Is It Grief or Depression? A Terminal Illness Can Lead to Both

Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone.” – Fred Rogers

Learning that you have a terminal illness is a terrible blow. Almost everyone experiences a host of difficult emotions, including sadness, anger, shock and disbelief. The sense of loss is deep and pervasive. Even if you are still feeling relatively well, if you’re like most people, you can’t help but anticipate the day when you no longer will.

And that anticipation leads to grief.

Grieving a terminal diagnosis is normal and expected. Whether the news came as a complete shock or was more or less anticipated, knowing that your life will be cut short is a reason — perhaps one of the best reasons — to grieve. After all, what more is there to lose than yourself? Even if you are a firm believer in an afterlife, death still marks the end of your life on this earth and your relationship to everything you hold dear. It means saying goodbye to the people you love. Even worse, it means leaving the people you love behind and knowing how much they will hurt when you are gone.

When you are seriously ill, you also grieve the loss of your health and vitality — the loss of your ability to do the things that have given your life meaning or joy. Illness and frailty limit our choices — life contracts to the point where it can seem that suffering is all that’s left.

Grief is a response to all of this and more.

Grief  Versus Depression

There is a difference, however, between grief and depression. They may look alike on the surface. Grief and depression both manifest in many of the same ways — lack of appetite, difficulty sleeping, difficulty concentrating, lack of energy, labile emotions, and more. But there are important differences too.

Grief is painful and distressing, but it is also dynamic —  even motivating. Certainly, some aspects of grieving are overwhelming. I have spoken to people who are grieving a terminal illness who say there are days when they can’t even get out of bed to brush their teeth. But there are also days, they say, when the knowledge that they are dying adds meaning and purpose to their lives.

“It’s a roller coaster,” says Marie, a 68-year-old woman with stage 4 breast cancer who has been told she has months to live. “It’s not one day at a time but one hour — sometimes one minute —  at a time,” she says. “I feel sad and lonely and mad as hell. There are times when I wake up in the middle of the night so scared I can hardly breathe,” she adds. “But then there are these amazing moments of incredible joy.”

Experts say that grief is about processing —  an adaptive response to the pain of loss. It includes a whole spectrum of emotions and reactions that tend to ebb and flow. But it almost always leaves room for connection and engagement and hope. Even in the midst of great physical suffering, most people who are dying are able to open up to the possibility of spiritual healing and take comfort from being around the people they love.

Depression, on the other hand, is spiritually depleting and physically enervating. People who are depressed often describe themselves as being stuck in a “black hole” where there is no light, no sense of purpose, and no hope. They suffer from feelings of worthlessness and helplessness. Typically, they feel both unlovable and unloved. Although we tend to conflate depression with sadness, it is much more common for people with depression to express very little emotion at all.

Why It Matters

It may seem that the difference between grief and depression is a semantic one. If each causes similar symptoms and psychological distress, why does it matter how we label what’s wrong?  “Isn’t it enough to know that I’m miserable?” you may ask. “I’m dying, after all!”

But the truth is, it does matter. And it matters because depression is a treatable illness that can profoundly affect a dying person’s quality of life. According to experts, major depression in a terminally ill person may lead to worsened physical symptoms, poor pain control, disrupted relationships, and a shorter life expectancy. Perhaps most importantly,  it can interfere with the person’s ability to find meaning and comfort as their life comes to an end.

If you are living with a terminal illness and are experiencing symptoms of depression, talk to your doctor about how you feel. This is especially important if you are having thoughts of suicide, which is a very real concern in people who are terminally ill. Your doctor may reassure you that what you’re feeling is normal and encourage you to talk with your loved ones, join a support group, or both. But they can also refer you for psychological counseling or prescribe medication that can lessen your symptoms and allow the rest of your life to be as fulfilling and joyful as it can possibly be.

About Kathleen

Each month Kathleen Clohessy, R.N., offers a new perspective on living with a terminal illness. Kathleen comes to SevenPonds with 25 years of experience as a registered nurse caring for families and children facing a life-threatening illness. She began her career in the Pediatric Intensive Care Unit at Nassau County Medical Center in New York. After relocating to California, she spent 15 years as an R.N. and Assistant Nurse Manager at the Pediatric Oncology & Bone Marrow Transplant Unit at Lucille Salter Packard Children’s Hospital at Stanford. She uses her knowledge and expertise to enlighten our readers about the challenges associated with chronic illness and its effects on family relationships.