With each person in our life that passes away, our world changes. Sometimes we have time to prepare ourselves if the individual struggles with an illness before their passing. Other times, the end of an agonizing struggle can bring strange and confusing feelings of relief. In any case, enduring the loss of a loved one (especially those particularly closest to us) can be an overwhelming process. Being that grief and mourning the loss of a loved one is something that I am currently going through in my life, I thought it would be an important topic to explore in WBYIT. We all experience loss and death at some point in our lives and most likely it's more than just once. Just as we are all different people with unique strengths and weaknesses, we all have different ways of coping. Most of us can recognize when someone is not coping well (e.g. substance abuse, self-harm behaviors etc.). Even if we can avoid extremely poor ways of coping, however, many of us may still have questions. How long should grief last? Is this just grief, or is this depression? How do I know when it's over? Will it ever be over? And when is it time to see a therapist?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most commonly used diagnostic manual used by mental health professionals in the industry today. It has been used throughout it's revisions and updates as the primary guide for defining and diagnosing any given mental illness. The most recent version, DSM 5, includes an update that describes the differences between appropriate behaviors following a loss and more concerning indicators of major depression.
It is important to note that there is no expectation that grief will lead to a Major Depressive Episode (MDE) or Major Depressive Disorder (MDD) in and of itself. MDE's and the full diagnosis of MDD are diagnosed under a comprehensive assessment of several symptoms and, as explained by the DSM 5, may have existed within the person prior to their bereavement. It is possible, however, for a person to think, feel, and do things after a loss that may blur that line between grief and depression. For the benefit of therapists and the general public alike, they gave us some helpful points to differentiate the two.
Their points are as follows:
As you can see, the differences shown by the DSM 5 generally focus on whether these thoughts, feelings, and behaviors are directly associated with the deceased, or whether they are more pervasive. The more pervasive your thoughts and behaviors, the more likely it is that you are experiencing depression.
There are models that help define the phases that we may go through in coping with loss. Elisabeth Kübler-Ross penned possibly the most widely known five stages of grief in her book On Death and Dying. Despite the help of the Kübler-Ross model and others that define the loss process, we all have our own way of coping. This means that every path is unique, there is no clear roadmap to healing, and everyone's definition of 'healing' is different. That, understandably, can sound very daunting for someone to hear (especially when those feelings of loss are at their most intense). Our outlook can appear very nebulous and overwhelming without a clear definition of a diagnosis and prognosis. Mental health often does not come with the clear answers we can expect when we break a bone or contract a virus. What is a good way to cope and what is bad? Well, as stated above, there are behaviors that are always clear warning signs. Those include substance abuse, self-injuring behavior, criminal behavior, harming others, etc. If you or someone you know is showing any of these behaviors, I would certainly advocate for immediate need for therapy. I would also recommend therapy for anyone that is experiencing the pervasive depressive thoughts and feelings as outlined above. But, what if you compulsively shop to deal with the stress of your late brother's birthday? What if you've gained 50 lbs since the death of your sister? These inquiries are harder to answer especially if the behaviors in question don't pose a direct risk to your quality of life. For me as a therapist, I try to assist you with your process according to how this grief is affecting your goals. My first question for any given behavior you may be worried about is, "is it disturbing your life?". If the answer is yes, then we've found a great place to start.
I hope you enjoyed this week's #WBYIT blog.
If you would like help with your healing process, please feel free to contact me and schedule your first session.
References:
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, D.C: American Psychiatric Association.
Kübler-Ross, E. (1997). On Death and Dying (1st Scribner Classics ed.) New York: Scribner Classics.