bleak, emotional pain to stop. He doesn t feel like he has much to live for anyway. Meet Wanda. She has been a widow for almost a year now. Her husband died after a two-year struggle with cancer. Although she isn t crying as much as she used to, she just can t seem to get on with the task of living. She goes through her days in a haze and is not responsive to her children s attempts to involve her in their lives. She has gained almost 50 pounds since Wallice s death and spends most of her days either sleeping or reminiscing about the past. If I had only been there when he died, maybe things would be different, she tells herself.

3 Did I Lose Something? 3 Zoe, Jack, and Wanda are all struggling with symptoms of depression. If you are struggling with symptoms such as those listed above, or you know someone who is, read on. In the pages that follow, we will investigate the potential causes, symptoms and treatments available for people like Zoe, Jack, and Wanda who are in the midst of grief and/or clinical depression. To do this, we will first explore the differences between clinical depression and grief and discuss the importance of the mourning process. We will also take a brief look at what the Bible has to say about grief and depression and conclude with some practical advice on what to do if you or someone you love is in the midst of overwhelming grief or depression. The term depression is often used to describe a negative mood state that seems to come from nowhere and leaves one feeling blue, sad, or tearful. It is true that depression affects many people, in fact it has been estimated that 3% of men and 6% of women will have a major depressive episode severe enough to require hospitalization (Meyer & Deitsch, 1996). However, despite this, many do not seek help because either they do not believe they have a problem or they believe that it will take care of itself. Christians in particular may also see their struggle as sin, a test, or a punishment from God and may not seek help because they believe that they should be able to handle it on their own. What is grief? Grief is a normal, emotional reaction to the loss of someone or something in our lives. One of the most recognizable sources of grief is the death of a loved one, such as Wanda s loss of her husband. As human beings, we were designed to be in relationship with others in order to receive support and security. Hence, when we lose a companion to death, we also lose that source of comfort. We may also experience grief when we face significant changes in our lives and/or our relationships with others. Sometimes it is obvious that a negative relationship change has

4 Did I Lose Something? 4 occurred, such as when you broke-up with your high school sweetheart. But sometimes these changes may appear to be only positive in nature, such as the birth of a child. In either case however, the reality is that the other relationships in our lives may also need to change as a result. Combined with this may also be the loss of a valued relationship quality due to a needed change in role for one or both parties. Take Zoe for example. Although she deeply wanted to be a mother, she now does not have as much time to spend with her husband as she once did. She is also becoming overwhelmed by the awareness that she is now responsible for the new life that she and her husband have brought into the world. Never again will she and her husband be just a couple. They are now a family with all the joy and pain that comes with it. Grief may also come when we realize that life is not turning out the way we hoped it might. Or grief may come when we realize that our parents or other significant people, both past and present, do not live up to our expectations. In her book Necessary Losses, Judith Viorst explains how we experience multiple losses of this type throughout life as we pass from one developmental stage to the next. Part of Jack s current pain may be linked to this. He is entering what many call a mid-life crisis. Due in part to his age and current station in life, he may be wondering if his life is ever going to be a challenge again, like it was when he was younger, or if he has to just survive the next 40 years of his life. We may also experience grief when some ideal is lost or our perception of our world changes. Perhaps one of the best examples of this may be when you found out the truth about Santa Claus or the Easter Bunny. This type of grief may also occur when we experience a crisis of faith that causes us to rethink our theology or our world-view in general. For example, when a young woman is raped by her boyfriend, she will no longer be able to trust that the world is a safe place for her. She may also not be able to trust the men in her life or find comfort in

5 Did I Lose Something? 5 relationships with the opposite sex. At the same time she may cry out, God, why did you let this happen to me? and then become angry when no answer seem to comes from on high. What happens when we grieve? Although each of us will experience multiple losses throughout life, the work of grief, also known as the mourning process, enables us to process loss on a deep level. The ultimate goal of this process is to free ourselves from the burden of holding on to that which we no longer need and to make ourselves available for new relationships and experiences. Elizabeth Kubler-Ross identified four stages of the grief process. These stages are as follows: Denial: When a person is not able to admit to themselves or to others that either something will be lost soon (i.e. I don t have cancer! ) or that something has been lost (i.e. Bob isn t dead, he is just sleeping. ). Bargaining: When a person begins to work through all possible options to avoid the loss of the person, relationship, or ideal (i.e. If I eat more carrots I won t lose my eyesight even though the doctors tell me that my eye condition is beyond repair. ). Anger: When a person begins to come to terms with the reality of the loss and experiences intense emotions such as anger, sadness, pain or distress. At this stage it is also common for people to feel guilty for being angry either at the person who left them or at themselves for having feelings that they may consider to be bad. Wanda s guilt about not being at her husband s side when he died would fit here. Wanda may also be quite angry at Wallice for leaving her alone, but is not able to allow herself to feel the anger and work through it because she may tell herself, I love Wallice, how can I be angry with him? He was sick and he struggled as long as he could.

6 Did I Lose Something? 6 Acceptance: When a person has come to a point of being able to let go of the anger while continuing to hold on to the reality of the situation. At this stage, people often have a greater sense of peace and calm and are better able to look forward to new experiences. For example, when Wanda is able to think of Wallice fondly and yet is able to admit to herself and others that he is gone and is not simultaneously overcome with guilt, anger and depression, Wanda will have accepted the fact that Wallice is dead. Although everyone may experience these four stages at some point in the mourning process, everyone grieves in their own way and in their own time. Most people do not move sequentially through the stages as they are listed above. Instead they may move from one to another and back again as needed. For example, some may deny that they have been diagnosed with a fatal disease for only a few moments and then quickly begin the bargaining stage while others may stay in the denial stage until their illness eventually ends their life. In short, there is no right or wrong way to grieve; however, all of us need to grieve at various times throughout life. One of the unique qualities of loss is that if we do not grieve a loss when it occurs, we will need to grieve it later when another similar loss occurs in life. When we do not actively mourn the losses of life either individually or collectively, however, we run the risk of our grief turning into depression. What is depression? Sigmund Freud believed that depression occurs when people fail to grieve or do not work through all the stages necessary to release the energy that has been associated with the lost object (Freud, 1947). Other psychological theorists echo this belief and believe that depression, in some cases, is the result of appropriate anger being turned inward instead of being directed at the appropriate person or object. Recent biologically based research

7 Did I Lose Something? 7 also suggests that in some cases, people are genetically predisposed to more severe cases of depression that have been found to respond well to anti-depressant medications. In other words, clinically diagnosable depression is not the result of unpleasant experiences such as getting a flat tire on your way to work; rather it may have either a biological basis and/or be linked to the unfinished mourning of a past or present loss. In order to be diagnosed with as having a major depressive episode, according to the Diagnostic and Statistical Manual of Mental Disorders, 4 th edition (1994), an individual must either have a depressed mood or a loss of interest in most of one s usual activities for a period of at least two weeks, nearly every day and must have at least five of the following symptoms: Either increased agitation or fidgetiness, or decreased or slowed body movements, Either significant weight loss or weight gain and/or loss of appetite, A consistent inability to sleep or a tendency to sleep too much and yet not feel rested, Increased fatigue or loss of energy, Feelings of guilt or a sense of worthlessness, Increased difficulty thinking and/or increased indecisiveness nearly every day, or Persistent thoughts of suicide or death. In short, diagnosable depression is not simply having a bad day, but rather it is a type of mental illness that can affect every area of one s life. Sometimes people who exhibit symptoms such as these may not know why they are feeling the way they do. Jack would be an example of this type of depression. For some, the symptoms of depression can be quite overwhelming. For others for whom the symptoms are less severe, it may be an indication that more grief-work needs to be done. In either case, medication prescribed by a competent psychiatrist or family doctor may help facilitate the process of therapy by helping to make the symptoms more

8 Did I Lose Something? 8 manageable until the individual is able to work through the mourning process. In most instances, medication alone will not eliminate all symptoms of depression. Some type of therapy will also be needed to facilitate the healing process. What does the Bible have to say about grief and depression? The topic of grief is one that I believe is close to the heart of God. Adam and Eve were the first to experience the loss of ideal relationships both with the Divine as well as with each other. They also lost the perfect perspective of themselves and began thinking of themselves more highly than they out to have thought (Hoekema, 1986). As a result, their ability to see themselves as God saw them was damaged and they in turn fell short of God s ideal life for them. Because of sin, Adam and Eve were forced to leave the Garden and found themselves separated from God. In essence, their worldview was forever changed. Because God knew that humanity would not be able to survive without Him, he gave us the ability to mourn the loss of the ideal relationship with Him and accept our own humanness. He then provided a new means of returning to relationship with Him via his Son, Jesus Christ. If Adam and Eve had not left the garden and mourned the loss of it, they could not have built a new life for themselves and their descendents. In this sense, the ability to mourn is a gift because it helps us to let go of the false, sin-based ideals and expectations that hinder our ability to be in true relationship with Him. Grief also provides a way for us to get an accurate view of ourselves so that we may identify our true needs both physical and spiritual (Chen, 1997). By using the mourning process, we can eventually discard that which is no longer beneficial to our spiritual growth (Hoekema, 1986). In practical terms, however, the mourning process also gives us the ability to cope with the reality of sin in the world sin that often makes no sense to us. In John 11, Jesus is confronted with the real loss of his friend, Lazarus. Although Jesus could have easily focused on

9 Did I Lose Something? 9 the miracle that he was about to do via bringing his friend back to life, He chose to express his grief in much the same way that we do he wept. Jesus understood that sin had damaged the possibility of humanity staying in a perpetual state of communion with Him and with each other. He also, in his Divine wisdom provided a way for us to cope with this earthly reality by giving us the gift of grief. As far as depression is concerned, the term itself is not mentioned in Scripture. However, there are many examples of people suffering from depressive symptoms are mentioned. For example, King David pours out his heart in the book of Psalms and is overcome by feelings of intense grief. The book of Job is also the tale of a man who does not understand why the Lord has taken away everything that has meaning to him. The author of Lamentations wrestles with the apparent meaninglessness of life and his view of the world. Upon reading any of these passages, the depth of emotional pain and anguish becomes apparent. However, in each case, the authors remind us of one central truth our Creator hears our cries and has the power to save us and use our suffering to bring us back to Himself. The author of Lamentations writes, But I called on your name, Lord, from deep within the well, and you heard me! You listened to my pleading; you heard my weeping! Yes, you came at my despairing cry and told me, Do not fear. Lord, you are my lawyer! Plead my case! For you have redeemed my life. (Lamentations 3:55-58, NLT). In short, depression is not a sin. It is not something that we can always recover from on our own. God has given us the tools to work through the pain of loss. He has given us not only his Word so that we may know that we are not the first person to experience such pain, but to remind us that we do not have to endure the pain alone. He has given us Himself via his Word and others

10 Did I Lose Something? 10 within the Body of Christ to help us mourn so that we may let go of the past and look forward to our future with Him. If I think I or someone I know may be depressed, when should I seek help and where might I find it? Thus far, we have discussed the difference between grief and clinical depression and have outlined some of the potential causes, symptoms and treatments for each. We have also taken a look at what the Bible has to say about grief and depression. Because the severity of symptoms and causes of depression can vary greatly between people, consider the following treatment options. If there is an identifiable stressor or life change, such as the death of a family member, change of job, or loss of relationship and you feel as if you are able to function in your daily life, consider getting involved with a local support group or other community agency. Many churches, hospices and community mental health agencies have specialized groups for those who are recently widowed, those who are coping with the serious illness of a family member, or those who are recovering from divorce. Because the mourning process is often quite different from person to person, and loss to loss, it may seem like you or someone you love is not doing it right. For example, It may take a good year or two for a spouse to fully mourn the loss of a husband or wife whereas it may only take an adult a few weeks to mourn the loss of a family pet. A common rule of thumb is to allow a minimum of a year to mourn the loss of a loved one before demanding that you or someone you love move on with life. A mental health professional should be consulted, however if the symptoms mentioned above begin to interfere significantly with daily life. For example, if it is

11 Did I Lose Something? 11 difficult for you to get out of bed more days than not or you are thinking about suicide often, seek help from a mental health professional as soon as possible. If you don t know why you are feeling blue, or if you feel like you are having great difficulty coping with everyday life for two weeks or longer, and/or have a family history of depression, consult a mental health professional. A therapist, psychologist, or psychiatrist will be able to assess your symptoms and suggest possible treatment options. This may include a visit to your physician for a routine physical to rule out any possible medical reasons for your mood change. Depending on the severity of your symptoms, your doctor or a psychiatrist may also prescribe an antidepressant medication. These medications are often intended to be used in addition to psychotherapy with a psychologist or therapist. If you are thinking of killing yourself or of harming someone else, and/or feel as if all hope is gone, get help as soon as possible. Many communities have a 24-hour hotline for those who are considering suicide. If you feel you may harm yourself, seek out help either at an emergency room or call a mental health professional. The hospital staff will be able to assess your needs and care for you in an appropriate manner. Summary. Loss is a part of life with which we must continually cope. Grief is a normal, emotional reaction to the loss of people, relationships and ideals and we are able to process the intense emotions associated with loss via the mourning process. When we do not fully mourn, we run the risk of becoming depressed. In some cases, this depression may best be helped by the combination of antidepressant medication and psychotherapy with a mental health professional. In other cases, we may need to seek the support in our church communities and come to a better

12 Did I Lose Something? 12 understanding of ourselves before God. In either case, we have been given this gift of grief as a means by which to cope with the reality of our fallen world. For more specific information about depression, consult the National Institute of Mental Health at or your local mental health professional. References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4 th ed.). Washington, DC: Author. Chen, L. (1997). Grief as a transcendent function and teacher of spiritual growth. Pastoral Psychology 46(2), Freud, S. (1947). Mourning and Melancholia. In R. V. Frankiel (Ed.), Essential papers on object loss (pp ). New York, NY: New York University Press. Hoekema, A. A. (1986). Created in God s image. Grand Rapids, MI: William B. Eerdmans Publishing Company. Viorst, J. (1986). Necessary losses: The loves, illusions, dependencies, and impossible expectations that all of us have to give up in order to grow. New York, NY: Fireside.