Grief is a perfectly natural response to traumatic life experiences – usually associated with loss.

The trauma could be the result of many things including divorce, unemployment, theft, assault, displacement due to fire or natural disaster, permanent injury, diagnosis of chronic or terminal illness, or the death of a loved one.

It can leave someone stunned, disoriented, hurt, frightened, uncertain, and bereft.

 The Grieving Process

Grief is a bewildering mixture and range of painful feelings that rise and fall in waves, like a rollercoaster. With the normal grieving process, over time the ups become more frequent and long-lasting, and the downs (or pangs of grief) become less pronounced and fewer and farther between.

Complicated grief and depression

Sometimes, however, it seems like we will never be free of our grief, and it may be that we are not experiencing the normal journey through the grieving process.

There are clear distinctions between the ‘normal’ grieving process and what is known as ‘complicated grief’ or major depression.

Individuals with persistent complex bereavement disorder, or complex or prolonged grief disorder, are incapacitated by grief and focused on the loss to the exclusion of other interests and concerns. There is rumination about the death and longing for reunion with the deceased, identity confusion, inability to accept the loss, anhedonia, bitterness, difficulty trusting others and a feeling of being “stuck” in the grieving process. These are present every day, cause distress or functional impairment and persist for more than 6 months after bereavement. Patients report loss of self-worth and sense of self, feel emotionally disconnected from others and do not wish to move on from bereavement, sometimes feeling that to do so would represent a betrayal of the deceased (Prigerson, Bierhals, Kasi, Reynolds, Shear, Newsom & Jacobs, 1996).

In contrast to the normal grieving process, complicated grief is characterized by debilitating or prolonged denial, avoidance, anxiety, intrusive or suicidal thoughts, and isolation.

Major depression is characterized by a pervasive, dull sadness, numbness, bitterness, and/or excessive anger. Unlike the difficulties of normal grief, complicated grief and depression confer a feeling of being stuck, as if trapped in a hollow of the rollercoaster or even in a continued downward spiral. With normal grief, you fall apart but gradually there are respite-periods of time when you can engage with life, get stuff done, or even smile at a joke or appreciate beauty. With complicated grief, you fall apart and remain broken. There is little to no respite. Because of the clear distinctions between normal grief and complicated grief or major depression, rest assured, just because you are grieving the death of a loved one, you will not be automatically diagnosed as suffering from a “mental disorder”.

Treatment

If you feel that you are experiencing prolonged grief or depression, you should seek help. Medical professionals will be able to discuss and recommend the appropriate therapy for you, which may include talking therapy and or medication.

Medication and therapies do not necessarily lessen the pain, but they can provide a floor to the abyss. So instead of feeling stuck or continuing a downward spiral, the right treatment can offer you the comfort of a good foothold, renewing your ability to adjust.

There may be some helpful sources of information and support in our useful links – specialist organizations page.