Grief is the natural process
we all go through when we lose someone we love. The paradigm of
grief is the loss of a loved one through death. But we also lose
people in other ways; we divorce, we move away, we change jobs,
we simply grow apart. And we also lose the meanings of people as
they, and we, change. Our parents retire to Florida, and we suddenly
realize how much we depended on them. Our spouse has a stroke, and
isn't the strong partner we were used to. Our children marry and
start their own families, and we wonder if they need us anymore.
Most first episodes of depression
are the result of loss of a relationship with a loved one. And the
experience of grief is very much like the experience of depression.
Yet grief is inevitable, and depression is not. When normal grieving
is prevented, depression can be the result. When we suffer a loss,
we must allow ourselves the time and opportunity to mourn.
All of us now are familiar with
the concept of the stages of grief. What comfort the model can provide
is the knowledge that in grief we are caught up in a process. Something
foreign has taken us over, and we don't have as much control as
we used to; but though the experience is bound to be painful, it
is predictable, and the pain will diminish.
But we depressives try to avoid
or control our grief. The loss awakens a primitive unconsolable
distress, and we become fearful of becoming permanently destabilized
by the force of emotions we can't control. We feel powerless. We
blame ourselves, assume that we will never recover, and that the
loss will sap all possibility of joy from every aspect of our lives.
We don't display our feelings, and so don't elicit comfort from
those around us.
When grief can proceed normally,
there is a gradual resolution, an acceptance of the loss. But people
who are truly depressed can rarely reach this stage. In fact, one
of the treatments known to be effective with depression, Interpersonal
Psychotherapy or IPT, assumes that abnormal grief reactions are
one of the primary causes of depression. But the IPT therapists,
and others before them, have noted the difficulty of diagnosis:
when the patient presents with depression, he or she may have absolutely
no idea that the depression is connected with a death or loss; that's
why it's essential for the therapist to do a thorough history and
exploration before treatment is begun.