It’s Not Depression, It’s Grief

In the mid 1960s, psychiatrists Thomas Holmes and Richard Rahe studied the correlation
between stressful life events and illness on 5000 subjects and published their results as the
“Social Readjustment Rating Scale,’ better known today as the Holmes – Rahe Stress Scale.
In their questionnaire, subjects were asked to indicate which, if any of 43 ‘stressful’ life
events they had experienced (even positive occasions like marriage or getting a promotion
were included) and the total was added up. Their data showed a distinct correlation between
a high score (in other words, experiencing a lot of life ‘stressors”) and the onset of illness.
At the top of the list of life stressors?

Losing your spouse. But you knew that already.

I want to make absolutely clear before I go any further that I am not a psychiatrist, a
psychologist or a therapist with extensive training in mental health and illness. What I on is a
parish minister who has more than 25 years experience ministering to individuals, families
and congregations and walking with them through almost every facet of human existence.

Of course, I have counselling training as well and I’ve also been a hospital chaplain who has
been part of a health care team in mental health settings as well as medical, surgical and
palliative wards for people at all ages and stages of life. Like most of you I suspect, my life
has been touched by mental illness both among my family and in my circle of friends. And,
perhaps most significantly, I have experienced both depression and grief myself personally
on a variety of occasions, all related to losses of various kinds.

All of this has shown me that there is a difference between being bereaved, grief-stricken
and sad and being genuinely, seriously and especially clinically depressed. And that it’s
important to try and understand the difference so you can get the help you need whatever
your mental state. But this is where things get complicated. Because, as Homes and Rahe
discovered, losing your spouse is one of the most stressful (and I would add, depressing)
things that can happen to you! And bereavement is one of the chief causes of situational
depression – what is known medically as “adjustment disorder with depressed mood.’

In layman’s terms, it means that when sad things happen, you feel sad. Or, to quote Viktor
Frankl (a survivor of four concentration camps and the author of Man’s Search for
Meaning) “An abnormal reaction to an abnormal situation is normal behaviour.” There
would be something wrong with you if you didn’t react to the death of your life partner
with deep sadness, loneliness, depression and melancholy. It’s called ‘grief.’ No-one gets up
the day after their beloved has died and says “Well, that’s done. What’s next?”‘

The trick becomes identifying normal sadness or temporary (situational) depression, brought on by a very sad life event, and recognizing when it’s in danger of becoming something else – like real ongoing depression. It’s even more confusing trying to figure it out while in the grip of early grief’s overwhelming emotions. Because the ‘symptoms’ of early, intense grief often mirror the characteristics of other mental health conditions, in particular anxiety and depression.

If you think of it as a Venn diagram, it might look something like this:

Grief is a normal response to bereavement and loss, and Anxiety and Depression are serious mental health conditions that range from mild to severe and often (but not always) respond to treatment. But in the first early days of grief, you may find yourself experiencing a bewildering array of emotions and physical symptoms that feel very much like anxiety or depression. 

Akin to anxiety, you may find your heart racing and it hard to get your breath, experience nervousness or a feeling of agitation. You may find you lose your appetite or want to eat all the time. Your may feel nauseous or have an upset stomach or digestive system, experience headaches, body aches or sensations of fear and panic with shakiness and trembling. 

You may also experience depression-like symptoms, feeling ‘low’ or sad, unable to get out of bed or function. You may cry uncontrollably for long periods of time or have a sensation of heaviness in your chest, a choking feeling in your throat or a hollow in the pit of your stomach that won’t go away. You may be unable to sleep or want to sleep all the time. You may have dark, morose thoughts about the present and the future.  

So how can you tell the difference between normal, situational feelings of depression or anxiety related to grieving – and something that is more serious and requires medical attention? One way is to seek help and expertise early in your journey. A grief or bereavement counsellor, doctor, therapist, or other helping professional can help you sort out whether what you’re feeling is a normal, situational response to your loss or may possibly be on the way to becoming something deeper. 

Other signs can be related to perspective and duration. 

• You’re grieving if you feel lonely and bereft. You’re depressed if you can’t imagine that you
  will ever feel any different.
• You’re grieving if you feel overwhelmed at the thought of all that lies ahead. You have anxiety
  if you feel so paralyzed by your fears that you’re utterly unable to face them.
• You’re grieving if you don’t always want to get out of bed and deal with the day. You’re
  depressed if that feeling lingers for long stretches, seriously interfering with your functioning.
• You’re grieving if your sleep or nutritional needs get off track for a while. You have anxiety or
  depression if you stop eating completely, are plagued by insomnia that lasts for days and are
  completely unable to care for yourself or those in your charge.
• You’re grieving if you feel like you can’t imagine going on without your spouse. You’re
  depressed if you’re thinking about actually joining them.

Grief, with help, effort and time, does tend to get better. The loss is always there, but so is the Love. You can look back at yourself two or five years after a loss and realize that you are not in the same place as you were after one year. It doesn’t always hurt as much as it did at the beginning. But depression or anxiety don’t naturally necessarily get better with time. They require more specific attention, often from medical or other professionals, to be resolved, healed and overcome.

A final word on the complex relationships we see in that Venn diagram; sometimes what began as a normal grief reaction can become depression, anxiety or another mental health condition. Lingering sadness or unresolved grief over time can cause physiological and psychological changes in the brain that become self-perpetuating. So familiarize yourself with the symptoms of mental health concerns like depression and anxiety and keep a close
watch on your own feelings. Seek the help you need early and often.

But as you do, remember that grief is not only a normal part of the human condition, it’s the price of love. And it’s one worth paying.