Synopsis: Everyone deals with grief at one time or another. An expert discusses how it’s experienced by most people, and what separates normal grief from more problematic depression A writer/illustrator discusses his experience dealing with his spouse’s sudden death.
Host: Nancy Benson. Guests: Dr. Ronald Pies, Professor of Psychiatry, State University of New York Upstate Medical Univ. and Clinical Professor of Psychiatry, Tufts University; Danny Gregory, author and illustrator, A Kiss Before You Go
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NANCY BENSON: Queen Elizabeth II has said, “Grief is the price we pay for love.” It’s true. Losing a loved one, getting a divorce, or even losing a job can all be heartbreaking experiences. And it’s something everybody goes through. But while we all grieve at some point in our lives, not everybody does so in the same way. So how do psychologists define grief?
RONALD PIES: Grief is the expectable, emotional reaction that most people have after a major loss of any kind, though it is different for each person. Often, grief is mixed in with positive feelings and memories.
BENSON: That’s Dr. Ronald Pies, Professor of Psychiatry at the State University of New York Upstate Medical University, and clinical professor of psychiatry at Tufts University. He says that while most grief follows a somewhat predictable path, no two cases are the same.
PIES: There is no precise time frame for grief. There’s no cutoff for how long a person should be grieving. In some cases, for some people, grieving is actually a lifelong process. And folks with complicated grief often feel intense anger, bitterness; this is often accompanied by distressing, intrusive thoughts related to the death. Some folks may develop a major depressive episode after the death of a loved one. It’s important, though, to say that major depression is very different from ordinary grief.
BENSON: So, what are the differences between ordinary grief and depression?
PIES: When people normally grieve they are generally able to function in their day-to-day activities. Generally, their feelings of loss and sadness are intermingled with pleasant memories. In contrast, for example, in major depression, the person typically is unable to function in most activities of daily living. Very often, sleep, appetite, energy levels are profoundly and adversely affected; often they feel suicidal. They do not want to go on with life. They may be extremely slowed down or very agitated. All of these are signs that something has gone wrong, that this is not ordinary grief.
BENSON: For those dealing with depression after the loss of a loved one, getting the help they need just became a little easier. Psychiatrists practice according to rules outlined in what’s called the Diagnostic and Statistical Manual of Mental Disorders. in the most recent version of this manual, a rule called the “bereavement exclusion” was taken out.
PIES: The bereavement exclusion basically said, in the old manual, that with only a few exceptions, clinicians were told not to diagnose major depression in a patient who had all of the usual signs and symptoms of major depression, but had experienced the death of a loved one within the previous two months. So, unless the patient was suicidal or psychotic, the old manual was saying, “It may look like a duck, it may talk like a duck, it may quack like a duck, but it’s not. It’s not major depression,” if it occurs within two months of the death of a loved one.
BENSON: And while Pies believes that the bereavement exclusion was a well-intentioned attempt to avoid medicating ordinary grief, he says those who develop depression after a death do respond to treatment.
PIES: When a person has lost a loved one, and also meets the full symptom duration and severity criteria for major depression, they have roughly the same course of illness and response to treatment as anyone else with major depression. In other words, what we call “post-bereavement depression”, depression after the death of a loved one, isn’t really much different from major depression occurring after a divorce, let’s say, or a job loss, or a loss of house or home, or from major depression that just comes out of the blue and doesn’t seem to have any loss associated with it at all.
BENSON: So what causes someone’s ordinary grief to escalate to complicated grief, or even depression? Doctors say there are many factors that influence how grief progresses. But there’s one element that doctors think might keep the bereaved from becoming depressed.
PIES: One factor that we’re very interested in studying, that seems to protect against complicated grief or depression, is something we call “resiliency”, basically, how well a person can roll with the punches and retain his or her mental equilibrium. And people differ greatly in this respect. While there is a very wide range of grief responses after the death of a spouse, the most common pattern is actually one of resilience. So, contrary to the notion that everybody falls to pieces, falls apart after the loss of a spouse, actually, the more common response is to deal with it and to cope reasonably well.
BENSON: That’ something that Danny Gregory, illustrator and author of A Kiss Before You Go, knows a lot about.
DANNY GREGORY: My wife was taken from me very suddenly, and I think that that was such a blunt shock. It took me awhile to even know how to feel. I think when something happens that’s this traumatic, this quickly, this out of the blue, it just sort of sends your emotions into a spin. And so, it took me a long time to even feel it’s full impact.
BENSON: Gregory wrote his illustrated memoir of love and loss to chronicle his grief. He discovered his love of drawing helped him heal, and start to move on after the loss of his wife.
GREGORY: I didn’t draw everyday. In fact, for a couple weeks right after she died, I didn’t draw at all. But, then my son and I went on a trip to Boston. It was a vacation that we had planned while Patti was still alive and we decided to take it anyway. And while we were there, we drew a lot together. I realized how much it meant to me and how much it was something that I could do with him as well, so that we had, you know, an activity that was ours. So, you know, I got back into drawing and I felt like whenever I drew, it helped to focus my mind and it helped to intensify my emotions in a way that I wanted to have. You know, I wanted to be able to feel strongly, to bring it to the surface. Cause a lot of the feelings that I would have, there would be a temptation to push them down.
So, drawing and painting and writing things down was like a safety valve that allowed my emotions to come out, and allowed me also to direct how I was feeling into making something. As opposed to, beating myself with it.
BENSON: So, what advice does Gregory have for those dealing with losing a loved one?
GREGORY: Find ways to express yourself to yourself. Keeping a journal is really important, having a place to put your feelings down and thoughts down is really crucial. But, I think it’s also important to have some plans of where you’re going with your life. I mean, we knew our son was going to be leaving home to go to college in a couple of years, and we had been making plans for what we would do once he was gone. And suddenly, I didn’t have those plans anymore. It was really important to me, I think, to start think about where am I going with my life, you know. What am I going to do every evening. Plan a trip, see other people; just keep living. Keep going somewhere. Don’t succumb. Don’t withdraw. And that doesn’t mean that you’re going to forget that person. It just means that you’re going to do what I think they would have wanted you to do, which is to, ultimately, get on the path to being happy.
BENSON: You can find out more about Gregory’s book, A Kiss Before You Go: An Illustrated Memoir of Love and Loss, at dannygregory.com. For more information about all of our guests, visit our website…radiohealthjournal.net, where you can also find archives of our shows. You can also find our shows on ITunes and Stitcher.
Our production directors are Sean Waldron and Nick Hofstra.
I’m Nancy Benson.