However, grief can also be debilitating and injurious to physical and mental health. If not properly handled by the griever and his or her close friends and family, the sense of bereavement and loss can impair daily life even months after the initial loss. When the grief goes beyond expected or acceptable levels and duration, it stops being a healthy process to recovery and resumption of normal life, and becomes a mental disorder unto itself, with its own causes, effects and treatment.
There are a number of different presentations and stages of grief, and depression is one of them. Feeling anger at the loss, guilt (the sufferer wonders if he or she could have done more), loneliness (especially after a death or divorce) and anxiety are all expected ways that depression can manifest in someone who is grieving. For how natural it is, however, depression can spiral into unnatural levels if it is left unchecked.
If the mourner is unable to focus on anything but the loss he or she has experienced, even weeks or months after the initial event, then this could be a sign of what is known as a grief disorder or complicated grief. Further separating complicated grief from “normal” grief is that the mourner’s everyday life and functioning is incapacitated by their depression. While such a disruption is a possible factor in a healthy experience of grief, the nature of complicated grief is such that the person’s life continues to suffer as much as six months after the trigger event.
The manifestation of complicated grief is similar to that of healthy grief but magnified; the loss becomes an obsession – all the individual can think about. He or she is unable to move on with life, so stuck are they on pining for the days before the death, divorce, job loss, etc. Obligations and responsibilities go unmet, job and/or academic performance declines, and hobbies and activities no longer provide entertainment, satisfaction or fulfillment. This can either stem from a fear of going on with life without the spouse, partner, job, etc., or the belief that by not “letting go,” the sufferer will be able to maintain and preserve the initial happiness that they derived from the spouse, partner or job.
Other symptoms of complicated grief can include:
- Bitterness about the loss
- Detachment from current life events and happenings
- Irritability towards others who have moved on
- Desolation about the future, unsure how to continue living without the loved one
While a sudden and negative life event, such as losing a job or the termination of a relationship, can be responsible for the onset of complicated grief, it is generally the death of a close friend or family member that puts a sufferer at the most risk for complicated grief. As many as 20 percent of the people who experienced the death of a loved one went on to show symptoms consistent with that of complicated grief. Research done by Yale University showed that 40 percent of people who experienced the death of a spouse showed signs of anxiety and panic within the first year of their spouse’s demise – symptoms and a timeframe consistent with that of complicated grief. Unexpected death is the most reliable predictor for causing complicated grief. The shock and trauma of losing someone who was not expected to die can cause bereavement symptoms that go beyond the standards for healthy and natural expressions and timeframes of bereavement. The death of a child – especially if the death is not natural (i.e., the child is killed) – can be exceptionally devastating to parents, and is considered one of the greatest risk factors for complicated grief.
“Excessive dependence” on the loved one to provide a sense of identity may also be a factor; parents of infants and young children, for example, may see themselves primarily as parents over any other characteristic. When the child dies, the parents lose that sense of identity, and, in effect, lose themselves.
Similarly, suicide exacts a long-lasting toll on family members and friends who are left to wonder if they should have noticed their loved one’s state of mind. The lingering and eternally unanswered question of “Was there anything I should have done?” is a common catalyst for complicated grief. With satisfactory answers hard to come by, survivors of suicide loss may feel guilty, ashamed, resentful, confused and depressed.
Complicated Grief and Substance Abuse
Because depression is such a significant part of complicated grief, its sufferers have a high risk factor for developing an addiction to drugs or alcohol. They may resort to taking stimulants like cocaine, alcohol or methamphetamines to shake off the clouds of depression and boost their activity and energy levels. Stimulants work by forcibly triggering the release of a hormone called dopamine in the brain, which usually makes an individual feel good after doing something rewarding or pleasurable. But while the brain eventually reabsorbs the dopamine under normal conditions, the stimulatory drugs force it to produce excessive amounts of the hormone, rapidly and intensely hooking the user, who might be experiencing positive feelings and sensations for the first time since the loss.
Furthermore, while these substances offer a temporary reprieve from the crushing weight of the complicated grief, the effects are illusionary. All stimulants have a “comedown” effect, where the (apparently) positive effects wear off and are replaced with crippling negative effects. With cocaine alone, the comedown effects could include:
- More depression
The replacement of the buzz and euphoria by even more depression, compounded by the looming presence of the complicated grief, can make a sufferer even more likely to seek solace in another hit, diving deeper into a cycle of addiction and depression. There is also a neurological connection between the preoccupation with the source of loss that is symptomatic of complicated grief, and the likelihood of a sufferer developing an addiction. A professor of psychiatry at Columbia University noted that the chemical composition of the brain of people who suffer from complicated grief is different to that of people who don’t, suggesting that people who are at risk for complicated grief in the event of a tragedy have a high propensity for developing an addiction to cope with it. Because the brain has gotten so used to the presence of the loved one in the sufferer’s life, their sudden departure has a parallel effect to that of the withdrawal symptoms of drugs/alcohol. The systems in the brain that are activated when a sufferer of complicated grief is obsessed with the return of a deceased loved one (or a departed spouse/romantic partner) are similar to the systems that are in play when the patient craves a hit of a drug or a shot of alcohol.
Treating Complicated Grief
Because of the delicate nature of complicated grief, treating it requires a great deal of care and sensitivity. Cognitive behavioral therapy is commonly used to help victims identify, confront and eliminate the damaging thoughts that prevent them from accepting their loved one’s demise and moving forward with their own lives. A unique approach to treating complicated grief using cognitive behavioral therapy is that the therapist will ask the bereaved patient to have imagined conversations with their deceased loved one. The idea behind this is to lift any unresolved thoughts or impressions of guilt the patient may be harboring towards themselves for the death of their friend or family member. Through this approach, the therapist will help the patient understand the futility and irrationality of holding onto the guilt and eventually come to terms with the tragedy. Such forms of therapy have shown efficaciousness when helping patients overcome their prolonged bereavement. In one study, over 50 percent of participants experienced improvement, with only 13 percent reporting comparable improvements with standard therapy. At Futures of Palm Beach, we understand how difficult it is to move on with life after someone close to you dies, or how impossible it might seem to rebuild after a relationship or job ends. Our staff will work closely with you on formulating a treatment plan that answers your specific needs, or the needs of a loved one currently going through complicated grief. Even in cases where substance abuse has made the bereavement that much deeper and more painful, our facility is well equipped to offer a safe, protective and restful environment to help our patients break the multilayered dependency on drugs and alcohol. Once they are free of their physical craving for illicit substances, we can begin the process of addressing why they sought escape in drugs or alcohol and then trace this back to the reasons they fell under the spell of complicated grief. Call Futures of Palm Beach today to find how to take your first step on the road to healing and closure.