Tackling depression among the bereaved

"Is there a therapy that would assist with speedy healing following sudden death of a loved one? My nephew lost a spouse and risks running into depression. We have tried talking to him about the loss but nothing seems to work"

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On the day President Jomo Kenyatta died back in 1978, I was a young student of psychiatry in London. As the news of the demise of Mzee was being communicated to me, a middle-aged woman was in tears crying over the death of her recently departed companion, a cat.

I did not, at the time understand how the death of a cat could have caused so much distress to a human being. At the time, her loss compared to mine were in my view like day and night. Hers small, mine life changing. I was wrong. Both of us had suffered great loss.

Many years later a lady I knew well run over her cat with her car. For months, she was devastated, and it took many months of therapy to get her back on her feet. The lesson for me here is that the significance of the loss is at the centre of the grief reaction. Jomo was important to me, the felines were important to the two women.

One of the most remarkable facts about the grief reaction is that we share the experience of grief with some animals, most notably elephant. It has long been known that elephants have a way in which they mourn their dead sometimes by visits to the place where death took place.

In his celebrated 1917 paper, Sigmund Freud, wrote on the subject of “Mourning and Melancholia”, in which he discussed at great length the differences and similarities between the two. In essence, mourning is over the death of a loved one, and melancholia the reaction to an unconscious loss. Complicated?

Freuds’ debate continues to rage to this day and experts are yet to agree on such basic questions as to whether one can diagnose depression in a person who has been bereaved or not.

Other seemingly easy questions without ready answers are how long a normal grief reaction may be said to last.

Most experts are, however, agreed that a very intense period of grief that interferes with normal life can be considered as a mental illness. Most are also agreed that the mourning process is mostly individual and is often coloured by many factors, including the relationship with the dead.

Following death of her husband, we saw a lady who was severely depressed. At first, she experienced great relief, or even happiness. He had for the 20 years of their marriage abused her physically and emotionally, and as she told us in therapy, she had scars all over her body from beatings.

Her prayers for a way out of this world of marital torture had received a dramatic and favourable answer. Sadly, she did not enjoy this newfound freedom for long. Guilt soon set in. It was indeed a very complicated situation for her.

The freedom she now had become the chains that bound her to the past and the prayers she had so often prayed came to haunt her. She felt as though she had sinned through prayer.

Some people who care for loved ones for years also find themselves in similar predicaments. To see a loved one suffer any terminal disease often leads one to wish death to take them away from the pain.

After all the Bible tells us that “In heaven, we will feel no pain, no sorrow, and there will be no death”. As soon as the prayer is answered, guilt sets in. Did I do enough to take care of my loved one or did I let them die so that I can enjoy life?

By way of conclusion, and to address the matter of your nephew, take note that grieving is mostly individual, but most people go through the typical stages of denial (that death has taken place and is not reversible), anger (that God/doctors let it happen), bargaining (that if my loved one comes back I will love them more), depression (as described by Freud), and finally, acceptance (of the reality and finality of death as a way of life).

So, where in this process is your nephew and what is the extent of the impairment to his life has, he experienced?

Many experts opine that normal grief can go on for up to a year and that one does not have to do anything actively until then.

One must be careful with this view. For example, one who is a threat to their own life due to either self-neglect, or suicidal, medical expert opinion must be obtained.

In this spectrum where is your nephew? If in doubt consult a mental health expert.