Tonight's picture was taken in May of 2003. I took Mattie to a local petting zoo, and he was simply fascinated by all the animals. Mattie loved animals right from the beginning, and he literally wanted to jump out of my arms that day and into the pen with the animals. I loved Mattie's hands, and as you can see specifically from his right hand, each of his fingers were like antennae which put out a signal to help him understand the world around him.
Poem of the day: No One by Charlie Brown
Do you think
That men don't cry?
Sometimes the tears
Are all inside.
This little boy
He was my son (sun).
So impossible to believe
His time is done.
And no one asks
Or says his name,
As if that could make
Tears fall like rain.
It hurts so much
That he's not here,
And it hurts too
That it's my pain you fear.
So find your courage
And walk with me,
Use his name
I am so happy many of you enjoyed hearing from Peter last night. As the originator of the blog, I feel it is very important for you to hear from him. His perspective matters! I think it is quite evident that though Peter MUST function and go to work, it doesn't mean that he is grieving any less than I am. In fact, in many ways, Peter is much more emotionally open about grief than I am, and I am happy he has the courage to voice his feelings and disappointments through the blog, which in essence has become our grief journal.
Today is Tuesday, and as such, this marks the 46th week Mattie has been gone from our lives. It is funny, I may not focus upon the fact that it is Tuesday, but somehow within my mind and body, I can feel the weight of this day. It is almost like an automatic response. Like when you see a camera, you smile. For me, when Tuesday is upon me, I just feel sad. This evening, while I was cooking dinner, our resident Jack Russell Terrier, JJ, came by to visit. I had our front door open, despite the humidity, because I like the summer sounds outside, and I know Patches (our cat) enjoys running inside and outside while I am cooking. Any case, with the door wide open, in walked JJ. JP, JJ's owner, was right behind JJ and he told Peter a story that I found VERY touching, and it seemed to be a perfect way to acknowledge Mattie on this Tuesday.
When Mattie was healthy he would run around with JJ everyday outside (regardless of the weather!). They practically grew up together, since JP got JJ when he was a puppy. One day while they were playing outside, JJ grabbed one of Mattie's sandals right off his foot. JJ claimed that sandal and basically because Mattie's feet were growing and he just got new sandals, Mattie gave the pair of sandals on his feet to JJ to play with and take home. This incident has to have occurred about two years ago at least. JP told Peter tonight that he finally caved in and decided to throw Mattie's old and dog chewed sandals in the trash. Or that was his intention, but clearly he did not check this action out with JJ. When JJ went to his toy area and did not see Mattie's sandals, he began a full search. Needless to say, JJ ransacked the kitchen garbage can, made a mess in the process, but he maneuvered the can just so, that he was able to retrieve the sandals and reclaim them once again. I don't know about you, but this story is striking to me, because Mattie's memory is so important to JJ that JJ couldn't part with this item from his special friend. Sometimes these simple stories are the ones that are the most meaningful, and just like children, I feel animals also react to things and people rather honestly. I have NO doubt Mattie is smiling over JJ's beautiful gesture to keep his memory alive today!
Unlike my usual blog postings, tonight's I admit is different. It is different because I feel the need to comment on the issue of grief versus depression. Particularly whether depression related to or caused by bereavement should be diagnosed and considered identical to all forms of depression? Before I continue on my soap box, I want to make sure we are all on the same page with this discussion. To learn more about Major Depressive Disorder (Depression), I attached a link. http://www.allaboutdepression.com/dia_03.html
This link provides the exact criteria used to evaluate someone for depression. Depression is a disorder that involves feelings of sadness lasting for two weeks or longer, often accompanied by a loss of interest in life, hopelessness, and decreased energy. Such distressing feelings can affect one's ability to perform the usual tasks and activities of daily living. Though many commercials out there would have you believe that your family practitioner can diagnosis depression accurately, I would caution you. Physicians have excellent training typically for what they are competent to treat, but the MAJORITY of them do not have the knowledge and experience to identity mental health issues and disorders. So I want to make sure you know where I stand on this..... only qualified mental health professionals such as mental health counselors, psychologists, psychiatrists, social workers, and psychiatric nurses should be making such crucial mental health assessments and diagnoses.
The other concept important to understand for this discussion is The Diagnositic and Statistical Manual of Mental Disorders (DSM). The DSM is published by the American Psychiatric Association and is the handbook used most often in diagnosing mental disorders in the United States and other countries. The first edition (DSM-I) was published in 1952, and had about 60 different disorders. Over time this manual has evolved and in 1994, the fourth edition of the book, the DSM-IV, arose. Now, almost 19 whole years later, the newest addition of the DSM, the DSM-V, is soon to released in May 2013. With this pending release will naturally be SOME changes, updates, and additions to how mental health disorders are evaluated and assessed.
This leads me to the proposed revision at hand. In a nutshell there are two camps within the mental health field. The first camp believes that the "bereavement exclusion" criteria should be removed from the evaluation of Major Depressive Disorder (Depression). According to the DSM-IV, if individuals are grieving the loss of a loved one, then they are then excluded in many cases from being diagnosed with depression. However, the DSM-V, would like to eliminate that exclusion criteria. So in essence under this scenario, if clients come in with the symptoms of depression, then despite the fact that they are grieving, they would be labeled with depression. The second camp is very much opposed to the removal of this exclusion criteria, because this camp feels as if bereavement and depression, though they may look the same, are different, and should be treated differently.
What got me on this topic tonight? Well several of my friends told me about a segment on NPR yesterday. My friend Carolyn spoke to me over dinner about this last night, and then my friend Christine, actually sent me the link to the NPR recording today. When I received an e-mail from Mattie's oncologist, Kristen, about this same debate, I realized I had to say something. I have to say something about this because I am not only a mental health professional, but I am someone in the midst of a very difficult grieving process. I have attached more interesting links below. The first one is to an article that was published on line through Medscape Today in 2008. The 2008 article highlights the research of Kendler and Zisook (both psychiatrists interviewed in the NPR recording). These psychiatrists fall under the first camp, in which they feel that the bereavement exclusion should be eliminated. For various reasons, mainly though because they feel that many people experiencing grief are undiagnosed and have a higher incidence of suicide if untreated. So in their world labeling clients right from the start as depressed, seems to be their panacea.
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Bereavement Related Depression Identical to Other Depression Types
From Medscape Today, December 4, 2008 (http://www.medscape.com/viewarticle/584829)
Major depression related to bereavement is essentially identical to major depression brought on by other stressful life events, suggesting that it should not be excluded from standard depression diagnoses, new research suggests.
Currently, the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) assigns special status to bereavement-related depression, claiming it is distinct from all other depressive episodes. However, these latest findings challenge this assertion.
"Depression that occurs in the context of the loss of a loved one is essentially identical to depression that occurs in the context of any other negative event or loss," study coauthor Sidney Zisook, MD, from the University of California, San Diego, told Medscape Psychiatry.
The study, led by Kenneth S. Kendler, MD, from Virginia Commonwealth University Medical School, in Richmond, was published in the November issue of the American Journal of Psychiatry.
"If a bereaved person's depression otherwise meets criteria for major depression, it should be taken seriously, diagnosed as major depression, and treated accordingly, rather than continuing to use the bereavement-exclusion rule and treating this as 'normal grief,' " said Dr. Zisook.
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The actual NPR recording is attached below. You can see a transcript in this link, but I highly encourage you to press the play button on this link to hear the 8 minute NPR recording.
Is Emotional Pain Necessary
by Alix Spiegel, National Public Radio
http://minnesota.publicradio.org/features/npr.php?id=128874986
The premise of the NPR broadcast that caught my attention was simply..... is emotional pain necessary? The broadcast opens up with a woman who lost her only child to a drowning accident, and though this was 20 years ago, emphasis TWENTY, she is still grieving and still sounds very broken up by this life altering loss. That struck me immediately, because I related to all the things she misses, she no longer sees her child's fingerprints around the house and the list went on. This mom and a Harvard researcher would argue that feeling emotional pain is crucial in order to process the devastating loss and to eventually find ways to cope. That medicating this feeling away is not the answer. What troubles me about removing the exclusion criteria is that this is feeding into our quick fix society. A society that doesn't want to see pain, that wants to pathologize something that unfortunately is NATURAL (when we lose someone it is painful, it has to be, because if it weren't then what does this mean about us, our relationship with that person, and more importantly the overall health of us as human beings). What makes us unique from other living creatures is our ability to not only think, but to feel and be able to express it verbally in words. Medicating and squelching these feelings should be red flagged as UNNATURAL. I honestly believe that if people who are grieving will now be immediately labelled with a depression diagnosis this will accomplish many things such as: 1) it will send a direct message to an already unhealthy society that grieving is bad and abnormal, 2) it will rush the grieving process, which really varies by the individual, and 3) by potentially medicating someone, this could in fact harm the grieving process, because unless emotions are felt and processed, they will eventually resurface at a later date and potential be even more volatile.
The pro-exclusion camp feels that if individuals came in to see a doctor for a broken bone, that no doctor would NOT treat the pain. In essence they feel the same is true for mental health pain. That it should be medicated appropriately. I understand the thinking behind this, and certainly agree, some people experiencing grief are truly clinically depressed and may need to consider medication. However, this breaking a bone analogy doesn't work for me at all. Sure if you break a bone, you need pain killers, other medical attention, and physical therapy most likely in order for you to heal from this trauma. However, the trauma from a loss requires different medicine. In fact, the medicine needed to heal from a grief trauma is much MORE time consuming, requires greater resources, and for the most part the medical community can not devote or create what is needed to heal this problem. Why? Because to heal from a traumatic emotional loss requires time, patience, love, unconditional regard, access to talk to a trusting person, and to find a way to feel safe again. I ASSURE you, NONE of this can be found out of a prescription bottle. I wish it were that simple, but it isn't, and any clinician thinking it is most likely hasn't experienced a true loss. I would like to quote Dr. Frances, the famous psychiatrist and a former editor of the DSM. From Frances' perspective, "if you can't feel intense emotional pain in the wake of the death of your child without it being categorized as a mental disorder, then when in the course of human experience are you allowed to feel intense emotional pain for more than two weeks?" Or as Mattie's oncologist wrote to me tonight, "YOU GRIEVE AS MUCH AS YOU LOVE." Well stated!
I would like to end tonight's posting with two messages. The first message is from Mattie's oncologist and our friend, Kristen. Kristen wrote, "On my walk yesterday morning I was listening to a discussion on NPR about grief. The topic was discussed because of a planned change in the next edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders. I struggled with this change. The gist of the story is the next edition of the DSM has removed the "bereavement exclusion" of major depressive disorder. Basically, now, those who are experiencing grief can be considered to have major depression if symptoms such as loss of appetite or difficulties sleeping (etc.) last greater than two weeks. I can imagine these symptoms persisting long after two weeks with the loss of a loved one and I question this narrow definition of grief. Those who argued for this change in terminology thought that the dangers of depression outweighed leaving the exclusion in place. Anyway, despite my disagreement with this new DSM plan I wanted to share the following quote with you because I think that it speaks volumes. The woman in the story (who also disagreed with the new version of the DSM regarding grief) lost her only child, a little girl, twenty years ago. What she said made me think of the two of you...
"I grieved her just as hard as I loved her."
I'll say that again.
You grieve as much as you LOVE.
I know how much you loved Mattie...and still do. When a time comes or a person remarks or you read a book that says grief should last "only so long" please think of this statement. Your love for Mattie is immense. And your grief for him immense as well. Thinking of you, this Tuesday, and every day."
The second message is from my friend, Charlie. Charlie wrote, "Vicki, I don't know how you write the blog each day and I don't blame you for wanting the break. Peter, I have to say I admire your courage in putting it out there as Vicki does; you both have a level of courage that few can match. I don't know why so many believe that men don't feel, don't hurt, don't cry even if those tears are inside. Generally women are more supportive than men in grief situations; so many men have been taught to hide or surpress their feelings of sadness that that the rest of us often forget that men feel pain too even though they may not show it. I am sorry for your loss, I wish that Mattie were here to share this summer with you and I am also sorry that you don't get the emotional support at work that would make it a little easier to bear. We've been told so often that men grieve differently; that they are "doers" that people forget that men are first people and that each person grieves differently and in their own unique way. Making assumptions about any group of grievers is a mistake as it is an individual path. So today for this short time, know that I am willing to walk beside you, to tell you that I miss Mattie and the stories you have both shared and that I wish he were here with you to create new ones. I hold you and Vicki gently in my thoughts."
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