Friday, June 11, 2010

I'm Not Depressed

A patient tells me that watching the old guy across the street upsets him because the man looks like his father. Before his father passed away, a little over a year ago, his father, too, was old, skinny, and sick. Seeing this man struggle down the front steps triggers the patient's depression.

Go help him, I say.

Contrary to popular belief . . . I'm not depressed.

If you catch that I am, what you're feeling is my V62.82, Bereavement. I don't even have the newly touted grief disorder, which would be cool in a sick kind of way, to have a brand new disorder, fresh off the press, Complicated Grief Disorder, or Prolonged Grief Disorder, so far as I know.

We diagnose a person who has lost a loved one with Major Affective Disorder only if that person is experiencing sadness, insomnia, poor appetite, and depressed mood beyond two months post loss. If major clinical features like these disappear at the two month mark, it's Bereavement.  My friend who lost his father over a year ago, is suffering from bereavement.

We call it depression if a survivor has
1. excessive guilt about things other than actions taken or not taken at the time of death,

2. thoughts of death other than feeling he or she would be better off dead or should have died with the deceased

3. morbid preoccupation with worthlessness,

4 marked psychomotor retardation,

5. prolonged and marked functional impairment,

6. hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person.

If you have those features (you might add the loss of appetite and problems sleeping) then you're talking Major Depressive Disorder.

So let's talk about me.

Slept great last night, 5.45 solid hours, dreamed of the Black Hawks playing hockey on a black and white TV set over forty years ago.  Had to have been nine or ten, but in the dream, can't tell.  It's cool that when you get older and you talk about things you did as a kid, you might dream about them.

It's Friday and on Fridays I like to have dinner prepared before leaving for work.  The idea is that when I get home I can just do what I want, meaning visit my mom, talk on the phone, clean, maybe even go to the movies with FD. So this morning I wake up and mumble a couple of things under my breath and stumble into the kitchen to see if the coffee's on.


I'm only writing the list below because (a) I like lists and (b)  to illustrate the difference between depression and bereavement. A person suffering from depression would be hard-pressed to get all of the following done (not bragging, just saying) in about an hour, between 6-7 a.m.  My wave must have crested yesterday.

(1) small corn salad, generously seasoned
(2) three loaves of bread, punched down for a second rise,
shaped and proofed
(3) nine raisin muffins.  Not sure why my recipe only makes 9, but it's okay.
(4) fish-- fairly tasty, not my best, but not bad
(5) introduction to this post--jotted on napkin--
Contrary to popular belief . .I am not depressed.
(6) grocery list appended--chocolate chips, zip-locks, decaf beans, rice
(7) added to the "to do" -- "Pay Gary" -- auto mechanic

Forgot the last.  The miracle is nothing burned.

Oh, and I changed the format to this blog.

The last, of course, was a tough call, because if you notice, to the right there's no blog roll, no Blogs I Love! It got lost in the shuffle and I'll have to do it by hand, add my resident buddies, many of you.  Time consuming, for sure.  When you grieve a loss you become painfully aware of how little of this you have, time,  and how important it is to use it wisely.  So email me if you're in a hurry to get me moving on it.


The new blog looks better though, doesn't it?  Eventually I tired of admiring my new look and wrote today's post. Here you go.

Some of you may have noticed that for the past four months (!) therapydoc's moods have been a little low, the tone a little lifeless. You can just feel the sadness, I'm sure, the palpable loss.  But that feeling's gone, virtually arrested.

You don't have a father for over fifty years and not lose a piece of yourself when he dies. I keep finding new questions for him that he refuses to answer.  Things like,
Dad, how to I fix this watch? I replaced the battery and it still won't run!

Or Dad, what DO you do with this gadget. It looks like a watch-maker's kit. Is it?

Or Dad, why did you make barrels of wine if you never intended to drink it or even serve it to anyone?  (He had a glass of wine perhaps once every couple of months, maybe.) 

One of my more fond memories is sitting on the couch and watching a ball-game with him, sipping his beer. (He had a beer maybe once a month, too.)

Or Dad, what do you want on your headstone? How about we go with your name and the date of birth, date of death.  Wait.  Nobody even agrees on your birthday! Your parents made it up at Ellis Island.  A little help here?

Or Dad, where did you put the (too many of these to list).
Things like that.

My mother is upset because she can't tell him about her day. Something amazing might have happened, like a visit to an assisted living place; and he's not around to hear about it. Or she gets herself to physical therapy, she's back in the driver's seat, literally (to our dismay). He would love that, knowing she's still driving.

Or she would tell him that now that he's gone, the neighbor who always harassed him about the landscaper is now harassing her.

My brother would ask him why he never got rid of old sets of golf clubs.  And why are there a hundred decks of cards in a file cabinet, each individually gift wrapped.

Enough. You get the idea.  This kind of dialogue, this kind of thinking, this is grieving, not depression. Sure, there are waves of sadness, tears, fewer at the four month mark than at the one. And sure, the thought of entertaining people or being entertained is loathsome.  So you don't. You just don't.

But there's no hopeless-helpless. There's no worthlessness, although apathy, yes, there's some apathy; and stresses add up faster, fencing these is harder.

In general a person's coping skills are less powerful, don't generally work. The things that made you happy, won't make you happy,   You're compelled to feel bad.  But you get your zip back, just when you think you've lost it, then you lose it again, maybe a few days, even weeks later. That's just the way it is.

Under depression, Major Affective, or an Adjustment Disorder,  you walk through fog, you try to force yourself to do things you know you have to do, and the same holds for bereavement.  Sometimes you accept that you can't force yourself, that you'll have to sit out a dance or two. 

Unresolved grieving, what we used to call it before it became Complicated or Prolonged Grief Disorder, when the grief of loss is seemingly interminable-- can kill some people.  When it's that bad it meets the criteria for Major Depressive Disorder and it should be treated medically, meaning medication and talk therapy.  You have to want to talk about it, however. 

I still tell most people, if it's a loss and it doesn't meet the criteria for Major Depressive Disorder, skip the anti-depressants. Just grieve.  Feel bad so it doesn't bite you later.  Resolve it. And keep it rational.

Before you blink, you'll have worked it through.  And you'll feel like dancing.



Beth said...

Interesting to read this post from a therapy-point-of-view, remembering my own grieving. And feeling sad and empathetic for you and what you're going through. Like you say, it gets better and the best way out is through. With a hug now and then.

Syd said...

I grieved both my parents, but I believe that the death of my father who was the first one of my parents to die was the worst. I grieved him every day for six months and even after that, there would be days when I would have dreams of him or catch a scent of an after shave or pipe that would remind me of him. Thanks for the post. I have been thinking about the suicide of a friend and am glad to see that it has been a bereavement of her that I am feeling.

TechnoBabe said...

I like your suggestion to your patient to help the man who reminds him of his father. For me, I am glad you described bereavement in detail. It is something I have not known in my life. I have a new and healthy respect for true grieving now. "'ll just have to sit out a dance or two." That I can get. said...

I love your posts. And I love the new design. Thank you!

lynette said...

therapydoc, my heart goes out to you. when my father died, i could not function for months. at first it was something i expected, the fatigue, the sadness, the yearning, the lost feeling, the bereavement. by eight months afterward, i could not work, could not talk to people, could not stop crying. it was then i was finally diagnosed with MDD, after a lifetime of it, that particular episode triggered by my loss.

i think two months is too short a timeframe for people to experience acute grief, really. i admire your taking the time to feel what you feel, i only hope you do not lose patience with yourself. i cannot imagine the challenge of your job under the current circumstances.

the new blog style is a nice change. i hope you keep admiring it, and keep posting.

best wishes,

Isle Dance said...

I'm glad to read this. And I love the new look.

Marcia said...

I have grieved the death of a parent. And I've been depressed. There is almost something tender and sweet about bereavement, but the vise of

I like the new look.

porcini66 said...

I like the new look, too. Sometimes a change like this helps, too, I think. With bereavement, I mean, at least in a tiny way...

I know that for me, organization is the key when I'm down. Closets beware, I'll organize them to a fault - when I get beyond the apathy of course!

I'm admiring your strength and yes, I'm learning something from you (even though it's virtual - funny how that can work, I think) about how to "be" with your feelings. Not something I'm terribly good at, so I appreciate your example! I wanted you to know that you are practicing your own advice to your patient - helping. It's such a great tonic!

As always, thanks for writing...

abroadermark said...

You're so cool, therapydoc! I'm happy to know you're not depressed, but sad to know that life isn't so easy for you right now. Don't know if it helps, but my thoughts and prayers are with you. Oh, and I really like the new blog look!

tuesday@11 said...

I am wondering why I waited to comment on the new look until after you acknowledged you changed it. Gee, I think because I am depressed and I already take Fluxotine. I am depressed, but no suicidal thoughts as years past.Is that improvement? I like it, and I don't accept change easily. I blasted my therapist when she moved her office, without warning, to a different room within the same building. Turned my therapy world upside down. Had to get use to looking at her right profile instead of the left. Oh yea, plus she was further away. Somehow I can't get turned upside down cause you changed things. Change is good,right? Then why is it such a battle? I will have to read this blog over and over until I can grasp the difference between depression and bereavement. I have so many changes that need to be made, but the bottom line is my precious friend is dead nearly two years and she's not coming back. That just sucks.

Anonymous said...

As I read this post, I wondered why there are so many forms/descriptions for bereavement and/or grieving. It is so purely what it is, why give it so many names? Anyway, I'm still missing my dad so very much. He died 5 years ago. On his headstone, we had his favorite truck carved (it is a fertilizer spreader, he owned a business). But, it was when I painted a large wooden wedge to look like a piece of watermelon and attached carefully to the base of his headstone, that many of his acquaintances and friends felt his memory had been preserved. He loved watermelon and grew hundreds of them to give to anyone who stopped by. It's always the simplest of things...

Ella said...

I guess it seems like you are a tiny bit defensive about maybe being depressed, or perhaps just assuring us that you are not? Shakespeare said something on this ....
Yes, just grieve.

Really, it sounds like you have a swath of amazing memories to go through! And while you are adjusting, you are also helping your mom to adjust. It's a LOT to do.

The Wendt Center in Washington DC is a great resource for support during grief.

therapydoc said...

Thanks all. The Shakespeare line, Doth protest too much, it is what it is. I find the process fascinating, feeling totally good, then totally bad, the middle ground as always, just life. But yeah, the totally bad is still a surprise and a drag, and there are other draggy things about this. I truly believe that it is a process and that for me, like for most people who lose a parent, there's no changing that. Has to take about a year. The rabbis, when it came to this sort of thing, were right on.

Margo said...

Liking your makeover :) What a nice surprise. It's warmer...and beige-r...

On other notes, it's amazing how generous the DSM is in distinguishing bereavement from general depression, especially this part: "1. excessive guilt about things other than actions taken or not taken at the time of death,", all within the realm of normal - wow.
It sounds awful. I like that phrase Beth used, "the best way out is through."

Wondering Soul said...

Love the new look blog, TD.

I felt my ears straining to catch what was behind some of the things you wrote.
Found myself asking, is that how SHE'S feeling or how she is saying it might feel for others.
Easy to take an "academic" and rational approach sometimes perhaps.

I've haven't expeienced the death of a parent yet, thank God, and yet, if I was to think about the one 'state' I am most familiar with, it is possibly grief. Though the depressiion overlap makes it hard to tell...

Grief is something so personal and so deep that it's almost impossible to verbalise I think.
There is a definite pattern which although seems skewed if you try to look while your eyes are still red, becomes more obvious when your look back after time.

And that word 'time'... is, frustratingly, about the only way it gets more bearable. I think.

Very much thinking of you TD.

Dawn said...

Great post. Its funny how things can come together at the same time in life. I lost my Uncle 3 weeks ago, and this was the first loss in my family. While I was not very close to him, I am close with my Aunt, and worry about my cousins.

Grief vs Depression is something that fascinates me. I really liked your post, though I agree with the poster who said two months seems too short of a deadline between bereavement and depressive disorder.

I am slowly understanding that you DO need to go through it full steam ahead with your emotions to be able to get through the other side.

The thing that gets me the most IS those unanswered questions. How can you not feel sad not having your dad to answer those questions? I'm so sorry.

Leora said...

The Pesach after my mother died, I remember lighting a yahrzeit candle at my mother-in-law's house. I said something about wondering if one ever gets over the loss, and she said, no, you always feel the loss. But you learn to live with the feeling (I added those last words).

blogbehave said...

Your rule out list for bereavement vs. depression is welcome and helpful. Especially the part about hallucinations, as I have found it fairly common for grieving individuals to believe, convincingly, that they "saw" their deceased loved one, that s/he "came to" them.

Cham said...

Really like the new design, very calming.

Anonymous said...

Leora, you've put it into words, perfectly, what I feel about my own mother's death a little more than 3 years ago. I don't feel her loss as a constantly active grief, as I did the first 2 or 3 months. But I still feel the loss of her, as in, I've gotten used to it. I've gotten used to telling people she died, am used to that as a fact. But still feel her loss, as I carry on with my life.

Mavenlive Physical Therapy Software said...
This comment has been removed by a blog administrator.
KathyC said...

Well, sure, everyone needs therapy. If we are secure and can communicate with the ones we love, we're better off - and therapy is the way to do that sometimes.

moviedoc said...

I wouldn't take those DSM criteria too seriously. The line between Major Depressive Disorder and Bereavement or grief isn't really all that clear. Even if you don't fit neatly into the MDD criteria it wouldn't be crazy to try an antidepressant if you're so inclined, and even if you do it wouldn't be crazy to forego the chemicals for awhile and try psychotherapy first.

Jew Wishes said...

I empathize with you TD. I'm thinking about you... I'm so very sorry.

I lost my father in 1961, 50 years is inconceivable to me that he has been gone that long, longer than his lifespan of 45 years. I think of him daily when praying or looking at his photo hanging on my wall.

Will I ever get over it, entirely...of course not! How could I? The void will always be there.

But, I can remember him with smiles and love, and cherish the moments I had with him for 16 years. I couldn't say that for the first year or two, that is for sure.

Lily said...

Love the new design and the insight into the different types of grieving. I am still taken aback by the loss of my 13 year old cousin, but no where near the intensity of what you listed. I can tell by your list (which one? the one of your memories or things you wanted to ask your dad) how much you love him. It makes me tear up.

  Bring them home, the Homeland Concert There's not much to say. Wait, I take it back. There's SO much to say it is too much. There ...