Top of FormBottom of Form
Write a letter to Hamlet using the information from the article below. In it, you must use the title, the author’s name, and at least three citations from the article, to convince Hamlet to stop being so depressed. Be sure it looks like a letter.
What’s “Normal” When It Comes to Mourning?
We each experience the loss of a loved one differently. Learn the depth of mourning and when you should consider seeking help to deal with your grief.
By Linda Foster, MA
Medically reviewed by Pat F. Bass III, MD, MPH
Mourning the loss of a loved one is one of the hardest experiences in life. We each mourn differently, for different lengths of time and while experiencing different degrees of loss. However, in some cases, the depth and length of the mourning period may signal that a person needs counseling.
How We Grieve
Psychiatrists and other mental health professionals usually don’t consider bereavement to be a psychiatric diagnosis since it’s a basic part of our human experience. Depression and its symptoms, such as sadness, crying, and withdrawing from social activities, are very typical after losing a loved one. You might even wish that you had been able to accompany your loved one in death. Loss of appetite and weight are also common signs of grieve and will usually improve after a few months.
“Besides [these] symptoms, you might imagine that you see, hear, or can even touch your lost loved one: This is also normal. These experiences are called illusions or hallucinations,” says Edison Houpt, MD, HCC, a grief expert in Pasadena, Calif.
An illusion is a misinterpretation of a real occurrence such as hearing a car sound in the street and thinking that your loved one has arrived home from work; hallucinations – like seeing the “ghost” of your loved one or hearing their voice -- have no basis in reality. Illusions and hallucinations can involve all of your senses, including smell, taste, and touch, and are a common part of mourning. They usually disappear over a period of months. If they go on longer, however, hallucinations and illusions can become pathological.
Dr. Houpt does not generally diagnose a grieving person with depression unless he has been mourning for more than three months, “or if there are serious symptoms of major depression or psychotic depression.” Grief becomes abnormal when it’s prolonged and persistent, or when its symptoms worsen.
The Depths of Bereavement
Depending on the person, a period of bereavement can end in recovery (most likely), no improvement, or further deterioration. According to Houpt, “Sometimes the bereaved can have a readjustment period of several months to a year, which may be diagnosed as an adjustment disorder. This is not serious and is considered normal.” Less frequently, the bereaved can show no signs of improvement and continue to have symptoms of depression or anxiety. Even less frequently, the bereaved can deteriorate and experience significant or major psychiatric diagnosis.
There are different degrees of this latter form of grief, with different outcomes:
· Prolonged or pathologic grief. Houpt says that unimproved depression can turn into prolonged grief or pathologic grief. Prolonged grief occurs usually in elderly spouses, and occasionally siblings, who have few resources for support. Often, a person in this situation feels that they have only memories of the good days to sustain them until their own death. With prolonged grief, the symptoms usually remain the same year after year, but some people can benefit from small amounts of antidepressants. “The antidepressants may not have any effect on the grief, but the medication can allow the widow or widower to compartmentalize their grief, lessen sadness, and enable them to get up each morning, focus on daily activities, and live a relatively normal life,” Houpt says.
· Psychiatric conditions. Pathologic grief can turn into a number of psychiatric conditions, such as a deepening of depression or even a depression with psychotic symptoms. Severe depression symptoms include suicidal ideas or completely shutting down emotionally and physically, and seeming to be in an inactive, zombie-like state. Psychotic depression symptoms include pathological guilt; serious illusions such as extreme suspicion of everyone; and hallucinations, such as hearing demonic voices, that extend beyond the loss of the deceased and involve all daily activities.
· Delusions. Besides illusions and hallucinations, which can be temporary, there is a separate class of psychotic sensory experience called delusions, or false beliefs. If the bereaved becomes delusional, this is always a psychiatric symptom and requires treatment. “Sometimes the delusions are not even mentioned and may be kept secret for a long time until the family notes that the patient is acting strangely. The family will usually figure out that these strange stubborn behaviors cannot be handled with logic. This is a good time to take a loved one for psychiatric treatment — before he or she acts upon the delusions,” says Houpt.
Who Is at Risk for Pathologic Grief?
Some people will recover from bereavement in a matter of weeks or months, and some may take up to a year or so. Houpt says, “Sociable extroverts recover more quickly than introverts do.” She says those at higher risk of developing deeper problems include:
· People who have minimal, weak, or nonexistent socio-economic support
· Older people, who often take longer to recover
· Poorer people, especially if the death of the spouse results in a significant decrease in income
· People who have had previous periods of depression
· Alcoholics, who are at greater risk of depression, aggravated alcoholism, and suicide; men in particular are affected, and Houpt advises family members to persuade gun owners to give up their firearms for safekeeping when in this state.
· People without a personal psychiatric history, but who have family members with depression and/or alcoholism
· People who have serious medical problems and are taking many medications
Mourning is a normal part of loss, but unending suffering is not. Feedback from friends and family who are usually good judges can help you determine whether your recovery from bereavement is on track. You should also turn to your doctor for help if you feel that you have been grieving for too long and may need help.