Grief and bereavement

Distinguishing between grief and depression is complicated. The experience of grief is similar to the experience of depression in that many people go through periods of intense sadness, notice changes in appetite or have trouble sleeping in the aftermath of a loss, but there is a difference between grief and depression.

Grief and depression overlap, but there are distinct differences:

Grief and bereavement are associated with loss, but people grieve for many different reasons:

• Death of someone close
• Loss of a job
• Loss of a pet
• Physical loss - vision, mobility, hearing
• Loss of driver’s license

For those grieving the death of someone close, they do not only grieve the loss of the person but also the role the person played in their life - spouse, daughter, parent, sibling, friend etc. An older adult who loses a spouse that was helping around the house, for example, may become faced with having to move into a retirement residence or long-term care facility because of the loss.

Grief can also be evoked over and over by the simple reminders in day-to-day life that trigger the painful feelings of grief, for example, watching an advertisement on television for Father’s day if you’ve lost your father.

It is normal for sleep to be interrupted and appetite to be affected – weight loss, no appetite – but it is important to be mindful of these symptoms and how long they last. Complications of depression can be triggered if attention is not paid to looking after your health – getting rest, eating healthy foods, etc.

Healthy signs during the grieving process:

• Able to look at photos of the deceased
• Able to laugh, recall fond memories of a lost loved one

Complicated grief:

In the early stages of grieving a person will usually:

• Be very sad
• Be very focused on the person who has died
• Not want to go out, or hang out in the same way as usual, socially

But within a certain amount of time, people will begin to ‘integrate’ the loss into their everyday life. They continue to miss the person who has died, but they are more focused on life – not just the loss.

In complicated grief, the shift (above) doesn’t happen. It’s as if they feel the person is still alive, and avoid reminders of the person because it’s too painful.

Warning signs of complicated grief:

• Unable to look at photos – too painful
• Harbour anger or bitterness
• Too focused on negative aspects of the ‘end of life’
  • i.e. blaming others (hospital, circumstances etc.) for the loss
• Unable to recount positive stories of their loved one – or even talk about them

If these behaviours linger for more than a year, the psychiatrist would look more closely for signs of ‘complicated grief’ and make and diagnosis. Tools such as the “Inventory of Complicated Grief” help medical professionals assess the syndrome.

Anger, sadness, even relief are all normal responses to grief, but these feelings should diminish over time. Complicated grief does not get integrated into living. It lasts, and it does not diminish. It is characterized by anger and bitterness, and a sense that people don’t understand what you’re going through.

Unfortunately, people struggling with complicated grief often don’t seek help, and therefore find no relief. If you recognize these behaviours in yourself or someone else, it is important to ask a professional for help. This is a treatable illness and relief can be the result.

Be aware – take care

• It is easy for someone who is grieving to overlook the basic requirements for remaining healthy, such as eating well, sleeping well and getting some exercise. During the early grieving process, sleep can be interrupted, appetite can diminish and lacking energy are common responses. Left unattended, symptoms such as a lack of sleep or a poor appetite can become risk factors for developing depression later on. The importance of looking after yourself during this difficult time cannot be stressed enough.
• It is common for a grieving person to be down or lack energy, but they tend to still have a sense of hope for the future. For example, they may say something like “I’m going to Florida with my family in a few months. I don’t want to go but I think I will go.” Whereas a person with depression loses interest in life, is negative, tends to be isolated, become socially withdrawn and would not be planning or thinking in this manner.
• While it is not unusual for an older adult who has lost a spouse of 30 to 40 years or more to say things like “it should have been me” or “I wish I were with them” – it is a different thing altogether to have constant thoughts about wanting to be dead. Thoughts of self-harm or suicide are hallmarks of a depressed state. Anyone feeling this way needs to seek help immediately.
• Voices: It can be normal for a grieving person to think they hear the voice of their loved one or see them in a crowd. Whereas someone who has severe depression may see or hear things – psychosis - which can happen as a complication of depression. It does not happen in bereavement unless someone is ‘clinically depressed’ and bereaved. This serious illness is called grief-related depression.
• Memory: Sometimes, when grieving, older adults may have trouble remembering or concentrating. These difficulties are often symptoms of depression as well. If you do not notice an improvement over time, it does not hurt to ask for help and let a health professional determine whether there is cause for concern.

A note to those who are grieving:

Most adults grieve normally. However, if you feel ‘stuck’ in your loss, then seeing a physician or psychiatrist can help give support or perspective through talking. Social groups are also important, for example widow or widower groups help you stay engaged with other people, busy, occupied and on the road to good mental health. Refusing offers to go out because you’re too caught up in your grief is a sign you may need help.

• Don’t be too hard on yourself.
• You can have good days and bad days.
  • Having a bad day does not mean you’re slipping back to the beginning of the grieving process.
• Be aware of ‘triggers’ for grief:
  • Significant dates
    • Wedding anniversaries, birthdates, other major life events
    • In the week leading up to the anniversary of the death – people sometimes feel tired, sad and don’t know why -a common reaction
    • Holidays
• Accept offers to be social
• The profound change associated with grief can impact sleep, changes in appetite and feelings of loneliness in the early days or weeks following a death. But if symptoms persist for a long period of time – ask for help.

Grief-related Major Depression

For most people, grief diminishes and the ‘waves’ become less frequent over time, but for some, it continues. Someone who has a past history of major depression is at higher risk of slipping into depression from bereavement.

Low mood, sadness and not wanting to socialize are normal during the initial stages of grief, but someone with grief-related major depression may develop:

• An anxiety disorder
• Changes in body movement
• Thoughts of self-harm or death
• Sleep interruption
• Feelings of worthlessness or guilt
• Low self-esteem
• Isolation

If you are experiencing any of these symptoms for long periods – it’s time to ask someone for help.

Depression is different from grief. Depression needs to be treated. It can also worsen and have a significant impact on other health issues if left unattended. If you are thinking about death, or don’t see a future, please go see your family doctor or ask someone for help.