Depression: How sad is sad?


The Difference Between Grief and Depression

A mourner looks outside and sees the world as poor and empty, while a depressed person looks inward and sees the self that way.

From Finding Your Way Through Grief: A Guide for the First Year, page 31
By Marty Tousley, RN, Certified Bereavement Counselor

A Word About Clinical Depression 

When grieving people feel sad we often say that they are depressed, but the sadness from grief is not the same as the sadness of depression because grief is not an illness. Grief is the emotional, psychological, physical and spiritual pain we feel when a person close to us dies. It is a normal human reaction caused by our love and attachment to the deceased loved one. Sadness is an expected part of grief and it is a natural response following the loss.

Depression is a treatable illness and one of several common mood disorders marked by loss of interest or pleasure in living, decreased self-esteem, shame, feelings of hopelessness and despair. Many people suffering from depression cannot imagine ever feeling better. The mood disturbance in depression is pervasive and unremitting and any positive mood fluctuation is usually minor without treatment intervention.

Shame and guilt are common in depression. When they occur in grief they often involve feelings of not having done enough for the deceased before his or her death, or regret over things said and done while the person was alive. In depression, the feelings arise from a fundamental belief that one is wicked or worthless.

Persons who have experienced previous depressions are especially at risk for becoming depressed at times of profound loss. Treating a griever’s clinical depression
 is a balancing act because sadness is an appropriate, natural stage of loss and clinical depression is a disorder. As difficult as they are to endure, both sadness and depression slow us down and take us to deeper places that allow for healing.  

Major depression, however, has the potential to become a medical emergency with risk for suicide. For the most part, grievers do not want to kill themselves, but the threat of suicide from anyone must be taken seriously. To read more about suicide, please click Thoughts of Suicide During Grief

In the United States, one in ten men and one in five women will suffer from depression at some point in their lives. Grief is universal to any person who experiences loss. Depression and grief share many features: sadness, tearfulness, anger, anxiety, loneliness, social withdrawal, forgetfulness, appetite and weight changes and poor sleep. 

Grievers can also lose interest or pleasure in living, and cannot imagine ever feeling better because life is unbearable; but the mood fluctuations come in waves washing over the griever and the dark moods respond to empathy, support, and most of all, the passage of time. Even in deep raw grief, moments of happy reminiscences are possible.

Grief, although intensely painful and sad, moves us towards learning how to live without our loved one in a forever-changed world. The reactive depression of prolonged grief, however, is a destructive "stuck place" that causes us even more pain because we cannot move forward.

Friends and family often react to sadness by avoidance or becoming eternal cheerleaders because most people cannot tolerate melancholia for extended periods of time. Seek out those few who can sit with you without telling you to cheer up or get on with your life.

Grief has no timetable and no absolutes. Grief may be universal, but we all grieve in our own way. How bad do we have to feel before we seek outside help? There are moments in all our lives when we can benefit from professional counseling but only you can decide: How sad is sad?

Learn more about the differences between grief and clinical depression at:


Are You Grieving or Depressed? By Beth Erickson, Ph.D.

Post Script: Kay Redfield Jamison is a Ph.D. psychologist and professor of psychiatry at Johns Hopkins School of Medicine. She also suffers from bipolar disorder. She uses her own experiences to fuel her work and her most famous book is An Unquiet Mind: A Memoir of Moods and Madness.

Dr. Jamison's newest work, Nothing Was the Same, is a well-written memoir that celebrates love and the life she shared with her husband Richard Wyatt. She offers a detailed chronicle of her husband's final illness and death from cancer and makes insightful distinctions between grief and depression. Dr. Jamison's story disappoints me as a grief book, however, because she devotes so few chapters to her life afterward. You can find my full review on the Support After Loss page. (listed alphabetically under Redfield, Number 11)

If you have clinical depression or bipolar disorder: (*)

· Stay on your medication(s).
· Try to get regular sleep and eat balanced meals.
· Participate in psychotherapy if you can afford it.
· Become involved with a support group.
· Read and learn about your illness.
· When seeing your doctor, never assume competence until it is demonstrated.
· Compile a list of questions before any appointment. Question everything.

(*)From BP Magazine: Hope and Harmony for People with Bipolar, “Kay Redfield Jamison: A Profile in Courage,” by Jacqueline L. Salmon, Winter, 2009, page 30.

Mental Health Resources: Information and Toll-free Helplines

Depression and Bipolar Support Alliance: www.dbsalliance.org, 1-800-826-3632

National Mental Health Association: www.nmha.org, 1-800-969- 6642

National Institute of Mental Health: www.nimh.nih.gov, 1-866- 615-6464

National Alliance on Mental Illness: www.nami.org, 1 (800) 950-NAMI (6264)

Depression information source for this article: Kaplan and Sadock’s Synopsis of Psychiatry. Ninth Edition, Philadelphia, PA: Lippincott Williams and Wilkins, 2003, pg. 63.

The information presented here and at the grief counselor site is general and is not intended as medical advice. Please get professional guidance if you need it.

For a different perspective on grief, read The Truth About Grief: The Myth of Its Five Stages and the New Science of Loss by Ruth Davis Konigsberg. She writes on page 16, "Our grief culture maintains that grief is unique, then offers a uniform set of instructions [on how to grieve]." From the back cover: "With this book, I hope to offer you a means of escape from our habitual ways of thinking about grief."

Konigsberg's work is thought provoking and well researched. Click A Change of Heart for my review of the book.  

Go to next page: Loving in Separation

Summer  2015


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I'll be away for a while... 
I am unable to make monthly updates or read and respond to any E-mail this summer. I hope to resume by fall. While I'm away, please visit a well moderated grief healing discussion group. It is free to use but requires registration to participate. I am not part of this group, but certified grief counselors are there to help, support and comfort grievers and those who love them.
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How complicated and individual mending is, the time required for healing
cannot be measured against any fixed calendar
. Mary Jane Moffat
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