When Robin Williams died in August, it seemed the whole world grieved. How could such a talented, funny man with so many admirers and friends take his own life? Much media analysis focused on the fact that depression afflicts millions, regardless of their social status or success. To boot, people in the comedy business have a particularly high rate of depression. The sad clown makes everyone laugh to keep himself from crying.
I read a lot of cancer blogs where the emotional aftermath is a continuous theme. It can be difficult to sort out the differences and overlaps between depression, grief and trauma. They may come about together, and they may also disguise each other, and the trick to getting help is to first know what is going on.
I’m no expert on these subjects but I have delved into them and have some thoughts.
My cancer doctors are alert to the potential for a patient to have emotional distress. Consistently, they have asked how I am doing and have cared. Yet oncologists are not therapists. I recall one conversation with my radiology doctor. I told her how blue I was feeling and she offered to write me an anti-depressant prescription. I said: “no, I’m not depressed. I don’t need that. I’m tired and I need to rest.” Someone else might have taken the RX which might have just covered over what was really at play.
I feel fortunate that I’ve never had a major depression. The chemo drugs themselves can bring on or exacerbate an underlying depression, and since millions of people are predisposed, depression is a common side effect of cancer.
My understanding is that depression has largely to do with brain chemistry. It may coincide with sad events and trauma. And it may plague someone like Robin Williams whose life appears good on the outside. Depression is described as a feeling that one is stuck in a dark pit unable to get out.
Grief is not so passive. It comes from loss. Someone died, someone walked out on us, a career was lost. Something we wanted that could have been wonderful fell apart, maybe all at once or over time. Grief is abject sorrow. It is not linear. It can crop up even long after an event has passed.
Trauma, it seems, goes hand-in-hand with grief. Trauma has to do with fear and rage and all sorts of other feelings – maybe even guilt – stemming from an assault of some sort, something we had no control over and feel we cannot keep from experiencing again. Someone who’s been through a war feels post-traumatic stress, with fear of a recurrence, and also grief over the many losses.
I conclude that cancer patients and survivors may suffer a trio of trauma, grief and depression in various combinations. The news that one has a life threatening disease is a trauma unto itself, followed by the medical trauma of surgery and drug regimens. There is grief over the loss or disfigurement of body parts and grief over the loss of confidence in one’s own good health. Add in cancer drugs that mess with hormones and brain chemistry, and one can also become depressed, feeling helplessness and futility.
Well after I finished cancer treatment, I felt surges of grief. I recognized grief from the many times I’ve experienced it before. It was not passive. I was not immobilized as I might have been had I been depressed. What I didn’t know right away was that grief was coming with a flare up of post-traumatic stress.
Coincidentally, about this time, an acquaintance sent me an offer for her services. She describes herself as a grief specialist though she seems to have little psychological training. She seemed well-grounded, and I asked for a series of grief work sessions with her.
Turns out she did not really understand what I was going through. She had her own agenda for our sessions. She wanted to spend my time “teaching” me to meditate, despite my telling her I already had a background in meditation. Then when I confided some disturbing, highly symbolic dreams, she took them almost literally and decided that we would do shamanic “dream work” to develop a “new story” about my past, ignoring my repeated comments that we had not yet delved into my past. She claimed I was “stuck” in a “story” about a long-ago part of my life, and that’s what I needed to focus on with her. Only it wasn’t really my story and it was not what I needed to address.
It took me about a month to realize that this was not a good place for me to work on my grief, that I was also suffering from trauma, and that this counselor was out of her league in dealing with post-traumatic stress. When I said I wanted to go work instead with someone who does trauma work, she did not let go gracefully. She accused me of not being a good communicator and causing all my own problems in life.
I tell this tale because it underscores the need to find the right kind of therapy and therapist. Especially when one is vulnerable from having survived a great trauma, one needs to work with someone who is psychologically trained and, frankly, credentialed by a reputable academic institution. I know credentials don’t mean everything. But anyone can call themselves a grief counselor, and they may not accurately see what is going on with another person.
I went and worked with a trauma specialist using a technique called EMDR which has been found helpful for post-traumatic stress. I had a small number of sessions with her, addressing what I went through in childhood, cancer diagnosis and other traumatic events. After just a few sessions, she told me to come back as needed, and that I would be the judge of what I needed and when. It was good therapy.
When looking for a counselor or therapist, it’s key to listen very well to what’s going on in the session. Is it your own story being told? Or does the counselor seem to have her own agenda and assumptions? Listen for your own voice in every interaction, and if yours is not the predominant voice being heard, it’s time to find a place where it will be.