When Grief Doesn’t Seem to End: Understanding the Difference Between Grief, Depression and Anxiety following Miscarriage and Infant Loss
Losing a baby during pregnancy or shortly after birth is an experience parents have little preparation for. The grief that follows is uncharted territory. Parents can feel blindsided as the hopes and dreams they had for their baby vanish even before there is a dirty diaper to change. The rituals of funerals and memorial services which help us heal and honor other loved ones who die often seem unavailable for babies lost early in pregnancy. Miscarriage can be an invisible loss – even family members or close friends might not have known of the pregnancy. Physically, women experience post-partum hormonal changes that impact emotional functioning. Culturally, we typically spend very little time talking about the physical, spiritual and emotional impact of miscarriage and infant death. In this complex aftermath of loss, it can be difficult for mothers, fathers and the loved ones supporting them to discern the difference between normal and healthy grief processes and grief that develops into more serious depression or anxiety.
Normal grief is a bit of a misnomer – there are many ways to grieve well and most times mothers and fathers grieve differently. Individual characteristics such as introversion and extroversion, communication style, family values and cultural traditions all impact the ways we process death. At the same time, there are several characteristics of typical grief that are common even among a variety of grieving styles:
- Overwhelming sadness
- Changes in appetite
- Increase or decrease in sleep
- Feelings of shock, numbness, anger, frustration, acceptance, denial
- Painful feelings coming in waves
- Difficult completing daily tasks such as showering, caring for a household and meal preparation
Older research on grief processes suggested grief was experienced in stages – a progression from denial, anger, bargaining, depression and acceptance. What we know now is that most people experience grief as a tangled web of emotions with overlapping and even conflicting thoughts and feelings. Feelings of jealousy around other new moms might be overcome one day only to show up again later down the road. This process is normal. As time passes and parents continually work to find meaning in their experiences and honor their lost baby, the waves of grief become more infrequent and a new status quo is established. However, it is not uncommon for parents to experience difficult emotions even years after a loss.
Grief and Clinical Depression
Many symptoms of grief and depression are the same – overwhelming sadness, appetite and sleep changes, and feelings of hopelessness. And, during the initial days and weeks of grief, differences are minimal. Clinical depression develops when almost constant feelings of hopelessness, sadness and significant disruptions in daily functioning persist past two to four weeks. This time frame is a guideline. While grief can be intense even past four weeks, by that point, most people have ever increasing moments where grief moves to the sideline of day to day activities. Depression, on the other hand, is characterized by global feelings of worthlessness, lack of interest in previously enjoyable activities and, at times, suicidal thoughts. While thoughts of wanting to be with a lost baby are part of normal grief, thoughts and plans of ending one’s life are not. Individuals experiencing depression describe feeling as if they are slogging through wet cement or are constantly in a fog.
Grief and Anxiety
Anxiety and fear are also normal components of grief. Like depression, feelings of anxiety become more concerning when they increase in frequency, intensity and generalize beyond context of miscarriage and pregnancy. For example, fears of a subsequent miscarriage are normal while panic attacks and worries about the safety of living children are more consistent with an anxiety disorder. Additional symptoms include increased irritability, paranoid thinking (i.e. wondering if a sleeping child is still alive), and increased worry that negatively impacts daily activities and responsibilities. Often racing thoughts can occur without our realization. In cases where thoughts race beneath the surface, muscle tension, insomnia, stomach pain and other physical symptoms might be the only signs of underlying anxiety. The development of rituals or checking behaviors to minimize emotional distress can also occur. These symptoms are consistent with OCD (obsessive compulsive disorder), another type of anxiety disorder. Even post-traumatic stress disorder can develop when women perceive a part of their loss experience as traumatic.
Hope and Healing
Grief is difficult under the best circumstances and the addition of a depression or anxiety disorder can be debilitating. Yet, these struggles do not have to be the end of your story. If any of these symptoms match your experiences or those of someone you love, start by talking. Acknowledge what is going on and ask for help. Talking to your doctor or other health care professional is important. They can offer both medical and professional supports (i.e. counseling) who can help you find the courage to face your grief well. Identify a friend whom you can call when you need a distraction or encouragement to put one foot in front of the other. Let them carry hope for you when you cannot. Return to hobbies and activities you enjoy even if you don’t “feel” like it. Find scriptures which illustrate God’s promises of comfort, hope and faithfulness to the broken hearted. Place them around so you can easily read them when you are in the midst of grief, depression and anxiety. Pray with painful honesty. Slowly, one step at a time, by God’s grace, you will find a way to heal and live the hope filled life in front of you.