The Stress Doc Letter
Cybernotes from the Online Psychohumorist ™

April 2000, No. 1, Sect. 2

The Stress Doc examines the fine line and conceptual confusions between grief
and mood disorder.  He also outlines the stages of grief.  His work with
reorganized and unemployed professionals provides raw material for
differentiating grief from situational and clinical depression. 

Good Grief:  Part I
Is It Mourning or Is It Depression?


As a training contractor for Fairfax County Government (in Northern Virginia;
home of America Online and the "Software Valley") I’ve been leading bimonthly
"Dealing with Stress, Loss and Change through Humor" and "Managing Anger and
Conflict" workshops.  Over the last two years, I’ve interacted with hundreds
and hundreds of individuals who have been terminated, downsized and
outsourced.  Some of these folks have been dislodged for just cause, some
because of management malice or mismanagement; some with severance pay and
some with a half-day notice.  The process of layoffs seems to be especially
volatile in the new economy -- here today, gone tomorrow – Information
Technology (IT) world. 

For most folks, when the dislocation from a job and a career is sudden,
unexpected and/or unwanted, there’s a period of shock, fear or rage, as well
as sadness or helplessness.  And when unemployment drags on from weeks to
months and a feeling of self-doubt and despair spirals unabated…are we
talking:  a) grief process, b) situational depression or, as we’ve seen, c)
prolonged stress effecting biochemical and mood disorder consequences?

It’s a vital and confusing question because:  1) grief and depression have
complex overlap along with marked differences as bio-psychosocial states of
experience and action and 2) depression needs to be differentiated between
situational or exogenous, that is, external and environmental forces (like
losing a job) and the clinical, the internal or endogenous (that is genetic,
family history and biochemical factors or predisposition).

Let’s begin the conceptual differentiation through word association.  What
comes to mind when you read the word, "depression?":  emptiness, exhaustion,
darkness, heaviness, black hole, mood disorder, food disorder, sleeplessness,
agitation, mania, paralysis, helpless, hopeless, endless, suicide…Prozac!! 
Perhaps not so extreme.  How about melancholy, inertia, apathy, sorrow,
sadness, joyless, loneliness, pessimism, deprivation, abandonment, bereft,
bereavement…grief. 

Quite a depression spectrum -- depression to grief but also grief to
depression.  What is cause, what is effect?  Is this a chicken and egg issue?
 It’s clearly not black or white; many shades and intensities of grayness and
darkness.

Drawing on the above-mentioned experience, let’s see if a scenario involving
an unemployed individual can shed light on some of the diagnostic conundrums.
 Clearly, the unexpected and/or unwanted termination of a job so often
triggers a profound sense of disruption and loss.  Very quickly the person is
thrust into a grief process and, initially, the person literally may not know
what has hit him or her.  So to clarify the many levels of confusion – from
conceptual to emotional – let me outline the stages of grief.  Clearly, what
follows is an ideal type as grief stage engagement rarely marches in
precisely aligned and sequential steps.  The bereaved may bypass a phase or
rapidly morph from one stage to another.  A person may waver -- two stages
forward, one stage back, or vice versa.  Anniversary losses, such as a death
or divorce dates, can easily trigger a feeling of regression, of being thrown
back to the vicious beginnings or the whirlpoolish depths of a grief (or
depression) cycle.  Fortunately, much of the time the regression is temporary
and the person with sufficient support and stamina will continue his or her
hard-fought, "Rocky" evolution and personal growth through "Good Grief!"

Stages of Grief

1.  Shock and Denial or "It Can’t Happen Here!"  It’s no big surprise when
given a days notice that an employee may experience a state of shock. 
There’s such total confusion and disbelief that a person often goes numb; the
mind-body system has to shut down.  Sometimes shock follows the downplaying
or denial of bad news.  For example, in the early ‘90s, there was talk of
significant restructuring in the US Postal Service.  A number of employees
took the early attitude:  "We’re always dealing with change here…No big
deal."  Alas, these folks didn’t count on Carvin Marvin Runyon becoming the
Postmaster General.  Talk about a shocker...Within a year 50,000 employees
were restructured out of the service!

2.  Fear, Panic and Shame or "Oh God, What Do I Do Now?"  Once the shock
wears off, you are no longer numb, there are some predictable next steps,
such as profound anxiety and vulnerability:  how will I survive this loss of
income, identity, my daily routine, my social standing, etc.?  There’s a
mounting sense of being out of control, which for many also evokes feelings
of shame and inadequacy.  And lack of control, not surprisingly, can stir up
childhood memories of the same, being or feeling tormented, rejected or
humiliated by family, peers, teachers, etc.

I vividly recall the lamentation of a postal supervisor on a management
fast-track, quickly derailed by reorganization:  "I once had a career path. 
Then this boulder fell from the sky and crushed it!  Is it only a career path
that’s been crushed?  How about the human psyche and spirit?  Has it too been
burnt up or burned out?

3.  Rage and/or Helplessness or "How Dare They!" or "Oh No, How Could They!" 
Do you think our once fast-tracked supervisor is feeling abandoned and
betrayed?  Most likely.  Often people in this phase swing between rage and
profound sadness.  Both states can be induced by deep underlying
vulnerability or helplessness.  You’ve been wounded, feel exposed and just
want to lash out.  Or you turn the rage inward in depression and
self-condemnation.  Now it’s crawling under the covers escapism, or going
through the motions of living or, even, straining as hard as you can to reign
victorious over your basic unworthiness; to battle a fear of failure and
lurking dread of being sucked into that compelling black hole of
helplessness. 

Consider this:  in the Random House Dictionary:  The Unabridged Edition, the
first six definitions of the word "failure" describe it as an act or an
instance.  It’s not until the seventh and last definition that "failure"
takes a personal direction.  So losing a job or being confronted with other
losses and separations are often more events or individual episodes than a
judgment upon you.

Also, please consider, that individuals predisposed to a depressive mindset
are likely to over attribute self-responsibility, that is, to blame
themselves for "negative" events.  These folks minimize the impact of
external factors or environmental stressors.  Which is why the next phase,
while often maddening, is also essential for moving through the grief
process.

4.  Guilt and Ambivalence or "Damned If You Do or If You Don’t!"  The
feelings and old voices of guilt (not living up to an important other’s
expectations or standards) and shame (violating or compromising an
internalized core value or essential part of your self-identity, integrity
and esteem) can become louder and more incessant   Self-directed rage keeps
taunting you for shortcomings, unworthiness, lost dreams, etc., and can
ultimately drain you.  If some energy returns or remains the battle may
continue in other arenas.  First, the classic approach-avoidance conflict: 
"Damned if I do, damned if I don’t; damned if I stay, damned if I leave." 
Take the paltry severance or not; leave the faulty marriage or not.  And
while the uncertainty is terribly frustrating, at least there’s a struggle.

Some may turn to a spiritual source for relief or rescue:  "Higher Power,
just tell me what to do" or "Higher Power, I turn it over to you."  And, of
course, some in desperation will proclaim newfound or "born again" allegiance
if they are only saved.  Yet, in the end, with or without your HP, one must
get focused and cut the entangling emotional cord.

5.  Focused Anger and Letting Go or "Turning a Lemon into Lemonade" and
"Freedom’s Just Another Word…"  This phase truly reveals the complexity and
potential creative energy built into the grief process.  To reach that
powerful, purposeful and passionate state of focused anger one must often
blend rage and sadness.  Some rage can propel us out of a shocked, paralyzed
or ambivalent state.  Yet, you must also face your sadness and loss and
struggle with uncertainty to temper uncontrollable aggression, to make sadder
yet wiser assessments and decisions.  Remember, rage unchecked much more
often leads to self-destructive behavior than it does to "Going Postal!"

If you’ve worked hard to integrate the previous stages then the reward is
"focused anger":  "I really don’t like what’s happened…but how do I make the
best of it?"  You’re ready to loosen – if not untie – the knot of hurt and
humiliation.  And best of all, you’re getting ready to knock on (maybe even
knock down) doors again.

6.  Exploration and New Identity or "Now You’re Ready to 'Just Do It!’"
(even if scared).  Letting go is often unnerving. It’s not just the financial
security that’s at stake.  But losing a job or a vital relationship also
profoundly shakes our personal/professional identity.  We’ve invested so much
time, ego, energy, money in this position or partner…Who am I without the
job, without my mate or significant other?

However, this vulnerable yet fluid state provides unprecedented opportunities
to get to know yourself, to assess your true individuality – strengths and
warts – and not only as it relates to financial dependence, job skills or
career paths.  Now is the time for a full scale person-in-situation life
inventory.  How healthy or toxic are seemingly vital relationships and
friendships?  What about your health?  During this transitional window, do
dysfunctional coping patterns -- habits of drinking, smoking, drugging,
eating, lack of exercise and limited socializing or spiritual support -- need
to be challenged?

Even with the most dear and painful loss or separation, the words of Albert
Camus, Nobel Prize-winning author and philosopher have the crystalline ring
of essential truth: 

"Once we have accepted the fact of loss we understand that the loved one [or
loved position] obstructed a whole corner of the possible, pure now as a sky
washed by rain."

A Mid-life Maelstrom or Father Finally Knows Best

Camus’ words remind me of an existential crisis faced by my father in his
late-40s. It’s a morality and morale-ity tale about how his corporate world
went from cutthroat cocoon to just cutthroat.  For over twenty years, my
father had been working as a salesmen for a large manufacturer in New York
City's garment center and fashion industry.  As I mentioned, the competition
was cutthroat, but still only figuratively.  And through aggressive and
tenacious persistence, he had carved out a legitimate and fairly successful
niche.   He had sales turf, some financial security and hard-earned pride.

Then, almost overnight, my father realizes that organized crime is
infiltrating the company big time.  (Perhaps some of dad's capacity for
denial was at play.)  Now he's going to have to report to one of these new
executive slimeballs.  His whole world is at risk; cutthroat is no longer
symbolic.  This isn't just downsizing...it's downright "frightsizing!"  Dad's
existential crisis is in high gear.  From this experience I first learned
there can be a fine line between homicidal and suicidal tendencies.  Day to
day, I didn't know if he'd go to work and punch someone out or not get off
the couch, immobilized by an explosive psychic cocktail of rage, fear and
depression.  (Good thing he was in group therapy at the time.)

He was caught in the classic reorganizational bind:  "damned if I stay,
damned if I leave."  Fortunately, my old man realized "discretion is a better
part than...'A Death of a Salesman.'"  He resigned.  Economic fears had him
precipitously joining another large manufacturer.  After a month, he knew it
was the wrong move.  What crystallized was his need for genuine control and
autonomy, and a playing field in which he could aggressively compete.  And he
eventually found it as an independent sales rep for a small manufacturer.  Of
course, the owner of this garment center business was a "goniff" (Yiddish for
thief) in his own right, and would often drive my father up the wall.  But
crazy we have practice with and can handle in my family.  It's when people
take cutthroat literally that we usually draw the line.  And in fact, my
father went on to have his most successful years in business. 

As Camus understood, a whole new corner of the possible can emerge when you
accept loss and take time and heart for genuine grieving and exploring.

7.  Acceptance or "The Glass is Half Empty and Half Full."  While submerging
yourself in the stages of grief for a time will feel hellish, there truly is
an opportunity for rebirth.  Getting out of the black box is a distinct
possibility if you can ride on and ride out this acutely emotional learning
roller coaster.  The grief encounter is definitely more than a learning
curve.  And there’s no absolute or fixed period of time for your movement
through the stages.  My blood starts percolating when I hear
"well-intentioned" family members, colleagues or friends say to the grieved,
"Hey, it’s been three months (or even six months) already.  Don’t you think
you’re stretching out this grief thing (or unemployment status) a bit too
much."  The implication, of course, is that you’re indulging in self-pity. 
Or, sometimes the verbal sting comes in a seemingly more innocuous message: 
"Gee, someone with your skills, talents, experience…I can’t understand why
it’s taking you so long to find a job."

The most important thing we can do after experiencing a major break – whether
break up or break down, social, physical or psychological – is to take time
to heal.  Now some after a loss of a job or a relationship feel compelled to
jump right back into the fray.  And getting back in the saddle is a cultural
icon and wise strategy for a thrown cowboy or cowgirl.  However, for a major
loss it’s wise to retreat and regroup, at least temporarily.  For example,
those folks who are participating in the Fairfax County Government
reeducation and training program are getting career counseling and job search
coaching, taking job training classes (for many students, leading to computer
skills certifications) as well as the Stress Doc workshops.  Perhaps most
important, they realize they are not alone. Also, folks are encouraged to
grieve and to gradually recover and discover:  Who am I?  What genuinely
feels like me?  What works for me and my family?  What seems to kindle (or
rekindle) my passion?

So remember, there’s a real difference between "feeling sorry for yourself"
and "feeling your sorrow."  When you are feeling sorry for yourself you are
mostly blaming others.  When you are feeling your sorrow you are
demonstrating the courage to face your fears and pain.  There are poignant
moments in life when we all must take time to embrace our sorrow.

As I once penned, reflecting on more than one soul shaking grief process:  "Wh
ether the loss is a key person, a desired position or a powerful illusion
each deserves the respect of a mourning.  The pit in the stomach, the
clenched fists and quivering jaw, the anguished sobs prove catalytic in time.
 In mystical fashion, like spring upon winter, the seeds of dissolution bear
fruitful renewal."

When It’s No Longer Just Grief

While many grapple productively with the ebb and flow of grief gradually, if
not grudgingly, working their way through the stages for other folks it’s not
uncommon to get stuck in "the big muddy" of mourning.  Mourning becomes
melancholia.  How do you know the difference?  My first therapist gave me a
handle; actually a heavy lid.  She likened the state of depression to a heavy
lid that often covers up or tries to hold down underlying bubbling and
boiling, conscious and unconscious thoughts and emotions – fear, rage,
obsessive ideation, panic, helplessness, suspicions if not paranoia, etc.  So
much energy is used in suppression and repression of this raw psychic tension
that exhaustion and apathy often result.  Also, some of the tension can
manifest as an amorphous agitation.  A number of classic depressive symptoms
may appear:

1. Fatigue, sadness, heaviness and listlessness,
2. Loss of appetite (though sometimes there’s compulsive eating) or using
escapist substitutes – alcohol, tobacco, drugs, etc. to numb one’s pain,
3. Difficulty concentrating and starting and completing tasks; general
diminishment in role functioning,
4. Feelings of shame and worthlessness and incompetence and inadequacy,
5. Restless and interrupted sleeping,
6. Difficulty getting active and focused especially in the morning,
7. Loss of interest in activities once seen as enjoyable or meaningful,
8. Withdrawing from friends, colleagues and family members,
9. Engaging in a variety of reckless and potentially dangerous – active or
passive -- undertakings, e.g., drinking and driving, drinking while taking
medication, etc.,
10. Communicating directly and indirectly a desire to harm oneself (or
others) that is, expressing or demonstrating suicidal or homicidal impulses,
gestures and/or actions.

As for the grief process, my analogy has a mythical bent.  Unlike
depression’s tendency to bottle up and stuff down emotions, for me, grief
work is like removing the cover of Pandora’s Box.  As was recently
illustrated, grief opens you to a whole range of harbored fears and furies –
past and present.  Ultimately, grieving releases and integrates a range of
emotions and energies that enables you to regain psychic equilibrium, helps
evolve a new or renewed sense of purpose and direction.  Vital mourning is
also the wellspring of passion and determination for exploring new roles and
identities.

However, key components of the grief process do overlap with key depression
dynamics such as deep sadness, agitation or anxiety along with helplessness
and rage (often inverted).  So when is it grief and not depression?  Or, how
do we know that a difficult and possibly prolonged grief process is not being
weighed down by or turned into situational or (unrecognized) clinical
depression.  (Remember, chronic low-grade clinical depression is difficult to
recognize and acknowledge. Over the years, the individual, as if living in a
constant smog environment has adapted, albeit not without disruptive
mind-body consequences, to this (mostly) moderately depressive and slowly
degenerative condition.  "It’s just how life is," cough, cough.)

Closing

Next time, seven bio-psychosocial dynamics and role contexts that may help
differentiate natural grief from morbid melancholy, including warning signs
of grief morphing into depression.  And finally, some inspiring "F"s for
mastering loss and change.  Until then, of course...Practice Safe Stress!

Mark Gorkin, LICSW, known as "The Stress Doc," is the Internet's and America
Online's "Online Psychohumorist"™.  An experienced psychotherapist, The Doc
is a nationally recognized speaker and training and OD consultant
specializing in Stress, Anger Management, Reorganizational Change, Team
Building and HUMOR!  His writings are syndicated by iSyndicate.com and appear
in a wide variety of online and offline forums and publications, including
AOL's Online Psych and Business Know How, WorkforceOnline, Mental Health Net,
Financial Services Journal Online, Paradigm Magazine and Counseling Today. 
Check out his USA Today Online "Hotsite" Website -- www.stressdoc.com .  For
info on his workshops or for his free newsletter, email stressdoc@aol.com or
call 202-232-8662.  Spring 2000, look for Practice Safe Stress with The
Stress Doc™, published by AdviceZone.com.

(c)  Mark Gorkin 2000
Shrink Rap™ Productions