ABC Radio National’s All in the Mind has an engaging interview with psychologist and author Kay Redfield Jamison who discusses her new book which is both a memoir of losing her husband and a consideration of the psychology of grief.
Towards the end of the interview she tackles the distinction between grief and depression, which has recently returned as a contentious topic after lying fallow for many years.
Since Freud’s essay Mourning and Melancholia, the two have been linked in many psychological theories. Freud’s idea was that both were similar types of reaction to loss although in depression it might not be clear to the conscious mind what was lost because the prior attachment might have had unconscious components.
In other words, a small event might trigger a big grief reaction event though it might not be clear why – because some of the psychological value of what you have lost might exist only in the unconscious.
Although the essay is one of the foundational texts of psychoanalysis, nowadays only the most orthodox followers of Freud would agree fully with this theory of depression and the idea that grief and depression are fundamentally the same is no longer widely subscribed to.
Nevertheless, psychiatry is once more approaching grief as a potential form of mental illness, albeit from a different angle.
The concept of complicated grief, where grieving is considered to be more intense, disabling or extended than normal, has been much discussed as an area where psychiatric treatment may be warranted. It’s an interesting concept because it essentially sets limits on what should be considered a normal response to personal loss.
More recently, the draft version of the new American diagnostic bible, the DSM-V, has gone even further and removed bereavement as an exclusion for a diagnosis of major depressive disorder. This means that two weeks of low mood, loss of pleasure and interest in activities, poor sleep, appetite or concentration after a loved one had died could get you a diagnosis of mental illness.
It’s a difficult area, because while it is important not to medicalise normal and healthy reactions to the loss of a significant person in your life, we also wouldn’t want to miss treating mental illness simply because the person has experienced a loss. Clearly there is a balance, although it’s difficult to say where it is.
Jamison has an interesting perspective on the issue, as she’s a clinical psychologist interested in mood disorders, but also has experienced profound depression and loss herself.