Throughout our lives we have losses. Loss of a friendship, loss of a job, divorce and so on. We also have loss due to the death of those we care about and love. This is inevitable and an event we all dread but have to face, whether we want to or not. When we observe the health decline of those around us, especially with those that have been diagnosed with a serious illness, we often begin the grieving process. This is particularly true for those that care for individuals with dementia. Loss of the person we knew, gradually over years as the disease takes over, this grief before death is known as Anticipatory Grief, or anticipation of the loss. Anticipatory Grief has many of the same physical, emotional and cognitive symptoms as grief after one has passed away.
In the past we believed grief came in stages. Many people are familiar with Elisabeth Kubler-Ross’s Five Stages of Grief: denial, anger, bargaining, depression and acceptance. New research on the subject now sees grief as less rigidly defined, more individualized and more unpredictable. It can be described as a roller coaster of emotions. While dealing and trying to cope with these random emotional ups and downs, grieving people may ask themselves, is this normal and when will it stop? While the majority of people are still able to function day to day with their grief, it certainly is not easy; some days are okay and some are really tough. As time goes on, the dramatic emotional swings and pain tends to lessen; however it is extremely important to understand that there is no deadline for grief, it's not something that one “gets over,” like a cold. While the symptoms of grief may lessen, the loss stays with you always, and we never stop missing the deceased.
But as time continues and the sadness still lingers sometimes the questions arise, “Is this still grief or is it something more? Am I depressed? Should I go to a see someone about it? Where would I even start?” While grief and depression do have some similar attributes, to help answer these questions it can be helpful to understand some of the differences between grief and depression.
Generally grief is a situational adjustment: the loss is what is causing the various emotions. When one thinks and misses that significant other, the waves of emotions can overcome them. But often there can be some enjoyment in other parts of one’s life at the same time. One tends to fluctuate between the wide range of emotions and the functioning of everyday life. But in depression it is often all enveloping, meaning that there is sadness and apathy about life in general, along with lack of motivation, and the ability to function in life can be limited. In grief, self-esteem tends not to be disturbed while in depression often there is an overwhelming feeling of worthlessness and hopelessness. In grief one may long to join their loved one that has passed, due to missing them so much. In depression the thoughts of death are to end life often so that they will “no longer be a burden” to others; the thought that “everyone will be better off without me.”
Everyone’s experience with grief is unique but generally time can help alleviate the pain of the loss. Again, there are no deadlines, as it can take years for the bereaved to process through it enough for pain to start to subside. But if after a significant amount of time one is still having difficulty functioning from day to day and it does not seem to be getting better, if there are indications of sadness beyond the individual loss, if the feeling of worthlessness and hopelessness grow, then it is time to reach out for help—especially if you are having thoughts of harming yourself. Those type of thoughts indicate help is needed immediately and taking the steps to get that help is very important.
Overall, it can be difficult to distinguish between grief and depression. It takes a clinician that specializes in mental health diagnosing, such as a clinical psychologist, licensed clinical social worker or a psychiatrist. If you are concerned that you have depression see your Primary Care Physician and ask for referral to a mental health specialist to ensure you get the appropriate diagnosis and medication. Along with medication, therapy is recommended as well since research shows that the powerful combination of medication and therapy have the best outcomes.
Grief is a part of life: we all experience it but there are resources out there to assist in getting the help you need. Connection with others is one of the best things you can do for yourself during this vulnerable time. Reach out to friends and family, join a support group or see a counselor. Talk to your medical professional if needed. Self-care is important as well; do not beat yourself up because you are struggling. That is to be expected. Through our grief we can slowly and mindfully learn to adapt to the “new normal,” the life we have to lead without that person. And most of all, be gentle with yourself.
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