MOURNING AND MELANCHOLIA

Victor Bloom MD

Death is a part of life. Life is full of necessary losses. Our natural reaction is to mourn and grieve these losses. Sometimes the loss seems overwhelming, giving us a feeling that life isn't worth living, or that we cannot go on. And yet experience teaches us that life does go on, and for the most part, we cope and adjust and even grow from the experience.

We experience losses from birth on. Eventually the infant is weaned, he or she is no longer the center of attention. Siblings come on the scene and we may be lost in the shuffle or fall through the cracks. Parents may die or leave; divorce may divide a previously stable and intact home. Teenagers learn their parents have feet of clay, they leave home and lose the nest and may be 'homesick' for a while. That is mourning a loss. Parents suffer the 'empty-nest syndrome', they have lost their parenting function and sense of family.

In the middle years some men may realize they are not in the right business or profession, or not with the right marriage partner. The woman may realize she has not expressed her creativity, whether at home or in a career; she may feel down because she is losing her attractiveness or a chance to have a baby. Decisions made in early adulthood are not always the right ones, they may not be durable, and so we quit jobs or get fired, or find ourselves in the wrenching process of divorce.

As the years go by, while some gain in confidence and recognition, others begin to lose their faculties and decline--- there is a loss of vitality and flexibility, a loss of health and creativity. Senior citizen discounts do not make up for a loss of hopes and dreams, a life that was not fulfilled. They do not make up for a loss of self-esteem or self-confidence, or having to live on a barely adequate fixed income.

When there is a loss through the death of a loved one, a parent or sibling, a spouse or child or close friend, there is an emotional shock. We are confronted again with the reality of death, the feeling of devastating loss. This is normal. Even animals show signs of mourning significant losses. For us our reaction is partly instinctive and partly learned. We cry because at bottom we are still children at heart, and react to pain and disappointment; we are afraid again of being lost in the woods, as if left alone to die. We are reminded of forces outside of our control, feeling helpless, unable to determine our fate, gratify our wants and needs.

We may cry and cry and then be left with a feeling of emptiness and loneliness, sometimes with feelings of hopelessness and despair. We turn to our friends and relatives for solace and comfort, to food and distractions, such as movies and sports. Some turn to medications and drugs, or to religious faith and the belief that we will rejoin the loved one in the hereafter. Some actually resort to suicide, as if they can join the dear, departed all the sooner. Some just grieve and grieve without ending, falling deeper and deeper into depression.

Most often the mourning period is self-limited and life goes on. This is more the case when the mourner is filled with pleasant and vivid memories of the departed one. We can even imagine conversations with the person, ones we have had or ones we could have had or create in our imaginations. How often we hear, "what would mother have said?" or "Freddie would really have enjoyed that." The dead person lives within us.

Sometimes the feeling is that we cannot hold on to anything or anyone, we cannot hold on to hope or faith or relationships or jobs or good feelings. More and more there is the despair of hopelessness, an aching emptiness that will not go away or a psychic pain that is unbearable. Sometimes the melancholy leads to an overwhelming feeling of inertia, a complete lack of drive or ambition, or a feeling of great weight and inability to move altogether, called 'leaden paralysis'. These are symptoms of a major depression which requires major intervention.

Such major intervention can only be done by a medical psychiatrist, who can decide whether the sufferer needs hospitalization or outpatient therapy, anti-depressive medication and/or psychotherapy. Most often these treatments are effective, especially when there is a prolonged followup by a caring therapist, who can do both psychotherapy and psychopharmacology. These severe depressions are not indicative of a defective person, despite the fact that some people are judgmental about a depressed person, suggesting they are lazy or self-indulgent, and should 'snap' out of it. Would that it were so easy!

More and more society is accepting the fact that depression is a serious medical condition, which often accounts for multiple somatic complaints, such as headache, muscular pains, sleep and appetite disturbances, malaise, fatigue and weakness. Depression accounts for billions of dollars in lost time from work and medical expense for studies and tests. It also accounts for almost all substance abuse, including nicotine and alcohol addiction, as well as the hard street drugs. Substance abuse leads to dysfunctional families, poor parenting, the abuse of children, gambling and other crimes, and in the most serious cases, leads to crimes that end in imprisonment. As the state hospitals have closed, more and more of the seriously mentally ill wind up in prison or homeless on the street.

Mourning is a natural and self-healing process. Melancholia is a disease we now call Depression, one which is amenable to treatment and management, if not outright cure. No one in this day and age should have to endure the handicap of severe depression as we now have enlightened attitudes and effective treatments abundantly available.