Posts tagged: Grief

Emotional Support

Buildings are supported, bridges are supported, governments are supported, and even people are supported.  It is relatively easy to spot sufficient support of the first three.  If the physical structure of the first two bear your weight and resist the urge to fall down, then the building or bridge is considered well supported.  Governments that receive sufficient financial support shoulder the desires of the populace and stand tall in adversity.  Similarly, people who receive adequate emotional support bear the weight of their world and remain standing throughout.  Perhaps physical support is not far removed from its emotional cousin.  Perhaps that is why the word “support” lends itself to both interpretations.

It may be less than flattering to compare oneself with a government, much less a building or bridge.  Americans do not readily accept support, and view the need for support as a sign of weakness.  Americans are great at providing support, especially physical support; perceiving the lending of support as virtuous and powerful.  Americans are much happier giving support than receiving the same.  Perhaps it is the vestiges of the pioneer spirit.  Perhaps it is a fear of appearing needy and weak.  It can’t be denied that the receiving of support automatically assumes a one down position.  How one chooses to perceive this one down position is the critical factor in the equation.

No matter the degree of intelligence and self-sufficiency, all people require support at some time in their lives.  Some people may never require further physical support after childhood, but they will require emotional support to thrive.  We are social animals, and the fact that ninety percent of us live in cities is sufficient proof of this allegation.  A particular subset of people called schizoid do not appear to need contact with other people; at least not much.  For the rest of us, depression ensues when there is a lack of emotional support in our social environment.  The experience of grief is largely the result of a sudden break in social support.  The recent surge in mass shootings almost always comes from those who, for one reason or another, lack emotional support.
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The schizoid person, mentioned above, does not perceive a problem with little emotional support.  This is their preference, and they may be quite successful in other areas of their life.  Such people are rather rare, accounting for far less than one percent of the population.  People that experience grief over a sudden loss are typically bathed in attention from other people, as this is the standard response of most cultures.  A progressive loss of support from illness or job loss does not curry the sympathy engendered by the death of an intimate attachment.  It may be difficult for this subset of people to develop supportive relationships, at least until they feel better or obtain a new job.  Those who take up a gun are exacting revenge upon a society that they perceive as purposefully withholding support.  They experience the lack of emotional support as a personal affront.

Perhaps the alienation many Americans experience is really a loss of emotional support.  We Americans are loath to ask for physical or emotional support, such that the subsequent alienation may be more prevalent in this country than others.  Furthermore, the recent economic downtown has disrupted work relationships and created greater familial stress over finances.    It is a general rule that increased stress engenders decreased emotional availability.  It is difficult to think of others when preoccupied with ourselves.  Many are injured and yet they do not ask for help.  Perhaps it is time for the pioneer philosophy to end.  It would be great to retain its spirit of optimism and enterprise, but this philosophy appears to come at the cost of our emotional well-being.  Increasingly, it is placing our physical well-being at risk from an alienated few.  If only Adam Lanza had decided to pick up the telephone, before deciding to pick up the gun.

Grief

Grief is not considered a mental disorder.  It is not even listed by its own name, but goes under the title of “bereavement” in the DSM-IV.  Most English speakers will typically use the term of “grief” to describe their emotional reaction after the death or separation from a significant other.  The mental and physical symptoms are not readily distinguishable from a Major Depression or an Adjustment Disorder.  About 30% of grief reactions meet the criteria of a Major Depression, and about 10% have psychotic symptoms.

Professionals do not regard grief as abnormal if the worst of the suffering is over by 6 months; a year at the longest.  Death from suicide or a medical illness is increased significantly during the grief reaction.  The immune system is depressed, cortisol levels increase, and there is an increased risk of heart disease and cancerous malignancy during the course of a grief reaction.

Most mental health clinicians will not diagnose grief or bereavement before six months from the time of the loss, though the DSM IV gives 2 months as the guideline.  It is normal to have thoughts about actions one might have taken to save their life or keep the person as an intimate attachment.  Grieving individuals often feel as if they should have died, instead of their significant other.  They typically feel worthless, and experience a profound slowing of thoughts and actions.  There is often impairment in social and occupational functioning for several months.  It is even common to hear the voice of, or see a fleeting image of, the lost significant other.

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It is not the intensity of suffering, but the duration and quality of the suffering that differentiates depression from grief.  Visual and auditory hallucinations are common in grieving, but considered abnormal if they persist longer than 6 months.  Additionally, the hallucinations of a grieving person are always associated with the missing object; never with someone physically present or personally unknown to the bereaved.  For example, if a person experiences hallucinations of their dead father, after the death of their mother, and a voice tells them to kill their brother, this is less grief than a psychotic disorder.  Expressions of worthlessness and regret are directly connected to the missing object; otherwise the grief is likely part of a chronic mental illness.  Thoughts of death are focused on the missing object.  Desiring to die in the place of the deceased, or feeling that life is not worth living without their significant other, is expected and considered normal.  Harboring a plan to commit suicide unrelated to the missing object is severe Major Depression.

I hope this article clears up some of the confusion between normal grief or bereavement at the loss of a significant other, and the more unrelenting chronic forms of mental illness.  Many people are surprised to learn the level of suffering mental health professionals consider normal in the bereaved individual.  They are also surprised that auditory and visual hallucinations of the lost object are common and considered to be within normal limits.  As professionals do not recommend treatment for normal bereavement, family and friends of the grief stricken play an invaluable role.  Mental health professionals may be consulted if the condition fails to lessen, or even becomes increasingly severe.  Most importantly, do not criticize their emotional reactions to the loss.  It is best to be a kind and patient listener, rather than an ersatz psychologist.  Encourage the mourner to talk at their own pace and rate.  Encourage the bereaved to participate in life without being pushy or critical.  Also pay special attention to important dates in the relationship between the bereaved and the lost object.  Mourners may have worked through most of their grief, but find themselves falling to pieces during times when they would have been together; e.g., the Christmas holidays, birthdays, etc.  Please leave comments about this article on grief in the space provided below.