The Difference Between Grief and Depression

This post is reprinted from my blog "The Gallows Pole" which can be found here: http://thegallowspole.wordpress.com/ There is a fundamental difference between what I called acute depression brought on by circumstance and major clinical depression. I think this poses one of the greatest challenges to breaking down the myths about depression and eliminating the stigma associated with it and other mental illnesses. Because all people experience grief or sadness, this gives rise to a popular perception that somehow these experiences are akin to major depression. I think many people assume that the only difference (if they even acknowledge there is a difference) is quantitative. In other words, I think a lot of people assume the only difference is in how severe the pain is. But there is another more insidious problem inherent in that assumption. If people experience grief when they suffer a loss and then see someone suffering from depression, they are often confused by the fact that the depressed person appears to be experience grief for no reason. They look at their own circumstances and think "my grief makes sense — I just lost a loved one, but this depressed person has no basis for feeling grief." Often, that logic leads them to assume that the person suffering from depression is weak, or crazy, or worse. From their perspective, there is nothing wrong in the depressed person's life that would cause grief, so why would they feel so sad? And it's not like I haven't gone through the same analysis in my mind. Why would I feel so much pain for no reason? There must be a reason. And often, so began for me a period of ascribing blame to aspects of my life in the desperate hope that I'd find the thing making me suffer and remove it, thus ending my suffering. It was a fool's errand. Depression is qualitatively different from grief. The source of depression is not external, but internal. Depression comes from inside my own brain. Here is what Kay Redfield Jamison, Professor of Psychiatry at the Johns Hopkins School of Medicine, an expert in the study of bipolar disorder, and herself bipolar, had to say about the difference between grief and depression. "I got very interested in grief and depression just because I had both. I certainly had a lot of personal familiarity with depression and clinical. But my husband died about five or six — seven or eight years ago. And I was struck then by the differences between grief and depression, even though they often get put together in the same category. Grief is something that always of us will experience, have already experienced, will experience. And depression is something that a lot of people will [experience], but not everyone. And the question is why do they exist and how are they different? And so I struggled with that in a book to try to sort those things out. And one of the things is that's most striking about grief is that when you grieve, you feel alive. Even though you may be desperately sad and unhappy and missing and mourning, you feel alive. You don't feel unconnected with the world. And, in fact, you can rather easily reconnect with the world if a friend comes in or you go out on engagements. And, in fact, grief comes and goes in very much waves when you least expect it. But it's not an unremitting state and you don't die inside, whereas with depression, depression is a deadened state that is unremitting that doesn't respond to the world around you, to the environment. You could be told the best or worst thing in the world and it doesn't have that much of an impact. It's an internal state." (This is an excerpt from an interview that appeared Episode Nine of the Charlie Rose Brain Series. See below for more information on where to find the entire interview.) I take Dr. Jamison's elegantly spoken point very much to heart. Sadness triggered by some painful external event is fundamentally different from major depression. As much as someone who has never experienced depression may want to use his or her prior experiences with grief as a means to understand what a depressed person is going through, it simply fails to provide a useful analogue. Worse, those who doubt the reality of depression can often use their assumptions about depression based on their experiences with grief to suggest treatments for depression that rest on a fundamentally flawed premise. What helps someone suffering from grief will not work with someone suffering from depression. In the same interview as was quoted from above, Helen S. Mayberg, MD, Professor of Psychiatry and Neurology at Emory University explained how those differences are capable of being mapped when examining the brain itself: "It's quite interesting because you can actually study intense personal sadness and map it and get a signature of that, and you can actually to that same thing in people who are depressed and actually look at the difference between being depressed and situationally sad. And there are areas of the brain that are different, and what struck me...from some of our own data, [is] that the part that differs is an area of the frontal cortex that is responsible for the self-connectedness. And in depressed people when they're currently depressed and they get sad, that area of the brain doesn't come on as it does in healthy people who are experiencing a past episode, recollecting a sad event." According to Dr. Mayberg and many others, the mind of a depression sufferer is physically functioning differently than the mind of someone experiencing grief. This mirrors my own experiences, in that I've always been able to recognize something fundamentally different between acute sadness and depression. Of course this presents challenges to not only the patient, but also to clinicians in trying to differentiate between when a person is grieving and when a person is clinically depressed and in need of treatment. And it is not as though there is no overlap between the two conditions, only further complicating the situation. The key thing to take away from this discussion is that using common shared experiences of acute pain and situational grief as a model for understanding clinical depression is unavailing. Grief and depression are simply not the same. Dr. Mayberg and Dr. Jamison (both exceptionally eloquent and vital voices in the world of mental illness) were interviewed for Episode Nine of the Charlie Rose Brain Series, a discussion of mental illness with Kay Redfield Jamison of Johns Hopkins, Elyn Saks of University of Southern California, Jeffrey Lieberman of Columbia University, Helen Mayberg of Emory University, Stephen Warren of Emory University, and Eric Kandel of Columbia University, which can be viewed in its entirety here: http://www.charlierose.com/view/interview/11113 I highly encourage anyone interested in mental health issues to watch that episode in full. It is essentially viewing.