|Good Grief: Part I: Is It Mourning or Is It Depression?|
Mark Gorkin, LICSW,
The Stress Doc starts taking some of his advice about setting limits and "letting go." Not just mind-body exhaustion, but self-perception and creative expression are at stake.
As a training contractor for Fairfax County Government (in Northern Virginia; home of America Online and the "Software Valley") Ive been leading bimonthly "Dealing with Stress, Loss and Change through Humor" and "Managing Anger and Conflict" workshops. Over the last two years, Ive interacted with hundreds and hundreds of individuals who have been terminated, downsized and outsourced. Some of these folks have been dislodged for just cause, some because of management malice or mismanagement; some with severance pay and some with a half-day notice. The process of layoffs seems to be especially volatile in the new economy -- here today, gone tomorrow Information Technology (IT) world.
For most folks, when the dislocation from a job and a career is sudden, unexpected and/or unwanted, theres a period of shock, fear or rage, as well as sadness or helplessness. And when unemployment drags on from weeks to months and a feeling of self-doubt and despair spirals unabatedare we talking: a) grief process, b) situational depression or, as weve seen, c) prolonged stress effecting biochemical and mood disorder consequences?
It's a vital and confusing question because: 1) grief and depression have complex overlap along with marked differences as bio-psychosocial states of experience and action and 2) depression needs to be differentiated between situational or exogenous, that is, external and environmental forces (like losing a job) and the clinical, the internal or endogenous (that is genetic, family history and biochemical factors or predisposition).
Lets begin the conceptual differentiation through word association. What comes to mind when you read the word, "depression?": emptiness, exhaustion, darkness, heaviness, black hole, mood disorder, food disorder, sleeplessness, agitation, mania, paralysis, helpless, hopeless, endless, suicideProzac!! Perhaps not so extreme. How about melancholy, inertia, apathy, sorrow, sadness, joyless, loneliness, pessimism, deprivation, abandonment, bereft, bereavementgrief.
Quite a depression spectrum -- depression to grief but also grief to depression. What is cause, what is effect? Is this a chicken and egg issue? Its clearly not black or white; many shades and intensities of grayness and darkness.
Drawing on the above-mentioned experience, lets see if a scenario involving an unemployed individual can shed light on some of the diagnostic conundrums. Clearly, the unexpected and/or unwanted termination of a job so often triggers a profound sense of disruption and loss. Very quickly the person is thrust into a grief process and, initially, the person literally may not know what has hit him or her. So to clarify the many levels of confusion from conceptual to emotional let me outline the stages of grief. Clearly, what follows is an ideal type as grief stage engagement rarely marches in precisely aligned and sequential steps. The bereaved may bypass a phase or rapidly morph from one stage to another. A person may waver -- two stages forward, one stage back, or vice versa. Anniversary losses, such as a death or divorce dates, can easily trigger a feeling of regression, of being thrown back to the vicious beginnings or the whirlpoolish depths of a grief (or depression) cycle. Fortunately, much of the time the regression is temporary and the person with sufficient support and stamina will continue his or her hard-fought, "Rocky" evolution and personal growth through "Good Grief!"
Stages of Grief
- Shock and Denial or "It Cant Happen Here!" Its no big surprise when given a days notice that an employee may experience a state of shock. Theres such total confusion and disbelief that a person often goes numb; the mind-body system has to shut down. Sometimes shock follows the downplaying or denial of bad news. For example, in the early 90s, there was talk of significant restructuring in the US Postal Service. A number of employees took the early attitude: "Were always dealing with change hereNo big deal." Alas, these folks didnt count on Carvin Marvin Runyon becoming the Postmaster General. Talk about a shocker...Within a year 50,000 employees were restructured out of the service!
- Fear, Panic and Shame or "Oh God, What Do I Do Now?" Once the shock wears off, you are no longer numb, there are some predictable next steps, such as profound anxiety and vulnerability: how will I survive this loss of income, identity, my daily routine, my social standing, etc.? Theres a mounting sense of being out of control, which for many also evokes feelings of shame and inadequacy. And lack of control, not surprisingly, can stir up childhood memories of the same, being or feeling tormented, rejected or humiliated by family, peers, teachers, etc.
I vividly recall the lamentation of a postal supervisor on a management fast-track, quickly derailed by reorganization: "I once had a career path. Then this boulder fell from the sky and crushed it! Is it only a career path thats been crushed? How about the human psyche and spirit? Has it too been burnt up or burned out?
- Rage and/or Helplessness or "How Dare They!" or "Oh No, How Could They!" Do you think our once fast-tracked supervisor is feeling abandoned and betrayed? Most likely. Often people in this phase swing between rage and profound sadness. Both states can be induced by deep underlying vulnerability or helplessness. Youve been wounded, feel exposed and just want to lash out. Or you turn the rage inward in depression and self-condemnation. Now its crawling under the covers escapism, or going through the motions of living or, even, straining as hard as you can to reign victorious over your basic unworthiness; to battle a fear of failure and lurking dread of being sucked into that compelling black hole of helplessness.
Consider this: in the Random House Dictionary: The Unabridged Edition, the first six definitions of the word "failure" describe it as an act or an instance. Its not until the seventh and last definition that "failure" takes a personal direction. So losing a job or being confronted with other losses and separations are often more events or individual episodes than a judgment upon you.
Also, please consider, that individuals predisposed to a depressive mindset are likely to over attribute self-responsibility, that is, to blame themselves for "negative" events. These folks minimize the impact of external factors or environmental stressors. Which is why the next phase, while often maddening, is also essential for moving through the grief process.
- Guilt and Ambivalence or "Damned If You Do or If You Dont!" The feelings and old voices of guilt (not living up to an important others expectations or standards) and shame (violating or compromising an internalized core value or essential part of your self-identity, integrity and esteem) can become louder and more incessant Self-directed rage keeps taunting you for shortcomings, unworthiness, lost dreams, etc., and can ultimately drain you. If some energy returns or remains the battle may continue in other arenas. First, the classic approach-avoidance conflict: "Damned if I do, damned if I dont; damned if I stay, damned if I leave." Take the paltry severance or not; leave the faulty marriage or not. And while the uncertainty is terribly frustrating, at least theres a struggle.
Some may turn to a spiritual source for relief or rescue: "Higher Power, just tell me what to do" or "Higher Power, I turn it over to you." And, of course, some in desperation will proclaim newfound or "born again" allegiance if they are only saved. Yet, in the end, with or without your HP, one must get focused and cut the entangling emotional cord.
- Focused Anger and Letting Go or "Turning a Lemon into Lemonade" and "Freedoms Just Another Word" This phase truly reveals the complexity and potential creative energy built into the grief process. To reach that powerful, purposeful and passionate state of focused anger one must often blend rage and sadness. Some rage can propel us out of a shocked, paralyzed or ambivalent state. Yet, you must also face your sadness and loss and struggle with uncertainty to temper uncontrollable aggression, to make sadder yet wiser assessments and decisions. Remember, rage unchecked much more often leads to self-destructive behavior than it does to "Going Postal!"
If youve worked hard to integrate the previous stages then the reward is "focused anger": "I really dont like whats happenedbut how do I make the best of it?" Youre ready to loosen if not untie the knot of hurt and humiliation. And best of all, youre getting ready to knock on (maybe even knock down) doors again.
- Exploration and New Identity or "Now Youre Ready to 'Just Do It!" (even if scared). Letting go is often unnerving. Its not just the financial security thats at stake. But losing a job or a vital relationship also profoundly shakes our personal/professional identity. Weve invested so much time, ego, energy, money in this position or partnerWho am I without the job, without my mate or significant other?
However, this vulnerable yet fluid state provides unprecedented opportunities to get to know yourself, to assess your true individuality strengths and warts and not only as it relates to financial dependence, job skills or career paths. Now is the time for a full scale person-in-situation life inventory. How healthy or toxic are seemingly vital relationships and friendships? What about your health? During this transitional window, do dysfunctional coping patterns -- habits of drinking, smoking, drugging, eating, lack of exercise and limited socializing or spiritual support -- need to be challenged?
Even with the most dear and painful loss or separation, the words of Albert Camus, Nobel Prize-winning author and philosopher have the crystalline ring of essential truth:
"Once we have accepted the fact of loss we understand that the loved one [or loved position] obstructed a whole corner of the possible, pure now as a sky washed by rain."
A Mid-life Maelstrom or Father Finally Knows Best
Camus words remind me of an existential crisis faced by my father in his late-40s. Its a morality and morale-ity tale about how his corporate world went from cutthroat cocoon to just cutthroat. For over twenty years, my father had been working as a salesmen for a large manufacturer in New York City's garment center and fashion industry. As I mentioned, the competition was cutthroat, but still only figuratively. And through aggressive and tenacious persistence, he had carved out a legitimate and fairly successful niche. He had sales turf, some financial security and hard-earned pride.
Then, almost overnight, my father realizes that organized crime is infiltrating the company big time. (Perhaps some of dad's capacity for denial was at play.) Now he's going to have to report to one of these new executive slimeballs. His whole world is at risk; cutthroat is no longer symbolic. This isn't just downsizing...it's downright "frightsizing!" Dad's existential crisis is in high gear. From this experience I first learned there can be a fine line between homicidal and suicidal tendencies. Day to day, I didn't know if he'd go to work and punch someone out or not get off the couch, immobilized by an explosive psychic cocktail of rage, fear and depression. (Good thing he was in group therapy at the time.)
He was caught in the classic reorganizational bind: "damned if I stay, damned if I leave." Fortunately, my old man realized "discretion is a better part than...'A Death of a Salesman.'" He resigned. Economic fears had him precipitously joining another large manufacturer. After a month, he knew it was the wrong move. What crystallized was his need for genuine control and autonomy, and a playing field in which he could aggressively compete. And he eventually found it as an independent sales rep for a small manufacturer. Of course, the owner of this garment center business was a "goniff" (Yiddish for thief) in his own right, and would often drive my father up the wall. But crazy we have practice with and can handle in my family. It's when people take cutthroat literally that we usually draw the line. And in fact, my father went on to have his most successful years in business.
As Camus understood, a whole new corner of the possible can emerge when you accept loss and take time and heart for genuine grieving and exploring.
- Acceptance or "The Glass is Half Empty and Half Full." While submerging yourself in the stages of grief for a time will feel hellish, there truly is an opportunity for rebirth. Getting out of the black box is a distinct possibility if you can ride on and ride out this acutely emotional learning roller coaster. The grief encounter is definitely more than a learning curve. And theres no absolute or fixed period of time for your movement through the stages. My blood starts percolating when I hear "well-intentioned" family members, colleagues or friends say to the grieved, "Hey, its been three months (or even six months) already. Dont you think youre stretching out this grief thing (or unemployment status) a bit too much." The implication, of course, is that youre indulging in self-pity. Or, sometimes the verbal sting comes in a seemingly more innocuous message: "Gee, someone with your skills, talents, experienceI cant understand why its taking you so long to find a job."
The most important thing we can do after experiencing a major break whether break up or break down, social, physical or psychological is to take time to heal. Now some after a loss of a job or a relationship feel compelled to jump right back into the fray. And getting back in the saddle is a cultural icon and wise strategy for a thrown cowboy or cowgirl. However, for a major loss its wise to retreat and regroup, at least temporarily. For example, those folks who are participating in the Fairfax County Government reeducation and training program are getting career counseling and job search coaching, taking job training classes (for many students, leading to computer skills certifications) as well as the Stress Doc workshops. Perhaps most important, they realize they are not alone. Also, folks are encouraged to grieve and to gradually recover and discover: Who am I? What genuinely feels like me? What works for me and my family? What seems to kindle (or rekindle) my passion?
So remember, theres a real difference between "feeling sorry for yourself" and "feeling your sorrow." When you are feeling sorry for yourself you are mostly blaming others. When you are feeling your sorrow you are demonstrating the courage to face your fears and pain. There are poignant moments in life when we all must take time to embrace our sorrow.
As I once penned, reflecting on more than one soul shaking grief process: "Whether the loss is a key person, a desired position or a powerful illusion each deserves the respect of a mourning. The pit in the stomach, the clenched fists and quivering jaw, the anguished sobs prove catalytic in time. In mystical fashion, like spring upon winter, the seeds of dissolution bear fruitful renewal."
When Its No Longer Just Grief
While many grapple productively with the ebb and flow of grief gradually, if not grudgingly, working their way through the stages for other folks its not uncommon to get stuck in "the big muddy" of mourning. Mourning becomes melancholia. How do you know the difference? My first therapist gave me a handle; actually a heavy lid. She likened the state of depression to a heavy lid that often covers up or tries to hold down underlying bubbling and boiling, conscious and unconscious thoughts and emotions fear, rage, obsessive ideation, panic, helplessness, suspicions if not paranoia, etc. So much energy is used in suppression and repression of this raw psychic tension that exhaustion and apathy often result. Also, some of the tension can manifest as an amorphous agitation. A number of classic depressive symptoms may appear:
1. Fatigue, sadness, heaviness and listlessness,
2. Loss of appetite (though sometimes theres compulsive eating) or using escapist substitutes alcohol, tobacco, drugs, etc. to numb ones pain,
3. Difficulty concentrating and starting and completing tasks; general diminishment in role functioning,
4. Feelings of shame and worthlessness and incompetence and inadequacy,
5. Restless and interrupted sleeping,
6. Difficulty getting active and focused especially in the morning,
7. Loss of interest in activities once seen as enjoyable or meaningful,
8. Withdrawing from friends, colleagues and family members,
9. Engaging in a variety of reckless and potentially dangerous active or passive -- undertakings, e.g., drinking and driving, drinking while taking medication, etc.,
10. Communicating directly and indirectly a desire to harm oneself (or others) that is, expressing or demonstrating suicidal or homicidal impulses, gestures and/or actions.
As for the grief process, my analogy has a mythical bent. Unlike depressions tendency to bottle up and stuff down emotions, for me, grief work is like removing the cover of Pandoras Box. As was recently illustrated, grief opens you to a whole range of harbored fears and furies past and present. Ultimately, grieving releases and integrates a range of emotions and energies that enables you to regain psychic equilibrium, helps evolve a new or renewed sense of purpose and direction. Vital mourning is also the wellspring of passion and determination for exploring new roles and identities.
However, key components of the grief process do overlap with key depression dynamics such as deep sadness, agitation or anxiety along with helplessness and rage (often inverted). So when is it grief and not depression? Or, how do we know that a difficult and possibly prolonged grief process is not being weighed down by or turned into situational or (unrecognized) clinical depression. (Remember, chronic low-grade clinical depression is difficult to recognize and acknowledge. Over the years, the individual, as if living in a constant smog environment has adapted, albeit not without disruptive mind-body consequences, to this (mostly) moderately depressive and slowly degenerative condition. "Its just how life is," cough, cough.)