Mourning and Melancholia

 

DSM 5 eliminated grief as an exclusionary criteria for Major Depression, http://www.huffingtonpost.com/kenneth-j-doka/grief-and-the-dsm_b_3340216.html, meaning that someone in mourning could be diagnosed with Major Depression. The question arising is when is a person “allowed” to grieve, and when must they be carted off to a psychiatrist? There is no good answer, except to say that grief is poorly understood, as is Depression. What we do understand is that both grief and depression are journeys, which should change, perhaps “improve” with time. Like some forms of music, it should go from a dark place to a lighter place, and then maybe back to a dark place again. The “persistent negative feeling state” which I spoke about in my last post, is the issue that should prompt treatment; persistent being the key word.

Mourning and melancholia, Freud says, share the issue of loss. In melancholia, the loss is often, the loss of one’s ideal in life, a job promotion, or a stellar child, whereas in mourning, the loss is of a loved one. Melancholia, Freud continued, often presents with self-hatred, whereas in
mourning there is more sadness. Of course, we know this not to be true. Many people when faced with the death of a loved one launch into a massive amount of guilt for all of the things they should have done. This guilt is clearly self-hatred, and as such, prolongs the mourning process.

Maeve, forty-one, comes to mind. She is a lawyer, happily married, no children, who just received word that her beloved aunt was diagnosed with pancreatic cancer. Maeve’s mood takes a free fall such that Maeve cannot function at work and her husband is very worried about her. When Maeve comes to see me, she is focused on her own mortality, and not her aunt’s grave prognosis. Maeve, as if, she had never thought of it before, realized the finite aspect of life, and as such, she was paralyzed with fear that she could not do her “bucket list”. Maeve straddled the line between Mourning and Melancholia. She was indeed anticipating the loss of her aunt, but at the same time, she anticipated the loss of her self, and these negative anticipations caused a complete shut down of her functioning.” Loss, the finality of it, can be so frightening that one wants to take control and end life, so as not to be out of control when death starts knocking,” I say, postulating that Maeve’s “depression” stems from her fear of losing control. Loss, like depression, is a vague word. It can refer to actual or imagined loss, and often both. In turn, the loss creates a hole, in our ego, Freud would say, leaving us depleted and fearful. With time, new relationships fill up that whole, and our ego is freed to expand, once again.