The loss of a loved one is a universal experience, but one that causes pervasive sadness that is distinct from the sadness caused by other issues such as loss of a job, financial loss, or loss of a home. Grief is a normal kind of sadness, one that doesn’t mean there is something wrong with you. It’s a life passage that most of us go through, process and eventually heal from. That’s why it’s not considered a mental disorder by the mental health community.
Let me make a clear distinction between Grief and Major Depression, which is a serious mental health problem that requires treatment. Both Grief and Major Depression involve deep sadness and social isolation from the activities of normal life. However, Grief also involves a sense of loss and isolation that comes in waves, alternating with positive memories of the deceased. In Major Depression, the sadness is constant and unrelenting, and the thoughts are almost always negative. In Grief, the person usually feels the same level of self-esteem that they had prior to the loss, whereas in Major Depression the person feels a sense of guilt and worthlessness. (www.MayoClinic.org) (DSM-5).
In normal Grief, the bereaved will experience pain and loss for at least two months, sometimes up to a year or more, after which they begin to accept the reality of what has happened, between the waves of sadness. It’s important that the bereaved not internalize the pain, but instead, let themselves cry, experience it and express their Grief. In normal Grief, the bereaved will eventually begin to adjust to the changes in their life as a result of the loss, and start to socialize again. Life will be changed, but it will go on, and there will be hope again.
Grief becomes complicated when the feelings do not resolve in reasonable time, and the sadness doesn’t come in waves, but is instead persistent and unrelenting. That constant state of loss and sadness interferes with healing. Complicated Grief can occur when the bereaved was very dependent on the deceased, and doesn’t know how to go on and perform many of the tasks of daily life that were performed by the deceased. It also is likely to occur if the bereaved has no support system, if the deceased is their child, if the bereaved has a history of Major Depression or if they are not resilient and adaptable to change.
The symptoms of Complicated Grief include a continued sense of mourning, persistent thoughts of the deceased and continued reminders of them, a sense that one cannot go on without them, bitterness, detachment, longing and pining for the deceased, continued focus on the loss to the exclusion of normal activities, lack of acceptance of the loss, a feeling of meaninglessness of life, a feeling of wishing you could join the bereaved (which is not suicidal thinking), irritability, and an inability to remember the positive things about the deceased and your life together. The bottom line is, if Grief has begun to interfere with your everyday life to the point where you are unable to function, you may have Complicated Grief.
If you think you have Complicated Grief, I recommend you talk to a Grief Counselor or therapist who works with Grief and loss. There are clearly times and circumstances under which Grief can become an issue which requires intervention by a mental health professional. If you have symptoms such as unrelenting depressed mood, inability to sleep, irritability, lack of energy, lack of appetite or too much appetite, lack of caring about things you normally would care about, lack of attention to your hygiene or personal appearance, feelings of guilt and worthlessness, you may have Major Depression, which requires treatment from a mental health professional. If you or someone you love show symptoms such as those above, don’t try to diagnose yourself or someone else; leave that to the professionals.
If you start to think about suicide and consider ways to kill yourself, it’s crucial that you be evaluated by a psychiatric professional immediately. Go to the emergency room, or call 911 for immediate help. Most people who consider suicide really want the pain to stop, and can be helped if a mental health professional intervenes right away to help them relieve the pain, either by talk therapy, medication, or possibly hospitalization, and they are likely to want to live. That’s why immediate intervention is necessary when there is any suicidal thinking at all. There is also a National Suicide Hotline, which is 1-800-273-TALK (1-800-273-8255).
People with Complicated Grief may abuse substances to relieve their pain, may be more susceptible to physical illness or exacerbation of a chronic condition they already have, and may experience Major Depression, Posttraumatic Stress Disorder, constant worries and unrealistic fears, problems with sleep, and trouble functioning in the normal activities of life.
The Center For Complicated Grief at the Columbia School of Social Work has a lovely, alternative way of viewing Grief. They see it as a form of love, and want to help the bereaved honor those feelings. They suggest seeking the support of others who have had the same experience, and gentle focus on self-care as one heals.
If the death was the result of suicide, it’s a traumatic form of Complicated Grief that cannot be understood by those who have not been through it. There is a mix of powerful feelings that include profound grieving, disbelief, shock, numbness, anger, guilt and self-blame (“what if I had done this, or not done that, I should have known”, etc.), and a lack of closure, especially if the deceased didn’t leave a suicide note. People who don’t understand tend to say insensitive things, such as, “You’re young. You can always get married again.” That’s why, in the case of suicide, the bereaved should seek out the support of a group specific to Survivors of Suicide, and a therapist or Grief counselor who has expertise in this area.
I’d like to remind you that Grief itself is a normal experience which doesn’t necessarily require medical treatment or therapy. However, someone with Complicated Grief ought to talk to a Grief counselor and join a bereavement group; whereas, someone with Major Depression needs to see a professional therapist for treatment. Again, don’t try to diagnose yourself or someone else. Get yourself or your loved one to a professional for evaluation of the problem, and make a plan to address it. It’s not necessary in this day and age to suffer needlessly. Don’t bottle up your feelings and suffer in silence. There is support, there are people out there who understand, there is treatment and lots of help available. There is most definitely hope. You can get better. Start today. There is hope.