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.
Yes!
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.
therapydoc-at-gmail-dot-com.
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.
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.
Before you blink, you'll have worked it through. And you'll feel like dancing.
therapydoc
