The Difference Between Grief and Depression, The DSM V
I believe that everyone would agree that the loss of a loved one is a jarring and tragic experience. It brings on a period of grief and mourning that is filled with feelings of sadness, anxiety, guilt and reliving of the past shared with the deceased going back years. People in the midst of the mourning process have described such feelings as: loss of appetite, nausea, tearfulness, restless sleep, guilt about not being able to prevent the death from having occurred and deep feelings of sadness. Many have described the feelings of grief sweeping over them and then subsiding until the process starts again. The process of reliving and talking about the person who has died can come with laughter as those who are grieving remember times that were funny and warm. However, there is now a controversy over whether grief is different from grieving?
In May, the American Psychiatric Association published its new Diagnostic and Statistical Manual, Volume V (DSM V). The DSM is used by psychiatrists, psychologists and clinical social workers to diagnose patients presenting with symptoms typical of the categories of diagnosis presented in the manual. According to the way diagnostic categories were presented in the DSM IV, there were distinct differences between grief and major depression. Now, in the new manual, those differences have, for all intents and purposes, been eliminated. In other words, if someone is grieving for more than two weeks, they fall into the category of having major depression according to the DSM IV. Let's look at the differences and similarities in symptoms of grieving after a loss as opposed to major depression.
1. Sadness, despair, mourning
2. Fatigue or low energy
4. Loss of appetite
5. Poor sleep
6. Poor concentration
7. Happy and sad memories
8. Mild feelings of guilt
Gradually and after an undetermined amount of time, these feelings remit as the individual regains their equilibrium as they return to normal life.
Many of these symptoms are shared by people with major depression but significantly different symptoms are part of the profile.
2. Exaggerated guilt
3. Suicidal thoughts
4. Low self-esteem
8. Loss of interest in pleasurable activities
9. Exaggerated fatigue
In major depression, these feelings are unremitting and carry with them the real danger of suicide. Daily functioning at work and home are impaired and the individual feels as if they will never climb out of these feelings.
It has also been said that an important difference between grief and major depression is that, in major depression, the feelings of loss of the loved one is compensate for by warm memories that are carried with the one who suffered the loss as part of their psyche. As one friend recently told me, the beloved people of his childhood are alive in him as wonderful memories.
On the other hand, major depression is characterized by feelings of loss resulting in internal feelings of emptiness. Nothing, not memories or anything, compensates for or balances the feelings of loss. Freud referred to this in his classic book, "Mourning and Melancholia," in which he pointed out that the one who is depressed turns their energy into attacking the self rather than integrating loved ones who are now gone.
This is an important issue because it relates directly to how people who are grieving will be treated. The DSM V states the anyone who grieves beyond two weeks falls into the category of the depressed. However, who is to say that it takes only two weeks to grieve? The amount of time spent mourning a loved one varies according to each individual. The danger of a mistaken diagnosis is that an individual could be prescribed anti depressant medication when none is needed. Ultimately, mourning runs its own course and resolves it's self. Of course, in the case where someone has a major depression and is also grieving, the grief process may be complicated by the fact of depression. It is also possible that, for some people, the loss of a loved one can turn into a depression. In fact, the new DSM was written the way it was in order to treat those who, in the process of grieving, may be carrying a major depression with them.
Diagnosing people with any mental illness is complicated and fraught with danger if the wrong diagnosis is made. That is why, if you are grieving but it seems to continue for too long, it's necessary seek help. In addition, if there is any doubt, it is best to seek help. Beyond this, it is normal to grieve after the loss of a loved one. After all, grieving is not easy but it's not abnormal.
Your comments and questions are encouraged.
Allan N. Schwartz, PhD