Ray and Bob were born less than six months apart, at the same hospital on the southside of Chicago in 1936. Their families lived across the courtyard from one another, and they were friends before either of them even knew what that meant. They played games together as children, and grew up together, separating only to serve their country (Ray was in the Army, and Bob the Navy). Not long after they got out, Bob introduced Ray to a girl he met through a friend. Ray ended up marrying her, and Bob was the best man.
The years turned into decades, and while life would sometimes interfere, they remained very close friends. Then, a few years ago, after being sick for several years, Bob passed away. Ray wasnβt even able to make it to the funeral, as his wife was also very sick. Just a few weeks after losing his oldest friend, Rayβs beloved wife also passed, just short of their 55th anniversary. Ray was plunged into a deep well of sadness, losing the two people in the world whom he had known the longest, and the best. Grief turned into bereavement-related depression, a painful and debilitating condition which has to be understood, recognized, and treated. It is more than just sadness: bereavement-related depression adds to deathβs toll by taking away the mournerβs ability to live.
Causes of Bereavement-Related Depression
Studies about bereavement-related depression often tend to focus on the widowed, which is understandable. A spouse or partner is the person with whom you are generally closest. This kind of loss is something many people have to deal with; by age 65, nearly half of all women in America have been widowed, and nearly 10% of men have.
Because it is so sadly common, and because everyone mourns differently, it is easy to mistake the normal process of grief from the onset of clinical depression. After Bob died, his widow had trouble eating and sleeping for months. But as time passed, while the sadness never went away, life began once again to take on normal rhythms for her. So why was it so much harder for Ray?
Part of it, of course, was the dual loss, but the causes of bereavement-related depression are far more complex than the merely mathematical. The losses not only robbed Ray of the people he knew best, but of the two people who knew him better than anyone in the world. This, he felt, took from him an important part of his identity. All he could think about was the time they had spent together, him and his two favorite people. The love and life he built with Doris, and the fun he had with Bob, from fighting the Nazis in southside playgrounds to watching each otherβs families grow. That was gone, and this sadness compounded his own normal apprehension about aging and dying. Ray had gone beyond mourning, toward depression.
Recognizing the Symptoms and Signs of Bereavement-Related Depression
One of the hard parts about dealing with depression is the way we understand grief. It is imagined to be a private thing, something everyone needs to deal with on their own. This attitude forestalls empathy. It often prevents us from looking closer, from trying to read signs. We say βheβs just sad,β instead of looking for symptoms of actual clinical depression.
Bereavement-related depression is similar to other kinds of depression in our aging loved ones, at least in terms of outward signs. There are, of course, several particularities.
- Mood disorders. A normally happy and cheerful person can become easily irritated and push people away. This is partly because depression convinces them that they can never be happy, and so why bother? The gut-punch, of course, is that driving people away only confirms their new sense of solitude. This is a mood change that family members donβt usually recognize as depression, instead chalking it up to βdad getting cranky since mom died.β
- Introversion. Bob was Rayβs closest friend, but after his death, Ray stopped seeing other people he was close to. They just reminded him that, at some point, theyβd all go away. A heightened recognition of mortality as we age is of course normal and healthy (and pretending it doesnβt exist is unhealthy), but for Ray, suffering from several kinds of trauma, it only increased his depression. Isolating yourself isnβt a normal part of mourning, and is often a sign of bereavement-related depression.
- Sleeping disorders. It is true that aging adults tend to have more sleep-related issues, but studies have shown that it is heightened among people suffering from a deep sense of bereavement. The inability to escape toward unconsciousness is both a symptom and an exacerbating cause of a real mental health condition.
- No sense of self. The ego, in the clinical sense, is our most powerful lifelong ally, providing identity. A sudden loss of ego, of self-worth, is a major sign that depression has set in.
If a loved one suddenly is showing these signs, or if they seem to stop caring about their appearance, what they eat, about keeping up with things they enjoyed, or about their health, this could be clinical depression. And it is something that needs to be treated.
Understanding Mourning and Seeking Treatment
The truth is that bereavement-related depression is very common, but we tend not to recognize it, because there is no timeline for grief, and we have difficulties separating someoneβs own individual sadness from an actual depressive state. Watching for the signs above is an important part of it, and equally important is knowing that while these may be all too common, they are not healthy.
At any stage of mourning, it can be good to get help from grief-specific psychological services. Depression can snake into someone weeks or months or even years after a loss, especially if they have not mentally dealt with that loss. Talking to a professional, and to people suffering similar losses, can be a huge help. It lets our loved ones know that they are not alone, and that there is a place toward which they can turn.
The family also plays a hugely important role in providing help. It is good to encourage behavior that Β decreases depression. Maybe dad doesnβt βfeel like going out to see people just yet,β and while that should be respected, there comes Β a point where it is a self-fulfilling behavior, and can lead to depression. Encouraging activity, such as pursuing old hobbies or joining a supper club [will link to eating alone piece once live], is important. Encouraging a change in routine can be crucial.
But perhaps the most important thing to do is to continually show our aging loved ones that they are vital, that they matter, and that they are loved. Bereavement can rob them of that feeling: everyone is leaving, and their time is a receding tide. Demonstrating, through our love, that this isnβt the case, and that happiness is always possible, can make grief something that is just a part of our loved ones, a sweet and sad part, but not an all-consuming whole.
Losing someone we love can trigger depression, and the need to connect with others is vital. At the Institute on Aging, we provide services to help cope with depression and loss. Β Connect with us today to learn more.
