Lying on the floor in my home office, I could barely gather a thought about what to do next, much less find the motivation to move. What was the point anyway? I didn't want to be in my life for those weeks because I couldn't bear the heaviness in my chest and stomach that I heaved around aimlessly from room to room. My face couldn't form a smile and I was consciously aware of my furrowed brow as my brain tried to catch up with this new reality I'd been forced into. People spoke and I didn't register a word. I didn't want to be around anyone and had to take time off work. Flashbacks invaded my mind along with the guilt and the constant questionning - could I have done any more? Did he suffer? Did he know I'd left him alone? Tears poured endlessly and without control. Nothing seemed to have a point. I couldn't eat. Not interested in food. Not feeling hungry. Only feeling a deep, deep sadness and the largest sense of loss. I couldn't recall a time when I'd felt such despondence. Despondence. That was the word. My house, silent for days. I didn't even notice nor try to fill it with empty sounds. Only silence. And a complete lack of interest in everything. Waking in a sweat many times a night recognising the emptiness before my eyes even opened. My world had changed forever, now so much less than before. I couldn't even trick my mind for a second. No reprieve. Just sadness and such a hollow emptiness.
If anyone else sat on my couch and described the symptoms above, I'd be pulling out my mental check-list for major depression:
Low mood - √
Anhedonia - lack of interest and pleasure - √
Lack of motivation - √
Cognitive dysfunction - lack of concentration, memory deficits, inability to focus attention - √
Sleep disturbance - √
Appetite changes with weight loss or weight gain - √
Hopelessness - √
Questioning the point of life - √
Symptoms causing distress and lasting longer than two weeks - √
I certainly would have been on my way to meeting criteria for major depression except for one major criteria. My symptoms were able to be explained by bereavement, taking most of the exact same symptoms as major depression but giving them another name - Grief.
"It is true that grief looks very much like depression and it is also true that grieving may develop into a depressive disorder." J. William Worden. To clarify even further, grief tends to leave out the negative impact on self-esteem and self-worth, and it also usually avoids the suicidal aspects that can accompany depression, but they're the only things missing.
Bereavement gave my symptoms context.
Bereavement normalised my feelings.
Bereavement explained why I felt the way I did.
Bereavement is not the only cause of grief though. Many people come into the clinic with the word depression written on their referral, yet when we begin our conversation it usually doesn't take long to reveal that they too have experienced a significant loss.
Sometimes they have lost a relationship, at times through death, but more often through separation or divorce, or a major fall-out with a friend. Other times people lose their role, either within their family or occupation or within their community. People also lose their place, moving homes or states or countries.
The last time I'd truly experienced grief happened seven years ago. My marriage ended (goodbye marital status, goodbye relationship, goodbye love, goodbye support system), I received a cancer diagnosis (goodbye hair, goodbye health, goodbye identity) and I relocated interstate for treatment (goodbye jobs, goodbye friends, goodbye house, goodbye lifestyle). Multiple losses all at once followed by some quite complicated grief afterward.
Make no mistake - whenever there is change, there is loss. Loss of how things used to be. At times, that loss can be so great that it can lead to a grief reaction. No matter how uncomfortable that it is, it is a normal and healthy human process and one that shouldn't be avoided, unfortunately.
This time, the death of my dog Alby caused my grief. Alby who came into my life and filled the void of the babies I could never have... Alby who loved me unconditionally and healed a broken heart... Alby who was my constant companion night and day when no-one else was around... Alby, who I constantly asked "what would I do without you buddy?" died suddenly one stormy Sunday night, when I least expected it.
I was thrown right back into the heaviness and sorrow that grief brings with it. I didn't want it. I didn't ask for it. But too familiar with it, I knew that my feelings needed to be felt, every last minute of them, if I was to heal from the latest event in my life.
We used to subscribe to Elisabeth Kubler-Ross's Five Stages of Grief - denial, anger, bargaining, depression and acceptance - a model that served us well for some time and that most of us could relate to, at least in part.
But it was during my doctoral training that one of my fabulous supervisors, Dr Kylie Bailey, introduced me to J. William Worden and his Four Tasks of Grief. Now I'd like to introduce them to you.
The following information comes from Springer Publishing Company's, Grief Counseling and Grief Therapy (3rd ed.) by J. William Worden
The Mourning Process: Tasks of Mourning
Task I: To Accept the Reality of the Loss
Disbelief is a common first reaction to the loss of a loved one, irrespective of how expected the death was. So, the first task involves truly adjusting to the reality that the person has died and will not be coming back. This first task is about accepting that you won't be reunited again with the person who had died, at least not in this lifetime. This is the opposite of denial.
In reality, this process would include accidentally recognising the deceased walking down the street and then being able to remind yourself that it can't possibly be them because they have died. Or, accidentally calling someone else by the deceased person's name, only to remember, that they are no longer alive.
I swear I can still hear Alby's nails on the floorboards as he used to click clack around the house looking for me, but I look and he's not there, and then I remember...
Unfortunately, acceptance isn't merely an intellectual matter - it's also an emotional one - and we often fluctuate between belief and disbelief as we grapple with this phase. Rituals such as funerals might help, but sudden and unexpected deaths make this first task all that much harder.
My Nana used to always say "time heals all wounds." She'd pull that out whenever I'd break up with a boyfriend. While I always thought it was a cliche, in some ways, time, while not necessarily a healer, does allow us to learn how to cope better. And time is definitely our friend for this first task.
Task II: To Work Through the Pain of Grief
The pain of grief can be physical, emotional, psychological and behavioural. And unfortunately, all of it needs to be worked through and felt in order to 'get the work done.' When the work of grief is avoided or suppressed, it prolongs not only the mourning period, but it can then also manifest itself for future expression as a mental illness such as a depressive disorder, or an anxiety disorder, for example.
But it's human nature to want to avoid discomfort, so this is often a tricky phase for us to work through.
It' s also vital that we understand that we all experience grief and loss very differently and there's no right way to grieve. However, having said that, if you have been deeply attached to someone who you then lose, then it's impossible to not experience some degree of pain that goes with that loss.
I've noticed when working with bereaved clients, that our brain realises that if we were to experience ALL of the pain of grief at once, we wouldn't cope. Instead, it seems to drip feed us portions of pain and realisation in amounts that are sufficient to aid our grieving process, but not too much, that we completely shut-down forever.
Here, society's discomfort with grief can complicate matters. This is the part where the people around us want to avoid the pain of witnessing our grief and they want to 'fix it' for us, often through saying something completely lacking in sensitivity!
"She's in a better place now."
"You're young, you can always have another baby."
"He had a good innings."
"You should get another dog right away."
These sorts of statements though can make us feel as though we shouldn't be grieving, or that we don't need to grieve and this is counterproductive to this task.
Instead of being understood as a natural and healthy human process, grief is instead stigmatised as "morbid" and "unhealthy."
Too often, people shortcut Task II by attempting to NOT feel their grief. They do this in many ways - romantacising the deceased (only remembering the good things about them); avoiding thoughts about the deceased at all; using alcohol or drugs or other methods of self-medication; distraction (becoming overly involved in a task or project in order to not have time to grieve, including work and travel etc.)
This vital task in grief is one the reasons people access grief and loss counselling - to gain help to navigate their way through this process. If Task II isn't successfully completed, a psychologist or counsellor will be needed later down the track. Remember, grief isn't only about sadness. Other common emotions include anger, anxiety, guilt and loneliness.
Task III: To Adjust to an Environment in Which the Deceased is Missing
1. External Adjustments:
This might mean taking on new roles as the realisation of the roles the deceased person played within the family come to light, usually around three months after their death. For someone who loses a spouse for example, it might mean adjusting to living alone, or raising children alone, or having to learn how to manage the finances etc.
2. Internal Adjustments:
Death affects self-definition, self-esteem as well as a sense of self-efficacy. For someone who loses their spouse, they may need to learn again to view themselves as a 'self' rather than as half of a couple.
Self-esteem can be affected if for example, a person believes they will never be able to be loved again, not like they were by the person who died, for example.
If a person's self-efficacy is affected by the death, it can lead to a sense of helplessness and inadequacy, leading to a deficit in self-confidence.
The internal tasks require relearning the world after a death and asking "who am I now?"
3. Spiritual Adjustments:
Death can make you question everything including your own personal values and philosophical beliefs. It's not unusual to question your own direction in life following the death of a loved one and even more common is to question "what's the point?"
This is particularly true when a loss or death is sudden and/or unexpected.
Not adjusting to the loss in the aforementioned ways, prevents a person from completing Task III.
Task IV: To Emotionally Relocate the Deceased Person and Move on With Life
The essence of this task is to find a way to remain connected to the deceased person but in a way that allows us to continue to keep going on in our own lives.
This essentially means being able to love again, function again, dream again without feeling as though it is taking anything away from the relationship had with the deceased.
The fourth task can be hindered if someone is holding onto past attachments at the cost of moving into the future and forming new ones.
It's important to know that these tasks don't necessarily happen in a linear fashion and may need to be worked and reworked at varying times, in varying orders.
This article has been in regards to an uncomplicated grieving process. In a later article, we will discuss complicated grief, and the circumstances which might lead to its development, as well as what you can do if you experience it.
To read the other articles in a depression series, click the links to our Analyse This, Coping Toolkit and Up Close & Personal sections on the website. Alternatively, search the word depression in the search tool on the Home Page.
It's been helpful for me to remind myself since Alby's death, that the processes I've been experiencing are a part of my grief and are very necessary to my healing. I miss him incredibly and to pay tribute to him, I'm sharing one of my favourite photos by Peta of my little man. Om mani padme hum Alberto. I'll love you forever. x
If you are grieving or need to talk to someone, contact your general practitioner for a referral to a grief and loss counsellor, or outside of business hours, call Lifeline 13 11 14.