Depression After Death

Grieving for the death of a loved one is an intense emotional experience. The acute phase of responding to the loss may last weeks or months. Achieving a complete resolution of the feelings toward the person who died or the circumstances surrounding the death may take a lifetime. Longing and sadness may return periodically upon celebrating life events without the deceased, or when experiencing another loss. Our culture expects depression and the process of grieving to share some symptoms. However, if the grieving person cannot refocus on the actions of living and planning a life, he or she could be experiencing clinical depression and might need further assistance to resolve this mental illness.

Theory

• Depression is one of the stages of grieving.

  Psychiatrist Elisabeth Kubler-Ross is famed for describing five stages in the process of grieving. Grieving people first deny the death. They seem unable to comprehend that the death is real. Then intense anger might surface. The anger may be directed at oneself, at specific people or circumstances, or generally at the world. Bargaining is the next stage, and it involves deals grieving persons make, usually with some higher spirit, to get back the dear ones lost. During the stage of depression, grieving persons feel intense sadness at the realization that the death is permanent and cannot be undone. Finally, grieving people can accept the loss and its meaning, and move on to reconstruct their lives without those who died.

Considerations

• Teens might try to hide their feelings.

  Grieving people may not go through all of these stages, or they may revisit steps several times during the grieving process. In addition, the process might look differently depending on the age of the grieving person and the circumstances surrounding the loss.

  A grieving 5-year-old might regress and exhibit behaviors such as thumb-sucking or poor bladder control. Being at a very egocentric age, children at this age might think they caused the death. If they lost a caregiver, they might have to contend with many secondary losses, such as the loss of nurturing, routine or financial stability.

  Grief for the elderly might bring to the front existential issues, such as anxiety for one's own mortality or intense feelings of loneliness. Complications in grief might come up when there isn't an opportunity to explore these developmentally appropriate themes.

  In addition, complications in grief might come up when people find themselves trying to come to terms with a unexpected or violent death.

Diagnosis

• According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), considered the bible of the field, the characteristics of depression include some of the following symptoms: depressed mood; decreased interest in activities; significant changes in weight, sleep and concentration; fatigue; psycho-motor agitation; feelings of hopelessness, helplessness and worthlessness; and recurrent thoughts of death. The DSM specifies that if the depressive symptoms begin in the two-month period following the death of a loved one, the diagnosis of depression should not be given. Thus, having depressive symptoms is a normal response for a person suffering the loss of a loved one.

Effects

• Depression can mask life as dark and hopeless.

  Grieving individuals experience clinical depression when depressive symptoms persist in duration and greatly impair the ability to engage in and enjoy normal life activities. They might feel like life is not worth living without the deceased and may think of suicide. They might be unable to let go of the yearning to be next to the deceased. They might continue to have intrusive anger or fear if the death was traumatic. This prolonged and complicated grief can affect a person's life immensely, producing negative consequences for careers and relationships and masking positive events with sadness and hopelessness.

Resolution

• Effective coping allows positive feelings to return.

  Grief counseling assists those who are moving though the five stages of grief in an uncomplicated way and those who are stuck within them. Grief therapy involves the retelling of the death story multiple times, expressing the negative thoughts and feelings associated with the death, resolving any irrational thoughts associated with the death and learning to allow positive feelings to rise without guilt. Grief counseling can be done individually or shared with others who are experiencing a loss. It might provide an opportunity to explore existential and spiritual themes on the road to acceptance of the loss.