IIC 18: Grief vs. Depression

Dr. Peter reviews the differences between grief and clinical depression with examples from Scripture.

[00:00:11] Welcome to the podcast Coronavirus Crisis Carpe Diem, where you and I rise up and embrace the possibilities and opportunities for spiritual and psychological growth in this time of crisis, all grounded in a Catholic worldview. Okay, so I know we’re now into some really heavy, difficult times in our country and in our world. There’s a lot of things going on. We have the pandemic, we have now the partial lockdowns, the partial closures. We have major unemployment issues. Nearly half of small businesses are in danger of shutting down permanently. We’ve got escalating tensions with Xi Jinping’s government in China, the persecution of the Hong Kongers. We’ve got the possibility of the Cold War with China turning hot. We’ve got riots and lootings over the tragic death of George Floyd while under arrest by a Minneapolis police officer. We have very flawed and contentious politicians battling each other in petty ways. And in an election year, we’ve got growing revelations of corruption by current and former government officials and bureaucrats. There’s a growing lack of confidence in our government, in our news media, and in our secular and religious institutions. None of those factors, though, none of them, changes the basic Gospel message and changes our hope. None of them. None of them can keep us from the psychological and spiritual growth unless we let ourselves be kept down. We need to rise up. We need to go beyond mere resiliency in these difficult times to become even healthier in the natural and spiritual realms than we were before.

[00:01:52] We need, in a word, to become saints. I’m clinical psychologist Peter Malinoski, your host and guide with Souls and Hearts at soulsandhearts.com. Thank you for being here with me. This is episode 18 of this podcast, Coronavirus Crisis Carpe Diem. And it’s entitled Grief vs. Depression. We’re releasing this on June 1st, 2020. Today, we’re really going to dive into the differences between grief and depression. And we’re going to illustrate the difference between grief and depression by looking at a number of people from the Scriptures. First, though, I want to offer a big thank you to all the Resilient Catholics Carpe Diem community members who came to our first Zoom meeting last Friday evening. We had a great conversation on unacknowledged or hidden or unconscious grief. It was very good for us to get to know each other better and for us to connect in relationship with one another. Thank you to all of you for praying for me. Know that I am also praying for you. So some of you may be asking, as we begin this podcast episode on grief versus depression, why it’s important to know the difference. Why is it important to know the difference between grief and depression? Both of them feel bad. We want to feel better. Why bother with the difference? The difference is that grief is a normal process. It has a normal trajectory toward health. And so when you’re going through an ordinary grieving process, there is a light at the end of the tunnel.

[00:03:26] It is something that actually leads one to health. In contrast, when we’re talking about clinical depression, that’s not something that anywhere near has a natural trajectory towards health. That can very much be a self-enclosed, self-absorbed, spinning almost like an eddy in a river going round and round without making any progress at all. So it is really important to understand what’s normal grief and what starts to look like clinical depression so that appropriate action can be taken. That’s important if you’re going through some difficult times yourself or if you’re looking to help somebody else. So let’s take a look at the differences between normal grief and clinical depression. Let’s just start with emotional patterns. What happens in normal grief with emotions? Well, in normal grief, you have waves or these intense pangs of painful emotion associated with your loss, which gradually soften. They gradually diminish over time. So over time, things get better with ordinary grief. Clinical depression, the sadness or distress that you experience doesn’t necessarily come in waves or pangs. It’s there much more frequently, much more often, much more continually over time. There’s less relief from it than you would see in ordinary grief. This ongoing depressed mood in clinical depression also has what we call anhedonia, and anhedonia is the inability to enjoy good things. It’s the inability to take pleasure in the good things in life. That’s a critical feature within clinical depression.

[00:05:09] We don’t see that in grief. In grief, you have the experience of emptiness and loss. You have a sense that something or someone really important is missing from your life. But there are also moments of happiness and joy. So what happens with self-esteem? In ordinary grief and normal grieving process, self-esteem generally remains intact. If there is an increase in self-criticism, it’s usually focused on perceived shortcomings, failures that have to do with the loss. Right? I should have visited my mom more often before she died. I should have told her that I loved her more. Right. So when you look at self-criticism or self-recrimination in normal grief, it has to do with the the person who was lost or the thing that was lost. I should have worked harder to please my boss. Maybe I would not have been laid off. Okay. That kind of thing. When you’re looking at self esteem within clinical depression, it’s much more global, right? The feelings of inadequacy, worthlessness, those are much more global. The criticism towards self, the self-loathing, much more general. Right. And it may involve significant shame. Shame is that sense of inadequacy, inferiority, that you as a person are defective. You don’t see that in normal grief. What happens in relationships? Well, in normal grief, your relational connections generally remain intact. There’s an ability to give and receive in relationships. And this is really important. In normal grieving, a person can be consoled, can take comfort in relationship with other people.

[00:07:00] You get to clinical depression, it looks different. There’s an emotional withdrawal from relationships, sometimes a physical withdrawal, a kind of isolation from relationship. And there’s difficulty being able to accept consolations and comfort from other people. That’s not coming as nearly so readily. What happens with thoughts? Well, within normal grief, there could be some ruminating or focusing on who or what was lost. But hope remains. There is the sense that life’s going on, that there’s this process that’s ongoing. When you look at clinical depression, these self-critical or pessimistic thoughts tend to again be more global. And there can be this tendency toward a loss of hope, a tendency toward despair. In normal grief, there may be thoughts of death, but those thoughts of death and dying are usually focused on the lost person, and often contain a theme of reconnecting with them in heaven. There might be some loss of desire to live on, but there are not overt wishes or impulses toward suicide. All right, let’s contrast that with what happens in clinical depression. In clinical depression, there are these suicidal thoughts, but they’re related to feelings of being unworthy to live or of not wanting to live anymore. Suicide could be considered an escape from unbearable pain. There are no other answers. It’s much more of a desperate type of experience. All right, so let’s take a look at what kind of triggers are involved in normal grief. Well, in normal grief, the experience of loss, the experience of sadness can be triggered by or activated by memories or reminders of the person or the thing that was lost.

[00:09:19] They tend to be very specific to the loss, right? That’s normal grief. In clinical depression, the depressed mood, the sadness, the distress, it’s not tied to specific thoughts or preoccupations. It’s not tied to one particular thing. Much more global, much more general. All right. So there we have the differences between normal grief and clinical depression. Normal grief, if you’re experiencing normal grief, there is the consolation that that is a process that’s going to be worked through in the course of time and with support from others. Clinical depression, that’s something that needs a more active and vigorous response. Let’s flesh out now some examples of grief versus clinical depression in the scripture. All right. Let’s take a look at what grief and depression look like in the Bible. We’ll start in Genesis. That’s a good place to start. Genesis 23. This is where Abraham experiences the death of his wife, Sarah. “Sarah lived 127 years. This was the length of Sarah’s life and Sarah died at Kiryat Arba, that is Hebron, in the land of Canaan. And Abraham went in to mourn for Sarah and to weep for her. Abraham rose up from beside his dead and said to the Hittites, ‘I am a stranger and an alien residing among you. Give me property among you for a burying place, so that I might bury my dead out of my sight.'”

[00:11:09] Let’s take a look at this. Abraham grieved Sarah. He wept for her. He mourned for her. Mourning is the manifestation of grief. It’s what we show other people. We learn that in the last episode, episode 17. But then he rose up from beside the body of his wife, and he carried on. He made arrangements for her burial. And there’s this sense that Abraham is going to be able to continue on. That’s normal grief. Even though he was devoted to Sarah, they had spent many decades together in relationship, had gone through some hard times, had gone through some great times. He was able to continue on. He was able to carry out his functions as the patriarch of the family. Let’s take a look at David and I, as a psychologist, am so appreciative of the way that David is portrayed in Scripture, because you really get a window into David’s internal experience. David is one of the most expressive men in the Bible, and we’re going to take a look at his grief. Right? This is after the time when Saul was killed and when Jonathan was killed. Jonathan, beloved friend of David. “Saul and Jonathan, beloved and lovely, in life and in death they were not divided. They were swifter than eagles. They were stronger than lions. O daughters of Israel, weep over Saul, who clothed you with crimson in luxury, who put ornaments of gold on your apparel. How the mighty have fallen in the midst of the battle. Jonathan lies slain upon your high places. I am distressed for you, my brother Jonathan. Greatly beloved were you to me. Your love to me was wonderful.”

[00:13:15] Okay, so we see here David in grief. This isn’t depression. This is specifically focused on the loss of Jonathan and the loss of Saul. Now, there are clearly conflicts between David and Saul. In fact, Saul was bent on murdering David at one point. But nevertheless, David could experience the sense of loss. He experiences these waves or pangs of painful emotion, but they don’t dominate all of his existence in the same way that it can happen in clinical depression. His self-esteem isn’t compromised by feelings of worthlessness. You don’t see him struggling with inadequacy or great amounts of self-criticism. He’s not thinking of his own death. He’s not suicidal in the situation, but he’s going through that process of grieving the loss. That’s what’s happening there. Now let’s go to Psalm 38, where David now starts to sound much more depressed. This is what David says in Psalm 38. “O Lord, rebuke me not in thy anger, nor chasten me in thy wrath. For thy arrows have sunk into me, and thy hand has come down on me. There is no soundness in my flesh because of thy indignation. There is no health in my bones because of my sin. For my iniquities have gone over my head. They weigh like a burden too heavy for me. My wounds grow foul and fester because of my foolishness. I’m utterly bowed down and prostrate. All the day I go about mourning for my loins are filled with burning and there is no soundness in my flesh. I am utterly spent and crushed. I groan because of the tumult of my heart. But I am like a deaf man. I do not hear, like a dumb man who does not open his mouth. Yea, I am like a man who does not hear, and in whose mouth there are no rebukes. Do not forsake me, O Lord. O my God, be not far from me. Make haste to help me, O Lord, my salvation.”

[00:15:42] Okay, so in this, you’re starting to hear more sounds of depression. Now, I’m not going to make this argument that I can diagnose David accurately thousands of years later based off of this psalm. But you can see that the distress is more continuous over time. It’s much more global. It’s mixed with a lot of guilt because obviously there had been some iniquities here, some sins that David is grieving that have harmed his relationship with God. But there’s much more of this feeling of inadequacy, much more self-criticism, much more worthlessness, much more critical towards the self. Now, some of that is justified, right? I mean, David has done wrong. He is in this process of repenting. So it’s not entirely clear that this is, you know, absolutely and solely clinical depression. I’m not arguing that, but I’m using this as an example to show you that he is experiencing something very different here than in the death of Jonathan and in the death of Saul. He talks about being crushed. No health in my bones, no soundness in my flesh, utterly spent, the tumult of his heart. Right. This is a much more global phenomenon that he’s experiencing. And that sort of captures the difference here between sort of an uncomplicated grief and something much more global, much more akin to clinical depression. So let’s take a look at Elijah. So Elijah in First Kings, he had this tremendous victory over prophets of Baal. This was when he was confronting King Ahab and Queen Jezebel. 450 of Baal’s prophets were destroyed in a single episode with Elijah. He was able to best them all in a glorious fashion. Right? It was extremely dramatic how he was able to challenge them to a contest and then be successful single-handedly, you know, by the grace of God. But shortly afterward, Jezebel finds out about this, and she is an extraordinarily powerful and wicked woman. And she sends a message to Elijah. And this is how the scripture reads in 1 Kings 19. “Ahab told Jezebel all that Elijah had done, and how he had killed all the prophets with the sword. Then Jezebel sent a messenger to Elijah, saying, ‘So may the gods do to me, and more also, if I do not make your life like the life of one of them by this time tomorrow.'”

[00:18:32] So Jezebel sent this death threat to Elijah. And the Scripture goes on to say, “Then Elijah was afraid. He got up and fled for his life and came to Beersheba, which belongs to Judah. And he left his servant there. But he himself went a day’s journey into the wilderness, and came and sat down under a solitary broom tree. He asked that he might die. ‘It is enough now, O Lord, to take away my life, for I am no better than my ancestors.’ Then he lay down under the broom tree and fell asleep.” Okay, this is looking much more like depression than grief. Why? Because he’s got desires to die. He feels totally unworthy. I am no better than my fathers. Take away my life. He says, it is enough. Sounds more like depression than uncomplicated grief. One more example, and one of my favorite examples, is Jeremiah. Jeremiah really wrestled with great loneliness. He wrestled with insecurity. He wrestled with feelings of defeat. The ministry that God called Jeremiah to was quite difficult. He’s got the nickname the Weeping Prophet. He was often the bearer of bad news. He was a man rejected and despised by the people he was trying to help. He remained faithful to God. He really worked on resiliency, but the things that he went through would get to almost anybody.

[00:20:06] The rejection, the poverty, the ridicule. He displayed great confidence in God. But yet we also see how he wrestles with despair. This is from Jeremiah chapter 20, and this is Jeremiah speaking of himself. “Cursed be the day in which I was born, the day when my mother bore me. Let it not be blessed. Cursed be the man who brought the news to my father, saying, ‘A child is born to you, a son,’ making him very glad. Let that man be like the cities that the Lord overthrew without pity. Let him hear a cry in the morning and an alarm at noon, because he did not kill me in the womb. So my mother would have been my grave and her womb forever great. Why did I come forth from the womb to see toil and sorrow and spend my days in shame.” Again we see how thoughts of death, desires to die, rumination that is very global, very self-critical, feelings of worthlessness. All of this, you know, no sense of sort of essential or ontological goodness, lost contact with the sense of being loved by God. That’s what’s happening here for Jeremiah, so much more akin to depression than it is to uncomplicated grief. What does Saint Paul say? He says in 2 Corinthians chapter one, “We were so utterly burdened beyond our strength that we despaired of life itself. Indeed, we felt that we had received the sentence of death, but that was to make us rely not on ourselves, but on God who raises the dead. He delivered us from such a deadly peril, and he will deliver us. On him we have set our hope that he will deliver us again.”

[00:22:07] So these are words of great hope for those of us that have ridden waves that have led us into valleys of depression. Even great saints, even great prophets, have experienced these depths, have experienced in their subjectivity, this despair. And the promise is that we hope anyway. Hope not being a kind of optimism, fair weather kind of optimism, it’s much more solid because it’s a theological virtue imbued in us in God. And that’s what we need to be relying on, rather than our assessment of how things are going in the present moment. So now we’re going to take a look at a story of grief that turns into depression, but then comes to resolution. This is the story of Naomi. Naomi and her husband were from Bethlehem. When famine struck in Bethlehem and starvation was on the horizon, they moved to Moab. That’s a neighboring country which had been spared from the famine in those years. And while they were there, Naomi’s husband died. Her two sons married Moabite women, but they died within ten years. And so at this point, Naomi’s future looked dismal. Her husband was dead. Her two sons were also dead. That left her destitute.

[00:23:33] No one to provide for her. She was a stranger in a strange land. No prospects of how she was going to make it or how she would live on. Naomi and her daughters-in-law heard that the famine had lifted in Bethlehem, and Naomi decided to return to her homeland. Her daughter-in-law, Ruth, insisted on going with Naomi. Naomi attempted to dissuade her from that, attempted to have Ruth go back to the house of her father, where she would be taken care of, but Ruth was committed to Naomi. There was a bond there. She would not leave Naomi. So Naomi agreed that she could come with her back to Bethlehem. So the two of them went on until they came to Bethlehem. “And when they came to Bethlehem, the whole town was was stirred up. And the women said, ‘Is this Naomi?'” Now, there’s a play on words here. Naomi means pleasant. That’s what it means. And so, “Naomi responded, ‘Call me no longer Naomi, that is, pleasant. Call me Mara, which means bitter, for the Almighty has dealt bitterly with me. I went away full, but the Lord has brought me back empty. Why call me Naomi when the Lord has dealt harshly with me? And the Almighty has brought calamity upon me.'” Okay, so here we see a deep bitterness, a deep resentment. This all started with grief, right? There were losses for Naomi. She lost her homeland. She had to move from Bethlehem to Moab.

[00:25:07] She lost her husband. She lost her sons. She lost her livelihood. She lost the sense of security. She lost a sense of direction. And now she’s coming back in, destitute, in a lot of uncertainty, back to Bethlehem. A lot of bitterness. But what happened then? What happened then? Well, that’s when Ruth, her daughter-in-law, met Boaz. They married. And there was this redemptive aspect to the story, because Ruth and Boaz had a son. And Naomi was intimately involved in the raising of that child, almost as though it were her own son. And through that line, the Savior of the world was born. That’s the direct lineage. Ruth was one of the ancestors of our Lord Jesus Christ. And so there is a resolution there that you can actually see in the story where she’s able to recover from not only her grief, but also that depression that had come on. And there’s a contrast here with Cain and Judas. Cain and Judas don’t have that resolution. Cain and Judas went into despair. “Cain said to the Lord, ‘My punishment is greater than I can bear. Today you have driven me away from the soil, and I shall be hidden from your face. I shall be a fugitive and a wanderer on the earth and anyone who meets me may kill me.” And Judas, Judas had great remorse. He regretted turning Jesus over to the authorities. He regretted the blood price of the 30 pieces of silver.

[00:26:57] But he didn’t repent. He said, “‘I have sinned by betraying innocent blood.’ But they said, ‘What is that to us? See to it yourself.’ And throwing down the pieces of silver in the temple, he departed, and he went and hanged himself.” Matthew 27. So let’s talk about resiliency. It’s time to talk about resiliency. So much of resiliency for us Catholics is dependent on our God image. It depends on how well we can hold on to a providential image of God, how much we can hang on to a knowledge of who God really is, how God has revealed himself to us as a loving father. And the next episode, we’re going to go over many ways to help ourselves and others move through the grieving process. You won’t want to miss that. So here’s what I’d like you to do. I’d like you to register for the Resilient Catholics Carpe Diem community. It’s free for the first 30 days. After that, it’s just $25 a month. Those subscriptions are what fund this podcast, and we don’t have any other sources of revenue at this time for the podcast. We’re still trying to figure out how to pay for it. So your subscriptions are really important. They really help us with the expenses and with me setting aside time to keep the podcast and the community going strong. We have discussion boards in our Resilient Catholics Carpe Diem community. We have special Zoom meetings, among other benefits for our community members.

[00:28:31] The recording of our first small group meeting on grief is going up in the community space, so you can access that. Our next small group meeting is on Saturday, June 6th at 5:00 p. m. Eastern Time, where we have an experiential workshop to teach you stress management skills at the time that I’m recording this. There’s one seat left. That probably will go quickly, so see if you can get in there. But we will also make the recording of that session available to community members so that you can watch it later if you’d like. In that session, we’re going to be practicing stress management techniques grounded in a Catholic worldview to help you through these difficult times, to help you rise up, to help you increase your resiliency and for you to really own what’s going on inside you so that you can move forward in becoming a saint with a strong spiritual life grounded in a solid, natural foundation. Here at Souls and Hearts, we are real Catholics, overcoming real issues with real transformation resulting in real growth. Come join us. Reach out to me at crisis@soulsandhearts.com. You can call me at (317) 567-9594 with questions about the community. I’m really looking forward to hearing from you. And with that, we’re going to bring this episode to a close. We’re going to invoke our patroness and our patron. Our Lady, our Mother, Undoer of Knots, pray for us. Saint John the Baptist, pray for us.