By Mickey Skidmore, ACSW

This is the second of a three-part series on Grief. This article was originally published in the 4/08/90 edition of the News Argus, the local newspaper in Goldsboro, North Carolina.

In the first article of this series (last month), an overview of grief was explored. In this overview, grief was defined as the process of intense emotional suffering caused by death, disaster, misfortune, or loss. More importantly however, the meaning of grief was expanded beyond the ordinary understanding of the word to include intense emotions of denial, anger, depression, bargaining, acceptance, and perhaps most importantly, the profound experience of loss. The previous article established that these intense emotions present themselves within a framework referred to as the “grieving process”. This article seeks to build on this foundation by exploring further the nature of grief work by examining the role it plays in mental health problems.

Although there are several mental health afflictions in which grief may play a crucial role, this article will focus primarily on the more common problems associated with depression and anxiety. Depression is one of the most common emotional disturbances in our society, with some studies indicating that as many as one person in five will experience depression significant enough to warrant treatment. Anxiety conditions such as panic disorders and post-traumatic stress syndrome are also on the rise, affecting many people and their ability to lead normal lives. Many people who seek professional help for these difficulties learn through the course of therapy that they have not allowed themselves to adequately grieve the trauma of their significant losses in the past.

Issues of dependency, vulnerability, and loss often surface during emotional difficulties. If a parent, spouse, or sibling were to suddenly die, or should we find ourselves unexpectantly separated or divorced … if we were “let go” from our job with no warning, we might surely feel depressed. We might also experience a sense of shock or numbness, or perhaps intense anger and rage. We may even find ourselves attempting to make deals with our boss “to never do it again if s/he will only give us one more chance”. Others may attempt to strike a deal with God to let them live just one more Christmas in return for giving up a favorite vice. In short, we would experience some of the intense emotions of grief. Any one of these losses would painfully remind us how much we depend on the people in our lives or our job for financial and emotional security, and remind us of our own vulnerability as well.

Depression is perhaps the most common affliction associated with the dynamics of grief. Depression is a common mood disturbance which includes feeling of sadness, disappointment or loneliness that can lead to withdrawal from people and activities; loss of pleasure and enjoyment of life; and physical discomforts such as aches, pains, fatigue, poor digestion and sleep disturbances. Depression can affect anyone at any time, yet depression affects everyone in different ways at different times.

There are many ways to classify depressions. One simple and useful method is by degree of severity. Mild depression, or feeling down or “blue” every now and then may be a natural reaction to stress and/or tension. This type is usually brief and does not seriously interfere normal activities. Many people have more serious periods of depression. Symptoms of moderate depression are similar to those of mild depression however, are more intense and may also include feelings of hopelessness and are longer lasting. Some people who are moderately depressed are still able to meet daily responsibilities, although professional help may be necessary.

Those who become severely depressed cannot face the demands of daily living. They frequently attempt to cope with alcohol and/or drugs or become suicidal. They lose interest in the outside world and gradually separate from reality. Professional treatment is necessary for one who is severely depressed.

Although there is a clear relationship linking grief and depression, there are other factors which can (also) result in depression. Among them are genetic patterns or tendencies and biochemical functions which are thought to play a role in many cases of depression. It is within the environmental arena however, that we experience loss, trauma, and death. Many of us have adequate coping skills and support systems which enable us to deal with our bereavement and move on. However, if the intense emotional experience of grief is avoided, suppressed, or “stuffed”, our unresolved grief often resurfaces in the form of depression.

Another condition many people experience is associated with the anxiety disorders and is referred to as panic attacks. A panic attack usually is experience as a cluster of symptoms which lead the victim to think s/he is having a heart attack. Such an attack frequently includes some combination of the following symptoms: shortness of breath, dizziness, palpitation or accelerated heart rate, trembling, sweating, choking, nausea, numbness or tingling sensation, flushing or chill, chest pains, and finally, fear of going crazy, doing something uncontrolled, or dying.

This is clearly an extremely uncomfortable experience. Frequently the attacks are short lived an can be managed with the short-term use of anti-anxiety medication coupled with brief psychotherapy. For others, it may be a signal from the body that they have “stuffed” their feeling for too long, and that they must find another way to deal with the intense feelings they have been avoiding or denying for many years.

Denial is one of the stages of the grief process, and it is also one of our primary defense mechanisms. In the face of threat, grief, or loss as we have defined them, people often deny what is going on. They may deny the hurt of what is happening, or that it is really impacting their lives. This defense may appear to “protect” us from the uncomfortable feelings associated with a significant loss experienced at a younger age. Over the years, this process of denying becomes second nature and unconscious. Even more importantly, it becomes easier and more convenient to deny than to express the feeling linked to the loss. However, as we learned last month (from the previous article), every detail of feelings that is ungrieved and unfinished will be expressed sooner or later in some form.

My own experience in treating panic disorders is that almost invariably when explored thoroughly, there is trauma, loss and unresolved grief. Other professionals have reached similar conclusions. Jane Middelton-Moz referred to panic attacks as the “window to the frightened child”. She views panic attacks as re-enactments of earlier childhood trauma. When an individuals’ symptoms and history are considered within a framework of grief, and grieving is done, frequently the panic attacks subside. Upon the establishment of a trusting, supportive, therapeutic relationship, the individual can feel safe enough to discard his/her shell of denial and allow him/herself to ventilate and release pent up grief. This is not to say that every panic disorder is rooted in a grief-related experience, but only that for many this rings true.

In our quest to further expand the notion of grief and loss, I believe we must stretch the meaning of these concepts to include trauma. Trauma and traumatic events encompass all forms of abuse, abandonment, rape, violence, severely dysfunctional family systems, and any event that is outside the range of usual/normal human experience.