Psychology: Everyone Looks So Happy

grief.jpgGrief is part of the human condition. But it is also largely a female state. Consider the facts:

· Nearly one million Canadians are newly widowed each year

· By the age of 65, 50% of women will be widows

· Bereavement leads to serious depression in 15% of spouses

· This grief can trigger depression and mania

· Likewise, depression can greatly worsen grief

Of all people, Kay Redfield Jamison might have been prepared for the pain of it.

Jamison is a psychologist and a professor of psychiatry at Johns Hopkins University School of Medicine. Her beloved husband was a brilliant physician who knew the score, and being a practical man, carefully set out his wishes should the cancer that was killing him finally succeed. Jamison had been through madness before, and has written eloquently about her struggles and triumphs over manic depressive illness.

The fact she was blindsided by grief, despair and an almost crippling pain when her husband of nearly twenty years, Richard Wyatt, died in 2002 demonstrates how little is known, or can be known, about the process of grieving.

As an academic Jamison did what came most naturally – she set out to learn more about this state of being and discovered that very little is known, little is studied, little is understood from a clinical perspective – grief is a universal human condition and yet left largely untouched by psychiatry.

It is familiar terrain – Jamison has written extensively about her mental illness both from an academic perspective and a personal one. In her memoir, An Unquiet Mind, she wrote of her manic depressive illness as a doctor and also from the deeply personal perspective of one who lives inside it. So it follows that she would take a similar approach when she found herself in a terrifying vortex of pain.

“I couldn’t find anything in the literature that, from a first person account, discussed what the differences were between depression and grief. Grief hits everybody, but women in particular, so be forewarned,” she said while in Toronto recently to talk about the outcome of her study and introspection. Her book Nothing Was the Same , published in fall 2009, is part elegy to the man Jamison loved and part description of what it is really like to go through “the wracking awful aching…the terror of losing someone forever.” Her memoir will naturally be compared to Joan Didion’s The Year of Magical Thinking, as both take a close look at what the mind does to itself in such a state of acute distress.

The famous five stages of grief, defined by Elisabeth Kubler-Ross in her book On Death and Dying, seems to be the best-known and most often quoted practical guide to mourning.

For Jamison, however, the “five stages” seemed far too basic to describe what really occurs – the stages aren’t neat, “it takes a lot longer than you think” to move through them, sometimes you miss a stage altogether.

“I think a lot of people do find the stages helpful. I just think grief is infinitely more subtle and complex, and it has its own time frame.
“I think people get sold this bill of goods that this is going to be straightforward. I found it comes in waves, and the waves can blindside you.”

Similarly, Jamison makes short shrift of Sigmund Freud’s seminal essay “Mourning and Melancholia” in terms of defining depression, something that strikes a few, and grief, which will visit each of us. She sums up the startling and essential difference between them: “In grief, death occasions the pain. In depression, death is the solution to the pain.”

But it is hard to know what’s happening to you when the worst thing in the world has actually occurred.

Jamison was fearful of descending again into her illness and found that grief is actually quite the opposite of depression. It is a hypersensitivity to life, events and moments rather than a dullness; it is a time of intense dreaming; and while both are a source of withdrawal from the world, there is a kind of discomfort that does not seem to exist with depression. In fact, some describe the agitation and discomfort as “an acute awareness of being alive” rather than the deadening quality of depression.

“I was very frightened I would be pulled back, and that concerned me more than anything. There is a real restlessness in grief that doesn’t get described very often, which scared me as restlessness was very much part of my illness. But grief does not have that other side, the euphoria or grandiosity.”

She also found it difficult to concentrate, another sign of her illness, but “unlike when I was actually depressed, when I paid attention I could do it, and the decisions I made were not bad ones. This is a sharp contrast to depression, where people are literally incapacitated.”

“Like mental illness, no one tells you how bad it really is. But I found there is an element of dignity and privacy that no one can predict.”

The withdrawal from life is a danger, and can lead to actual depression.

“There is a sanity to grief, in its just proportion of emotion to cause, that madness does not have. Grief…provides a path, albeit a broken one, by which those who grieve can find their way,” she writes in the prologue to Nothing Was the Same. “Still, it is grief’s fugitive nature that one does not know at the start that such a path exists….Grief, as it transpires, has its own territory.”

Jamison describes an unexpected upside to grief as well. Perhaps the biggest misconception, she says, is that the person you are grieving for is gone forever. Instead, Jamison says, the relationship continues but in a different form. Her husband is never far from her thoughts. She often sees or hears things that he would love and contemplates his response. She has learned more about him through friends and others who have come forward with anecdotes and stories about parts of his life where she’d hitherto been absent. Even in small ways the relationship has continued — She learned more about him by listening to the audio books Wyatt loved. Severely dyslexic, audio was the best way for him to enjoy a story. “I learned something about him by experiencing books as he did, something I’d never have bothered with before he died.”

The good news about grief, if there is such a thing, is that it does pass. The best news is that the dead don’t leave us. They truly do live in the heart and imagination and once again can bring joy.

Guess what? Jamison has moved forward decisively. She is in a new relationship that feels right. Both she and her new partner have lost a beloved spouse; they mention them freely when the moment suggests it. Death has brought new life.