Over the past several weeks a series of patients have presented in which the distinction between mourning and major depressive disorder was required in order to properly inform treatment decisions. The mourning period length shows much individual variation but is almost always completed in five or six months. Mourning is regularly triggered by the loss of a loved person or some abstraction such as freedom, a meaningful goal, health etc. The work of mourning is carried out piecemeal. The memories of the lost person are recalled and appropriate emotions are experienced around those recollections, piece by piece. When complete, they are assembled like a jigsaw puzzle and can be put away on a shelf. If the mourning period exceeds five or six months, then mourning needs to be distinguished from depression to make correct treatment decisions.
What are some of the factors that help to distinguish mourning from depression? The feeling state in mourning is one of loss or emptiness which washes over the person in waves whereas in depression there is a more persistent painful dejection, lowering of self-regard, and expressions of self-reproach, self-reviling, and inability to experience happiness, loss of capacity to love or experience pleasure. In mourning there are intervening periods of happiness or even humor and self esteem is usually preserved. This is not so in depression. If depression is present in mourning, it is usually centered on the departed and possiblly joining him/her. In depression those thoughts are focused on taking one's own life because of the painful lowering of self-esteem.