Grief

First episodes of depression are often the result of a loss of a relationship. The incidence of death of a parent in childhood is much higher among depressives than among other people. Freud thought that depression was always the result of a mourning process that couldn't be completed.

The experience of grief is very much like the experience of depression. Yet grief is inevitable, and depression is not. Although painful, normal grieving is not depression. When normal grieving is prevented, depression can be the result. When we suffer a loss, we must allow ourselves the time and opportunity to mourn.

The grieving person is sad and withdrawn, and may feel that his world has come to an end, but he knows that he will probably recover. He doesn't feel the sense of personal inadequacy that the depressed person does, nor does he feel irrationally guilty. His self-esteem is intact.

Grief is the natural process we all go through when we lose someone-or something-we love. The paradigm of grief is the loss of a loved one through death. But we also lose people in other ways; we divorce, we move away, we change jobs, we simply grow apart. And we also lose the relationships of people as they, and we, change.  For example, our parents retire and move to Florida, and we suddenly realize how much we depended on them. Our spouse has a stroke, and isn't the strong partner we were used to. Our children marry and start their own families, and we wonder if they need us anymore. We can also grieve for things, possessions, or opportunities. The victim of a house fire loses the family photographs, and with them a connectedness to the past.

The initial stage of reaction to grief is one of shock and denial, which for some may last for a long time. The remnants of denial can linger on for years in dreams that bring the dead back to life. But this phase does end, to be replaced by a period of intense painful emotion; here is where depressives find disaster. The mourner feels unbearably sad and feels that the pain will never end. The depressive feels intense anger (including anger at the dead person for leaving). The depressive also feels frightened and wants to regress, and feels guilty as well.

But depressives fear both the experience and the expression of feelings. They try to avoid or control their grief. Afraid of becoming permanently destabilized by the force of emotions they can't control, they reinforce their self-image as powerless. They apply depressed thinking habits to the circumstances of their loss, and assume they are personally at fault, that they will never recover, and that the loss will suck up all possibility of joy from every aspect of their lives. They don't display their feelings, and therefore get no comfort from those around them.

When grief can proceed beyond this middle stage of intense emotion, there is a gradual resolution, an acceptance of the loss. In adapting to and accepting the change in circumstances, they grow as individuals. hey take into and make part of themselves the admired and cherished attributes of the person they have lost. Identification, the same defense mechanism that enables children to comfort themselves and grow stronger during temporary separations from the parents, makes them become more like the person they lost.

Sometimes this is a completely unconscious and seemingly meaningless activity. For example, a wife who never paid attention to her husband's garden begins to tend to it after his death and finds herself as dedicated as he was, or a middle-aged man takes up fly fishing shortly after his father's death, not consciously emulating the times they spent fishing when he was a child, but still recapturing the experience. Sometimes it is a deliberate act, a way of showing respect for the dead that also teaches them to value what they valued. For example, a son faithfully maintains his father's stamp collection, or a husband starts attending the church his wife attended without him.

Psychologists use the term 'introjection' to describe a less mature form of identification resulting from incomplete mourning. Introjection means taking on characteristics of the lost person without integrating them into the self. They become little alien forces that "possess" people at times. They literally don't feel like part of themselves. This explains the fear that most children of parents who commit suicide have, that they are doomed to repeat the same act someday. Less concrete examples abound in the lives of the depressed.

These are the voices of critical parents that speak to them whenever they start to feel good, that reinforce all their self-doubts. They aren't able to achieve a mature, objective perspective on these parents, as perhaps people who had problems and stresses of their own, who sometimes weren't as patient or loving as they needed but who did love and value them. Instead, they still see them from the perspective of the four-year-old; they are all-wise, and they know the real truth about them; and when they say they're not good enough, it's like the voice of God.

People who are truly depressed can rarely achieve acceptance of a loss. In these cases, the therapist's goal is to facilitate a normal mourning process by getting the patient to talk about and express emotions about the loss, and to help the patient reestablish interests and activities that can help take the place of what was lost. Many patients with depression may have absolutely no idea that their depression is connected with a death or loss.

On the next page we will talk about the emotion of Anger.