Coping with grief and pain

If you want to be happy, you have to let yourself be sad.  Nobody gets a free pass.  The deepest joys in life come from our attachments—usually to other people—and life will take those other people from us at some point.  Grief is an essential feeling, the natural emotional response to loss. There are other kinds of pain that seem inevitable; physical pain that as we age becomes debilitating, the mental anguish that comes with stress and with disappointment, the sympathetic pain we feel for our loved ones.  The awful truth is that when we’re happy, we have a lot to lose.  But we don’t have to let grief or pain immobilize us, send us into a depression, or ruin our lives forever.

Grief takes time, but it works if we let it happen. 

Humans are marvelously adaptable, and we have a natural healing process.  At first, the loss is the biggest thing in our lives, but with the passage of time other experiences gradually push it into the background.  Time is essential, but in today’s world there is tremendous pressure to get on with things.  Our friends want us to be over it long before we’re ready.  Our job certainly expects us to be fully attentive again.  But be patient; grief and pain won’t kill you, but trying to stuff those feelings may make things a lot worse.

We have to learn the skill of mindfully sitting with pain.  As with other feelings, we have to learn to experience them without feeling overpowered by them—but this is different, more difficult, because it can hurt so much you fear you can’t stand it.

This is where meditation practice really helps; as in meditation, we can see our feelings as raindrops falling on a tranquil pool—they splash, they make ripples, but that’s all.  They don’t harm or destroy the pool; in fact, they add to it, as all our experiences, even pain, add to our lives.

The skills of depression

We learn the skills of depression out of necessity.  They served a purpose at one time, but they’ve become stuck in our brains.  They are part of the vicious circle that perpetuates the depression, and they make recovery difficult.  The self-destructive element of many of these skills is obvious, or will be explained shortly, so I will just comment briefly on a few at this point.

Depressed Emotional Skills

  • Isolation of affect. “Affect” is simply another term for emotion.  Isolation drives a wedge between the experience and the feeling.  We are aware of what’s happening around us, but we don’t experience the emotion that we would expect to accompany the event.  Isolation is useful for surgeons, rescue workers, police officers, and others who have to remain calm in very stressful situations.  But people with depression learn not to show, or even feel, their feelings because it has only worked against them in the past.  In some families, in some situations, to let others know how you feel is dangerous; it gives people ammunition to be used against you.  But turning off your feelings makes you a cold fish, and people who might be friends are turned off.
  • This is the use of the body to express feelings or an interpersonal message.  We all know people like this, who have pain they can’t relieve, fatigue that isn’t helped by rest, who are irritated by multiple stimuli, or easily nauseated, or have an irritable bowel.  Their bodies are saying You can’t do anything to help me, or My suffering gives me special privileges, or My suffering means you can’t expect me to do my share.  Somatization allows people to communicate feelings without having to take responsibility for them.
  • One example: A depressed father with an adult son who has lost his driving privileges because of a DUI conviction drives the son around town, absorbing his abuse:  “You’re just a lousy driver.  Can’t you drive a little faster?  You’re always late.  You can’t do anything right.”  Telling me about this, he is more embarrassed about his son’s bad behavior than he is about his own passivity in the face of abuse.  When I ask him how this makes him feel, he is completely unaware of feeling angry—but remains depressed.   The old saw that depression is anger turned inward is often quite true.
  • Repression has two meanings now, both important for depression.  One meaning is the opposite of isolation:  it’s experiencing the feeling, but detached from the experience that stimulates the feeling.  The depressive gets suddenly sad without knowing why—but the objective observer sees the event that led to the feeling.  This may be a criticism, a disappointment, a snub that passes quickly in and out of the depressive’s consciousness.  The event itself is quickly forgotten, repressed, but the feeling lingers.  This leads us to the other, more common, meaning of repression, that of “forgetting” events that are too painful to remember.  This is not an uncommon phenomenon with trauma—sexual abuse, combat, disasters.  The events are not really forgotten, of course, they come back as nightmares or in other manifestations.  The depressive who has been through traumatic experiences will use repression to help keep the feelings associated with the event out of consciousness.

Other depressed emotional skills include intellectualization; projection, externalization and internalization (an old stereotype with some truth:  men blame others, women blame themselves; neither can be objective); rageaholism (ranging from tantrums to physical abuse; the individual doesn’t take responsibility for his behavior and expects to be quickly forgiven); and anhedonia (the loss of all joy), hopelessness, and apathy, which can insulate you from feelings.  The Mood Journal [link] is a very useful tool to help us relearn the connections between our experience and our feelings.

Depressed Behavioral Skills

  • Procrastination.  A skill because it protects you from ever having to put your best self on the line. You always have an excuse: if only I’d had more time.
  • Keeping yourself in a haze of television or sleep or fatigue will mean you miss out on a lot of opportunities.  But for the depressed person, opportunities can be a challenge to be avoided.
  • Work till you drop, inability to prioritize, pushing yourself mindlessly—and never checking to see if you’re going in the right direction.  Thus not taking real responsibility for the decisions you make.
  • Obsessive and compulsive behavior. Psychologists understand these patterns as ways of attaching some real fears about life to behaviors or thoughts that can be more or less controlled.  Depression and fear are closely related, each causing the other in a potentially endless feedback loop.
  • Adrenaline addiction.  People whose work involves a lot of pressure or constant deadlines can get so absorbed by the pressure that they can forget about their depression.  They can spend 30 years in a job and when they retire, they go through withdrawal as if from heroin or cocaine.
  • Victimizing, violence, and acting out. Violence is often a response to shame.  It can make you feel powerful again without facing what made you ashamed in the first place.  Unfortunately, it usually leads to more shame.
  • Victimization and self-mutilation. Treating yourself sadistically—or allowing others to—can make you feel real again, and provide a sense of focus, calm, and control during times of great distress.

Depressed Cognitive Skills

  • Expecting the worst protects you from disappointment.  Many depressed people have been traumatically disappointed by abandonment, faithlessness, or abuse from loved ones.  Other experiences, like the failure to reach goals, can also turn you sour on hope.
  • Negative self-talk. Thoughts like I can’t, I’m hopeless, I’ll never succeed, I’m repulsive, I’m trapped, which run through the depressive’s mind like too-loud background music. See our essay on the Inner Critic [link].
  • Passivity.  People with depression tend to see themselves as acted upon by powerful outside forces, not in charge of their own lives, and thus not truly responsible for their fate.
  • Selective attention. By selectively paying attention only to what confirms our expectations, we avoid stress and feel more secure in the world we’ve built for ourselves.  This becomes an automatic, unconscious process in which we are blind to opportunities to excel, the affection and respect of others, the beauty of the physical world, and so on.  This helps the depressed person to maintain an even keel.
  • Depressed logic. People with depression tend to base their thinking on a number of false assumptions, which turn into self-fulfilling prophecies.  The basic assumptions of depression can be summarized as:  “Life stinks.  Life will always stink.  It’s my fault that life will always stink.”

Depressed Interpersonal Skills

  • Recruiting accomplices—restricting your social world to those who don’t expect much of you or enable your depressed behavior.
  • Social isolation, avoiding contacts that might challenge your depressed thinking.
  • Dependency, putting someone else in charge of your life.
  • This refers to a kind of phony independence, acting as if you don’t need anyone, when in reality there is a great fear of any need at all, masked by coldness or a feigned superiority.
  • Passive aggression. Expressing your anger in indirect ways, making others angry at you and yourself the victim.
  • Porous boundaries. Not deciding how others’ actions, feelings, and expectations should affect you, just letting yourself be influenced.

Depressed Treatment of the Self

  • Impossible goals, low expectations.  We believe we should be able to attain great things, at the same time as we believe we’re incompetent and inept.  But we keep trying to hit a home run:  This time will be different, this time I’ll make it, and then I’ll be happy.
  • No goals, lots of guilt. Conversely, we may avoid setting goals for ourselves entirely, to avoid disappointment.  But depressed people are not the laid-back happy sort who can coast through life without feeling guilty about not doing our best.
  • Inability to nurture, sustain, and soothe. A trait of depression, not really a skill, except when it comes to refusing to learn how.
  • Passive aggression against the self. When I make a mess in the kitchen and deliberately leave it for myself to clean up later, feeling too oppressed and overwhelmed in the present, I’m going to be angry at myself later.  The future me is going to be mad at the past me who left this mess behind.  Plus, the future me is going to feel hopeless and helpless, reconfirmed in the belief that I’ll never change and never catch up with life.

Depressed Treatment of the Body

  • The cycle of exhaustion/collapse. Your high standards and Inner Critic make you work far beyond what is reasonable; then you collapse and it takes weeks to recover.
  • Lack of exercise. Regular cardiovascular exercise—as little as a half hour 3 or 4 times a week—is now recognized to be an effective antidepressant.  When you’re depressed, it’s hard to get going, but make yourself start, and keep your goals small and doable.
  • Neglecting medical care/succumbing to quacks. Many depressed people haven’t seen their medical doctor in years.  Their condition could be complicated by all kinds of physical factors, but they don’t take the trouble to find out.
  • Emotional eating—stuffing your feelings with food, using food as a comfort or companion.
  • Abuse of drugs and alcohol.

These give very brief relief but they run the risk of physical dependence and make us feel weaker and less in control.

All of these ways of neglecting or abusing our physical selves are skills of depression in the sense that they keep us from having to face reality.  They are direct expressions of our belief that we don’t deserve to be treated well.

Depression is the replacement of parts of the self that are natural, spontaneous, and honest with these self-destructive skills.  It’s the loss of parts of the self, the gradual numbing of feelings and experiences that we gradually come to believe are unacceptable, and banish from experience.  Cure comes from recovery of the missing pieces.  According to Alice Miller, “The true opposite of depression is not gaiety or absence of pain, but vitality:  the freedom to experience spontaneous feelings.” The ability to experience the full range of human feelings in response to what’s happening to you—to be joyful when good things happen, angry when your toes are stepped on, sad when you’re disappointed, warm and loving with your family—instead of the dull gray curtain that separates the depressive from reality.

As patients learn from their experiences in psychotherapy and in real life that the breakthrough of suppressed emotions, however painful or upsetting, can be counted on to lift depression, they begin to change how they handle feelings.  Specifically, painful or upsetting feelings are no longer avoided, but experienced.

This leads to a re-connection with the lost parts of the self, a reintegration, and recovery.  Now that we know that destructive emotional habits are learned and are mediated by new connections in the brain, we also understand that we can unlearn these habits and replace them with healthier ways of living.  And through practice, these new skills that may seem self-conscious at first, become etched in our nervous systems, parts of ourselves.