Project 8 of 12 for high-nurturance families and relationships

Is it Depression or Incomplete Grief?
 - p. 1 of 2

These have similar symptoms, but different roots

By Peter K. Gerlach, MSW

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The Web address of this two-page article is http://sfhelp.org/basics/depression.htm

        Clicking links below will open a full window or an informational pop-up, so please turn off your browser's popup blocker or allow popups from this nonprofit Web site.

        This is one of over 150 articles focused on building high-nurturance family relationships and preventing divorce. This introduction describes the Web site's purpose and the best ways to use its resources. Each article is part of a mosaic of ideas, so the more you read, the more sense they'll all make. These articles augment, vs. replace, other qualified professional help.

        Before continuing, reflect: why are you reading this - what do you need?

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        Have you or your mate been depressed recently? Depression is so common in American kids and adults that treating it has become a multi-million (billion?) dollar industry. It often occurs in survivors of low-nurturance childhoods.

        This article  is one of a series on improving primary relationships. It will alert you to the difference between "depression" and incomplete grief, which seems to be common in typical divorcing families and stepfamilies. Incomplete grief requires different treatment than clinical depression. Can you describe the difference? This article...

Describes common symptoms of local and chronic depression,

Suggests that the real problem may be psychological wounds and incomplete grief,

Outlines options if you're "depressed," and...

Provides options if your partner seems seriously depressed.

        Get the most from this article by first reading...

  • premises on resolving (a) any relationship problem, and (b) typical marital problems,

  • requisites for a mutually satisfying relationship,

  • this introduction to normal personality subselves (like yours) - slides or text

  • this introduction to losses and healthy three-level grieving;

  • this research summary on "complicated grief";

  • this summary of five conditions that stress many average families; and...

  • if you're in stepfamily (or may be), this overview of "the basics" - slides or text

colorbutton.gif What Is "Depression"?

        It's a catch-all term for a mind-body condition ranging in intensity and impact from brief and minor ("a blue mood") to long-term and major. The condition inhibits personal happiness and productivity. Uncorrected, these can corrode family relationships and functioning, and may promote other physical and psychological problems.

        Symptoms of depression typically include some or all of these...

Low physical energy; "fatigue."

Apathy: marked disinterest in pleasurable life activities.

Notably sad, glum mood.

Unusual feelings of guilt, despair (hopelessness and pessimism), and/or worthlessness.

Difficulty concentrating: mind-racing and marked indecisiveness.

Trouble sleeping, or sleeping excessively.

Possible loss of appetite and related weight loss.

Recurring thoughts of death or suicide.

Crying urges or episodes with or without a "cause."

Excessive or unusual irritability.

If five or more of these symptoms are clearly present every day for at least two weeks, the condition is psychiatrically labeled clinical depression.

        Every one of these symptoms can also occur during normal three-level grieving.

        Many people believe that depression results from a "neuro-chemical unbalance, because "anti-depression" (mood control) medications often reduce these symptoms. Mental-health workers are divided on whether the imbalance is biological or is caused by psychological disturbance - or both. Some propose that taking a mood-control medication reduces the symptoms to tolerable, and leaves the causes unhealed. After 27 years' clinical experience, I believe the latter is often true.

        Depressions can be single episodes or a chronic (recurring) condition. Chronically depressed people experience these symptom-clusters as normal life, so they may have little motivation to change toward something they've never felt.

        Depression is a problem for the sufferer, and it can cause anxiety (worry), guilt, and frustration in people who depend on or care about the sufferer. Three possible problems are...

  • you’re significantly depressed,

  • your mate is, or...

  • you both are.

All can stress your marriage and other relationships, specially if you have other concurrent problems.

        If you don't feel significantly depressed but you feel your mate is, go here.


colorbutton.gif If You Feel Depressed, You Can...

Deny or ignore it and/or its impact on your lives, and wait for it to go away. If it doesn’t, you may...

Endure it, because getting undepressed would significantly upset someone else, or expose a family secret ("Let's face it: Molly's a sex addict, and we're all enabling her. We all have a problem!"); or...

Seek medical evaluation and chemical relief by using anti-depression drugs. This may pro-mote chemical and psychological addictions.

Feel optimistic ("I know this will get better, with time"); uncertain (inner-family conflict); or pessimistic ("There's no cure. I'll just have to live like this forever. It runs in our family...")

Label yourself ("I'm mentally ill, not well, messed up, or sick"); feel guilty ("I'm such a burden to _____") and/or feel ashamed ("I'm a bad person."). Get depressed about being depressed, specially if it's recurring.

Blame somebody or something (your mate, kids, parents, childhood, job, God, gangs, the Democrats, demons, the Methodists...), and give away your power and responsibility to feel better.

Choose the (helpless) victim family role, because it gets you wonderful comforting and attention that you haven't gotten otherwise. And/or you can...

Become determined to always look on the bright side. Rigidly avoid (a) thinking and talking about "sad" or "negative" things, or (b) associating with people who are "down," "gloomy," or "worrywarts."

(Add your own options...)

        Or...

If your depressive symptoms don't abate in an acceptable time, that may indicate a disabled true Self. Option: use Project 1 to assess for that and correct it.

        Which of these strategies appeals to you? I believe the last one is probably the healthiest response to significant or chronic "depression" symptoms. The one exception is if you or your mate are genuinely suicidal - then qualified psychiatric help is your best choice.

        What might be causing your other subselves to disable your true Self?


colorbutton.gif Possible Primary Problems...

        “Depression” and the sadness phase of normal grieving feel and look the same, emotionally and behaviorally. I suspect that many “depressed” adults and kids are really mourning major losses. If so, the cure is not pills, but identifying and removing any blocks, so grief can run its natural course. Have you ever considered this?

        Most Americans like you and your family members don’t know much about healthy mourning. To reality-check this, try this informal quiz and return.

"Good Grief" Basics

        Grieving is the natural response we humans and some other animals have to broken psychological attachments or bonds ("losses"). Except for wounded people who can’t form bonds, all kids and adults like you and your mate must mourn various losses as you age and change. Do you agree?

        Mourning is a natural [mental + emotional + spiritual] process which allows us to...

  • accept our losses,

  • return to normal balance and functioning, and...

  • free up energy to form selected new bonds.

        Each grieving level has several phases. They progress naturally unless they’re blocked by psycho-logical and/or social conditions. Blocking can occur when a griever perceives “It is not safe for me to feel and/or express my grieving emotions, thoughts, and behaviors.

        To grieve well, you need inner (personal) and outer (social) permissions to move through all three levels at your own pace. Survivors of low-nurturance childhoods often lack inner permission, and live among people who unconsciously withhold outer (social) permissions.

        For example, many of us are raised to believe that crying is "weak," and to resist crying in public (or at all) - specially males. Crying is a natural response that purges stress-producing chemicals from the body, like urinating or vomiting. Withholding permission to cry and express related emotions and thoughts blocks grief, and causes physiological stress. The same is true for repressing grief-related (or any) anger.  

# Status check: to shift this from these abstract concepts to your real life, meditate on these statements. T = true, F = false, and ? = "I'm not sure," or "it depends on (what?)":

I understand that grieving is needed for all kinds of life losses (broken bonds), not just the death of a loved one. (T  F ?)

I can name the phases of each of the three levels of normal grief. (T  F ?)

I believe grief (a) is a normal human response (b) which can be slowed or blocked.  (T  F ?)

I grew up in a “pro-grief” family – i.e. one who’s adults consistently encouraged and modeled (a) feeling and (b) expressing healthy grieving values, emotions, thoughts, and behaviors.
(T  F ?)

I’m comfortable now (a) feeling and (b) expressing _sadness and _ anger privately and pub-licly; and (c) I’m comfortable enough being around others who feel and express shock, sad-ness, and anger. (T  F ?)

I can clearly describe (a) my personal and (b) our family’s grief "policies": i.e. our sets of shoulds, oughts, musts, and values about feeling and expressing grief. (T  F ?)

I now live in a pro-grief home and family - i.e. one which consistently encourages everyone to mourn well. Note the difference between intentionally encouraging grief among your family members, and passively tolerating their mourning. (T  F ?)

I am now able to (a) identify and (b) grieve my losses well and thoroughly; or if not, (c) I know why, and (d) I'm taking effective steps to improve this. (T  F ?)

I can (a) clearly discern the difference between “depression” and incomplete grief now, and (b) I can name at least six symptoms of blocked grief. (T  F ?)

My partner and/or ex mate would answer each of these items “true” now. (T  F ?)

Now I feel some mix of calm, centered, energized, light, focused, resilient, up, grounded, relaxed, alert, aware, alive, serene, purposeful, confident, and clear, so my true Self is probably leading my other subselves (personality). (T  F ?)

        Have you ever assessed ideas like these? Notice what your "self talk" (thoughts, emotions, and images) is now…

        My clinical experience with hundreds of divorcing, single, and re/married clients who feel "depressed" is that they're really experiencing active or frozen grief. This can relate to...

  • past losses (broken bonds), including some in childhood and perhaps courtship;

  • recent invisible or tangible losses; and/or relate to...

  • an unavoidable future loss like youthful vigor, kids moving away, retirement, or death (anticipatory grief).

        If you, your mate, and/or an ex spouse weren't encouraged to mourn fully as a child, your depressive symptoms may signal being stuck in the sadness phase of emotional grief. "Rageaholics" are often stuck in the anger phase. How does the former work, and what can you do about it?

        The Project 5 articles answer these questions in some detail. A key concept is how unseen false-self dominance combines with ignorance of healthy-grieving basics to hinder grieving.

Personality Subselves and Grieving

        About 80% or more of my hundreds of adult therapy clients appeared to be psychologically  wounded - i.e. controlled by a false self. Most didn't (want to) know this, so they suffered recurring problems like unhappy or confusing approach-avoid relationships, divorce/s, addictions, "disturbed" kids, financial woes, some physical problems, and "depression." Such problems usually continue and compound, until the  adults hit true bottom and commit to progress on some version of Project-1 wound- recovery.

        To evaluate what follows, I encourage you to first study these slides or this article. They propose that normal personalities are composed of an interactive group of subselves, or parts, that each have their own purpose, values, needs, way of communicating, and view of the world. They create all the "voices" (thoughts) and images in your mind, and seem to cause a wide range of emotional and physical reactions.

        If you're skeptical or curious about this idea, read this memo to you, and then try this interesting, safe exercise. This idea is new enough so that most grief professionals aren't aware of it. Most do believe in psychosomatic illness. Do you?

        Psycho means “mind,” and soma means “body.” Do you feel that repressed anger, fear, shame, guilt, or sadness (“stress”) can hinder sleeping, digesting, and eliminating; and cause discomforts like headaches, tics, “tight shoulders,” and stomachaches? How about hormonal imbalances and allergies?

        Lacking factual information, most people must guess if, when, and how their minds (thoughts and emotions) can cause bodily discomfort or illness. From over a decade of studying and practicing inner-family therapy, I believe many bodily ailments and discomforts are promoted or caused by psychological repression and related thoughts. I’m now sure that our thoughts and emotions are governed by the well-meaning subselves that comprise our personalities.

        As with your physical family, your inner family of subselves can range from harmonious, contented, and calm to conflicted, insecure, and discordant, as your inner and outer environments change. Growing up in a low-nurturance family promotes inner-family chaos and the formation of a false self (a conflicted personality).

        Most such families are (unintentionally) anti-grief homes: that is, the (wounded) adults discourage feeling and expressing normal grieving emotions, thoughts, and behaviors. Restated: the false selves governing the adults often withhold permissions to mourn well. Impressionable children learn taught anti-grief rules (beliefs) like these:

"Real (virile) men (or males) don't cry." or "Crying is for wimps, babies, and sissies."

"(Feeling and/or showing) anger, or too much sadness, is wrong and bad."

"Keep a stiff upper lip (or we'll withhold our approval, respect, and love.)"

"Don't burden others with your sorrow."

"Get over your loss, and move on. No big deal!"

"It's not OK to vent repeatedly about your losses and pain."

"Put on a happy face (or someone will dislike, reject, or punish you)."

"Don't be gloomy or 'negative' (or someone will dislike, reject, or punish you)."

"Always think of the other guy (otherwise you're being selfish and bad)!"

"You only grieve when someone dies, and then it should take a few weeks at most."

"We don't talk about or evaluate our family's grieving habits, values, or rules - and we deny, minimize, and/or joke about this."

"If you must grieve, do it privately, and don't disturb anyone else."

"Always look at the bright side! (or we'll disapprove of or reject you)."

"Strong emotions are upsetting and bad. If you must feel them, don't show (express) them."

"When the going gets tough, the tough get going. We (parents) love tough people best."

"We (you) don't discuss family business (like losses and their impacts) with outsiders."

"It is not necessary or OK to get professional help in healing your losses."

"If it hurts, use sugar, fat, nicotine, and/or alcohol (or work real hard) to feel better - and ignore, joke about, or deny that you're doing this."

        Unless badly traumatized in early childhood, you and your early caregivers formed many attach-ments (bonds) which eventually broke (caused losses) during your lives. You may have learned as a small child that adults and kids who follow rules like those above get the respect, love, and acceptance which you craved. Kids that don't follow the family's (grieving) rules ("policy") experience subtle or obvious disapproval, scorn, and rejection. Those hurt!

        Like your parents did, you developed a normal group of personality subselves or parts who cause your primary emotions. Among others, you grew a sad part, a scared part, a shamed part, a lonely part,  and an angry part. Other subselves can feel these emotions too, including your Self (capital "S").

        Because your Inner Critic and Perfectionist subselves ceaselessly guards your young Vulnerable subselves from pain, s/he relentlessly gives you stern warnings and acid judgments if you start to feel or show grief sadness, confusion, and anger in a way that violates "the rules" (above.)

       You may also have developed a protective Catastrophizer subself that adds vivid images and thoughts about disasters that will surely occur if you don't follow the Critic's rules ("You'll be spurned, abandoned, and die a miserable death all alone in the gutter!")

        You may also have a protective People Pleaser subself, whose steady job is to focus you solely on worrying about meeting other's needs and standards, in order to avoid agonizing criticism, rejection, and abandonment. This subself is specially active in shame-based adults and kids who were unintentionally taught to assume they were worthless and unlovable.

        Another common Guardian subself can be called the Magician, Denier, or Illusionist. Its specialty is  turning painful or scary current realities into something else (reality distortions). So when you suffer significant losses (broken bonds), this subself gives you thoughts like "Losses? What losses?"; or "Yeah, well we've lost some things, so no big deal!", or "Take care of the kids' wounds now, and worry about me later" (self neglect).

        Probably no one in your family or social circle talked about "your inner family of personality sub-selves" so you became an adult without clear awareness of...

  • your Inner Critic and Perfectionist subselves and the rules they insists you follow,

  • your well-meaning narrow-visioned Catastrophizer, People Pleaser, and Magician subselves; and...

  • the group of Inner-child personality parts who are guarded by all four.

If these normal subselves often overwhelm your Adult and Spiritual subselves and your true Self, you unconsciously live your days and nights from a