Monday, June 18, 2012

Voices of Experience: Grief and Depression: Are They Different?

Photo by Lauren Cottrell
Elaine Mansfield’s husband died in 2008 after two years of illness. Since his death, Elaine has become a bereavement volunteer at Hospicare and Palliative Services of Tompkins County in Ithaca, New York. She writes for the Hospicare website and e-newsletter, and facilitates bereavement support groups for women who have lost their spouses or partners. The post below originally appeared on Elaine's blog on May 14, 2012, and is reprinted here with her permission.

It’s hard to distinguish between grief and depression. When does one slide into the other? Who gets to choose the labels anyway?

A New York Times article from January 25, 2012 explored diagnostic labels for mental illness. One proposed change put grief under the umbrella of depression, making a normal human response to loss a pathology. Is every grieving person mentally ill?

In the years after my husband Vic died, it was hard to tell if I was depressed. It was clear that I was grieving, but I had a few bouts of depression earlier in my life that dragged me down and under. The first was in 1967 when I was a freshman at Cornell, before easy access to psychological counseling or antidepressants. But I was grieving then, too. My mother had left for Europe to teach Air Force dependents just before I started my freshman year, and I didn’t see her or talk to her for ten months. I still hadn’t processed my father’s death less than four years before, so the isolation and sense of abandonment were more than I could manage. I crashed into a dark existential despair and tried eating and boozing my way out of it. The following summer, my brother and his kind girlfriend helped me find a path back to healthy food. In time, I recovered my equilibrium without medication or therapy.

I wasn’t surprised to experience persistent despair when my husband Vic died in 2008. Despair and tears seemed normal reactions, even if exhausting, even if socially unacceptable.

“Have you thought of trying antidepressants?” my therapist asked at the end of another tear-soaked session.

“No, not really. Isn’t this normal? I’m sad.”

“It’s been over two years,” she reminded me, offering the possibility of help without insisting.

I delayed, but had to admit that I wasn’t in a position to judge my situation. Was it normal to be crying this much for this long? Shouldn’t there be some easing after two years?

Why? I argued with myself. Why should there be? I loved this man. We matched. We affirmed each other and had fair fights. We like to eat the same food, live in the same country house, and meditate at the same time of day. Why should I get over it?

Because you have to, I told myself. Because you can’t keep living in the alluring cinematic world of the past. Because something worth loving is here in this life now. Because you promised Vic that you would find a way to be all right. Because you want to live.

I made an appointment with my doctor.

“I’m not sure it will help,” he said, “but it won’t hurt to try.”

So I tried Zoloft, a tiny dose, a child-sized dose, and it worked immediately. I felt happier, more interested in life, less interested in stuffing myself with carbohydrates and draining myself with tears, but as the dose got stronger, my gut grew more wretched. We dropped the dose, hoping I’d get used to it. My gut said no to even the smallest dose. It was a relief to say goodbye to Zoloft.

“Want to try a different antidepressant?” my doctor asked.

“Not really.”

“Wellbrutrim doesn’t cause gut problems,” he promised.

I gave it a try, one-third dose. At two-thirds dose, I felt agitated and anxious. I tried a full dose before calling it quits.

I’m OK as I am, I decided. I’m grieving and sometimes that spills over into depression. This is normal after losing the person I most counted on. Normal.

Nearly four years after Vic’s death, I cry less often and am enthusiastic about my new life. Still, every day is punctuated with memories of Vic, often sad.

Don’t mess with it, I tell myself. This grief is an incredible teacher.

© 2012 by Elaine Mansfield. For more of Elaine’s stories about love, loss and continuing bonds, visit her blog and website.

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  1. What an important distinction to make: grief is distinct from depression. Depression is an emotional state where the sadness has little basis in external reality. Grief is a healthy response to real events in our lives: our loved one's death. That the symptoms overlap makes it easy for grief to be diagnosed as depression and the experience treated as a medical problem. Elaine's essay provides a voice that gives more space to a middle place for working through one's grief by being with those feelings. Acceptance. Adjustment. Appreciation. All steps up from the darkness.

  2. Thank you for your perceptive comments and for recognizing my attempt to "give more space to a middle place." I had a history of mild, unmedicated depression that confused the issue, plus I lost my father when I was 14, after a 12 year illness. I could not express grief as a girl because it upset my mother. My husband's death pulled up memories of my father's death, and I knew that I needed to experience my sorrow this time. And I did.


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