Stressful Contexts for Turning Grief into Depression:Part II Is It Mourning or Is It Depression? by Mark Gorkin Part I of this series, "Good Grief:Is it Mourning or Is It Depression?" (Stress Doc Newsletter, APR 2000, No. 1, Sect. 2) examined the fine line and conceptual confusions between grief and mood disorder. The essay also outlined the stages of grief. In the past two years, based on my workshops with reorganized and unemployed professionals in career transition, here are seven bio-psychosocial dynamics and role contexts that may help differentiate natural grief from morbid melancholy. While mostly compiled with workshop students in mind -- many of who are refugees from the volatile engineering and high tech fields -- it's clear the distinguishing factors deepen and darken an array of loss and grief encounters. This listing also provides depression-warning signs; more than just grief clouds are in the picture. 1. Sleeping on the Job. One vulnerable group is high tech employees caught up in the mercurial, "24/7" IT work environment, especially those who literally stay at work around the clock. Not only are these folks exhausted from the hours and demands, but too many truly don't have a life. Friends and family, relaxation and recreation are forever on the back burner. And when suddenly informed that their contract is over or the project is completed and services are no longer needed...talk about an implosion. Now exposed on the front burner is the beleaguered employee's burnout process, which has been simmering and eroding from within. There's no spare energy and emotional resources to withstand the termination blow. Not to mention the sense of injustice and outrage:"How can you make me a sacrificial lamb after all I've given to the company, after all I've sacrificed in my life for you." (As we indicated earlier, burnout is less a sign of failure and more that you have given yourself away.) Often the most important lesson of this burnout-depression trauma is that, "Life Is Not Fair." Ultimately, we must learn to stand up for our psychological integrity and physical health. If we don't, the risk is predictable: the line between grief and depression can be too readily burnt into oblivion. 2. Breakup of a Marriage. Being confronted with an additional major trauma, for example, both losing a job and the dissolution of a key relationship, will also grease the grief to depression track. For years research has shown that the more change-related stress's experienced in a time-limited period, the greater likelihood of some physical illness or mental disturbance. Not just layoff or downsizing but even positive changes such as a promotion can heighten stress: higher performance expectations, new authority roles or collegial relations, etc. Too much change, too fast can induce a feeling of being overwhelmed, a feeling of being out of control - "future shock." And if these vulnerable feelings persist, the shaky/quicksand ground can quickly turn from "The Big Muddy" to having you trapped in "The Big Moody." 3. Past Traumatic Loss Experiences. One of the consequences of prolonged or sharply acute stress is a wearing down or the sudden snapping of our psychological defenses. These defenses keep memories of painful events and the concomitant disturbing emotions out of everyday consciousness. When cracks develop in your defensive armor brought on by the stress of loss or separation (such as losing a job or mate) then past associations to previous losses, abandonment's, rejections get stirred. Now a judgmental boss in the present starts more consciously reminding you of a former harsh supervisor, or perhaps a critical parent or a devaluing spouse. Especially if these past hurts and humiliations have not been sufficiently and successfully grappled with and grieved emotionally the result, again, is a depression predisposing mourning process. 4. Battered Employee/Spouse Syndrome. Sometimes an employee (or spouse) who has been subjected to a pattern of verbal and emotional trauma (not to mention physical abuse) does not know how to set limits and fight back, or does not believe that leaving the abusive scene is an option. This person is definitely vulnerable to helplessness, worthlessness and passivity. In the work setting, when management does not believe they can force out an employee, or they don't want to directly fire the person for fear of legal consequences...an insidious game may ensue. The targeted individual may be subjected to subtle forms of hostility by management or by a management surrogate. Perhaps management tolerates or ignores the baiting of the employee by colleagues. Even when the harassment seemingly isn't blatant it can be a legal issue if management should have known about the harassment and interceded. However, taking companies to court still can be another "holy grail" quest. Any of the above scenarios can break down an individual's will, spirit and health. And when an embattled employee hangs on trying to fight the system without sufficient financial and legal resources, the result, too often, is a greater deterioration of his or her physical and mental states. Once the proverbial backbreaking straw event occurs through trumped up dismissal, outsourcing or from the employee finally giving up the fight the endgame is predictable. Now grief is overwhelmed by "battle fatigue. A number of the working wounded collapse in a heap of depression. 5. Illusion of Security and Age Anxiety. In a rapidly changing, paradigmatic shifting economy - from the industrial to the informational/high technical - all folks but, ironically, many early computer trained or science degreed professionals may find themselves frighteningly out of date. Having created a seemingly secure position, for example, evolving mainframe expertise, once laid off these professionals suddenly feel like they've been dropped off on the moon. Compared to when they were last doing job exploration, the current IT field, gravity and atmosphere is so profoundly different. It literally is a shock. First there are the unanswered telephone calls and resumes mysteriously lost in the job listings black hole. Then there's the constant refrain:"You need to upgrade your skills and certifications." Of course, this scenario is a bit less daunting than the one for a basically middle aged computer virgin; just the thought of becoming computer literate can throw such an individual in a phobic or panic state. And, not surprisingly, age is a significant job/career factor even for those not technophobic. Frequently, a number of old timers in the computer field or (or post-40 year old newbies to IT) bemoan age discrimination in what's increasingly perceived as a Gen X run world. Once again, when psychological, educational and socioeconomic forces are conspiring against you (or are perceived as such) the boundary line quickly dissolves between grief and depression. 6. Multiply Downsized. A particularly at-risk individual is the member of the increasingly large horde known as the "Multiply Downsized."This creature is fen found in the engineering, aerospace and rapid startup-rapid fold IT industries, as well as in an array of government agencies. After awhile it appears this employee's main mission is as a statistical artifact in a restructuring process. Of course, some folks who have survived several layoffs or downsizings develop a thick skin - "been there, done that."Their transitional radar is finely honed and now the battle veterans know to jump ship before it crashes into the restructuring iceberg. However, the almost universally vulnerable employee is the one who has left a hometown. Of course he just hasn't left home. He has also sold the house, said good-bye to family and friends, moved alone or with family to a new section of the country for a "great opportunity"...and within six months the promised land/position has disappeared once again in the disorganizational black hole. This hole is more than unsettling; it's particularly dark and bleak. In fact, the person may not have fully grieved a previous downsizing (whether as organizational outcast or survivor) and may have been on the edge of depression before the latest transitional trigger. 7. Addictive Patterns and Depressive Propensities. Finally, two other classes of individuals susceptible for pathological grief are people: a) who routinely use addictive behavior - drinking, drugging, smoking, eating, cybersexing or "romantasy" obsessing," gambling, etc. - to avoid or numb painful emotions and difficult problems. This medical illness and/or escapist defense mechanism not only can be inherently toxic (for example, when abusing substances) but it impedes the chance for developing and shaping cognitive-affective muscles. Psychosocial maturation is retarded by a pattern of avoiding analytic, emotional and interpersonal problem- solving. Invariably, an addiction process which may have blocked out existing depressive signs and bottled-up rage, or numbed low self-esteem, etc., is no longer able to shut out or deny the "no exit" separation trauma. You have to deal somehow with the loss crisis. (I suppose a deadly overdose is a tragic exception.) Psychological defenses and addictive escapes, as well as the grief process itself, are overwhelmed. Massive depression, psychiatric breakdown or withdrawal may quickly ensue, and b) with a genetic/family predisposition to clinical depression who are not receiving proper medical/psychiatric treatment. These folks tend to be acutely sensitive to loss, emptiness and abandonment, to shame, humiliation and rejection. A history of having difficulty directing and sustaining energy and attention, seemingly a lifetime of self-doubt, feeling like an impostor, procrastinating, not completing projects or meeting goals, running from commitments, etc., all obviously shed light on the aforementioned sensitivity and vulnerability. Again, the boundary between grief and depression most likely has rarely been demarcated. So for significant numbers there's a progression from grief to depression and, finally, with enough adversity and unending stress, the possibility of further descent into overt clinical depression. Obviously, when there is a genetic predisposition, the contributing factor to a mood disorder is not just external or environmental. However, it's also true that chronic stress, untreated burnout or a prolonged and morbid grief process can either: a) bring out a latent genetic predisposition to depression or b) can adversely impact the workings of our biochemical and hormonal systems so that even as adults, without clear family history, a clinical depressive disorder can gradually build then "suddenly" emerge full blown. Clearly, a multi-pronged bio-psychosocial intervention is necessary for confronting major loss, for tackling comprehensively situational or clinical depression. The intervention goal is to help the wounded individual gain the emotional stamina to embrace and evolve through the natural grief process. Some combination of individual grief counseling, support group, couple counseling or family therapy, medication, exercise, relaxation or meditation, diet, assertiveness training and career counseling or retraining may well be needed. My personal recovery motto is not for the faint of heart: For the phoenix to rise from the ashes One must know the pain To transform the fire to burning desire! Closing Strategy Finally, here's a closing strategy for confronting loss and grief as well as situational and/or clinical depression. And the source of the inspiration shifts from the poetic to the alphabetic. By understanding the dynamics of distress, burnout, grief and depression and by applying "Practice Safe Stress" tools and techniques every day you will, for once, be proud to have earned an "F"...actually, six of them. May you successfully engage the path of "The Six 'F's of Loss and Change": Mark Gorkin, LICSW, known as "The Stress Doc," is the Internet's and America Online's "Online Psycho humorist" (TM). An experienced psychotherapist, The Doc is a nationally recognized speaker, and training and OD consultant specializing in Stress, Anger Management, Reorganizational Change, Team Building and HUMOR! His writings are syndicated by iSyndicate.com and appear in a wide variety of online and off-line forums and publications, including AOL's Online Psych and Business Know How, Mental Health Net, Financial Services Journal Online, Paradigm Magazine and Counseling Today. Check out his USA Today Online "Hotsite" Website-- www.stressdoc.com. For info on his workshops or for his free newsletter, email stressdoc@aol.com or call 202-232-8662. Spring 2000, look for Practicing Safe Stress with the Stress Doc:Survival Skills from the Online Psychohumorist, published byAdviceZone.com.