Is Grief a Mental Illness?

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For the majority of us, grief is an inevitability. 

If you have ever experienced grief, you may be familiar with questioning your own sanity… ‘Did I just fleetingly see my loved one wade through a crowded street?’

In some circumstances it can even result in us questioning our own reason for living. Whilst disturbing, these thoughts usually diminish over time, becoming less consuming and intense. However, sometimes these thoughts can pass the line into pathology, wherein treatment may be required to help alleviate and remove the developing problems. 

Pathological grief disorder (PGD) is a condition which is a fairly new addition to what has been dubbed the ‘bible’ of psychiatric disorders – referred to as the Diagnostic and Statistical Manual of Mental Disorders (DSM). This disorder is commonly known as traumatic or prolonged grief, wherein it typically lasts for longer than six months. However, the addition of the disorder to the DSM has been a fairly controversial one. The reason for this being because it allows for medical treatment of grief related depression within the first few weeks following a bereavement. Diagnosing someone with depression so quickly after a significantly traumatic event is, in my opinion, not the correct decision. 

Grief is a natural response the naturally diminishes over time. This is particularly pertinent to individuals who believe the ‘strong’ and ‘stable’ approach for other family members following a fatality – primarily being men. In 2017, Prince William discussed the destructive nature of the ‘stiff upper lip’ mentality, admitting that it had taken a devastating toll following the death of his mother, Princess Dianna. Thus, relying on medication to potentially numb the emotion of someone in grieving may only exacerbate the issue, especially when the medication is eventually withdrawn. If that was me, I would probably start to believe that prescription drugs were the essential crux for any potential happiness. Whereas in actuality, any recurring negative emotions would have likely reemerged due to not having sufficient time to process the death prior to pharmaceutical intervention.

Whilst immediate medication is not advised, it is crucial to identify signs of chronic psychological distress following a bereavement. Here are a few PGD symptoms to be aware of:

  1. Concentrating on little else apart from the deceased loved one
  2. Extreme focus on reminders of the loved one or excessive avoidance of reminders
  3. Intense believing that life has no meaning
  4. Inability to enjoy life or reminiscence on positive experiences with the loved one. 
  5. Wishing to die to be with the loved one.

Pathological mourning is not a new concept, with publications discussing its commonality and treatment options in the 1980s. The primary problem is that the DSM does not discriminate PGD from intense ‘normal’ grief, thus likely yielding huge false-positive diagnoses from psychiatrists. This is likely to cause additional stress to an already vulnerable individual.

A major reason for this is because the signs between PGD and ‘normal’ grief are practically identical. However, in PGD the symptoms are considerably more prolonged, debilitating and intense. Numbness and detachment can last for over six months, and perhaps extend considerably longer. It is in considerable contrast to feeling sensitive after being exposed to emotional triggers of that loved one – for example, videos and photos or anniversaries.

Nevertheless, ignoring any type of grief is potentially an extremely hazardous choice. The severe consequences of losing a loved one can, without intervention, manifest in post-traumatic stress disorder (PTSD). Whilst primarily associated with individuals who have worked within the military, PTSD is common amongst various groups, including the bereaved. A recent study looked into the rates of PTSD in 132 people who had lost a close relative due to cancer. Strikingly, at one month 30% of the volunteers were rated as having PTSD, with another 26% displaying pre-clinical signs of the disorder.

Interventions for pathological grief disorder

Because the diagnostic criteria for PGD is lacking, many suffers are instead diagnosed with major depressive disorder and are ‘treated’ with antidepressants. Whilst this is sometimes beneficial for the patient, evidence is lacking as to whether this is successful for PGD sufferers. 

On the other hand, grief counselling is available. Therapists for this type of support are widely knowledgeable and understand that each experience of grief is entirely unique, complex and emotional. Your culture, personality and individual experience will all affect the grieving process. A ‘one size fits all’ approach in terms of medication is unlikely to help the majoring of us. Grief counsellors on the other hand will intricately tailor treatment to meet your specific needs. 

I would strongly recommending reading about grief counselling if you believe there is a loved one who requires it. Communication with health professionals (alongside loved ones) is absolutely crucial for healing and recovery. Unfortunately, grief is a normal and upsetting part of life. Instead of immediately jumping towards medication as a potentially damaging crutch, take the right initial steps following a bereavement: Emote and communicate with friends and family. But remember, never be ashamed to seek guidance and support if you think you need to. 

Social anxiety and loneliness.

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Image: Pixabay.com

Fear, noun: an unpleasant emotion caused by the threat of danger, pain, or harm. 

Does that sound familiar to you and your experiences? Perhaps it may. Anxiety is often coined to be a particular type of persisting fear, wherein we worry about potential future outcomes associated with specific events. In fact, the way we feel when either frightened or anxious are extraordinarily similar, because the basic emotion for both remains the same. So, despite not being in any immediate danger, anxiousness can result in similar symptoms to that of fear: increased heart rate, feelings of sickness and/or dizziness, and a loss of appetite. For many, new social situations can be a common trigger of these symptoms, often termed as social anxiety. 

Social anxiety: what is it?

Also labelled as social phobia, social anxiety presents itself as a long-lasting fear of being humiliated or scrutinised by others. It is sometimes (and incorrectly) compared to general shyness. However, whilst shyness often manifests for many prior to an unfamiliar situation, this usually dissipates following exposure to the new social situation. This is not the case for social anxiety. The latter often manifests during adolescence, when the opinions of friends and peers become increasingly important. This impairment can continue into adulthood, wreaking havoc on a wide variety of important life events. Separating social anxiety symptoms from those of general shyness is thus essential before discussing management and treatment options. 

The symptoms

Symptoms of social anxiety (as with any form of anxious behaviour) can be wide ranging, and it is unlikely that any one individual would experience them all. All anxiety disorders can be associated with the symptoms mentioned previously. However, common identifiers for social anxiety usually include the feeling of dreading everyday activities, such as starting up conversations with strangers, speaking on the phone to unfamiliar people, or even going into work. As a consequence, social anxiety can result in the avoidance of many social activities such as eating out or going to parties.

Can social anxiety effect my health? 

Because of the primal need for social interaction between humans, the consequences of social isolation on both physical and emotional health can be catastrophic. A recent meta-analysis – a statistical approach which combines data from multiple studies – identified that a lack of social connections can heighten health risks as much as smoking fifteen cigarettes a day or having an alcohol consumption disorder. The analysis suggested that social isolation can significantly increase the risk of premature mortality, with the magnitude of risk exceeding that of other common leading health threats. A recent study in 2019 analysed the data from more than 580,000 adults, finding that social isolation increases premature death risk for every race.

The negative impact on both mental and cognitive health is also apparent. Evidence supports a link between social isolation and adverse health effects including poor sleep quality, depression and accelerated cognitive decline, the latter of which is associated with problems in memory, language and judgement. A 2018 study also discovered a clear association between loneliness and dementia, increasing a person’s risk of developing the latter by up to forty percent. Examining data from more than 12,000 U.S. adults aged fifty or older, participants rated their loneliness and social isolation alongside completing a battery of cognitive tests every two years for up to ten years. 

Do you think this applies to you?

As reported by a 2018 survey, loneliness levels have reached an all-time high. Of the 20,000 U.S. adults approached, nearly half reported feeling alone, with the youngest generation being the loneliest of all. However, isolation is also well characterised in the elderly. According to Age UK, over two million people in England over the age of 75 live alone, with over one million stating that they go for over a month without conversing with a friend, neighbour or family member10. 

It is essential to determine whether social anxiety and/or loneliness applies to either yourself or a loved one, and then take appropriate action. It is important to try and communicate with friends and family where possible. However if this is hindered, it is imperative to seek out advice from a qualified medical professional. 

The Tale of the Academic Black Dog.

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Image: Matej.

The idea that mental health issues are more common amongst university students has gained traction in recent years. Identifying this problem has led to the much-needed development of support systems for students whilst they study towards furthering their promising careers. However, psychological distress is running rampant at a much deeper level within our university culture, wherein the urgency cannot be understated. 

I am talking about the academics – the pillars of higher education. Yet, despite their obvious essentiality to students’ success, they are often overlooked by the people they teach. Comparatively to their students, research into the poor mental health of academics has received little attention, despite its clear importance. As with any individual, if you suffer in silence, understanding that you aren’t the only person with a seemingly unshakeable black dog can provide a form of release from some of the distress you may be feeling.

Acknowledge the Academic

During my undergraduate degree, I inevitably looked towards my lecturers as sources of extensive knowledge. I was always fascinated by their research and scientific interests. Yet, I never considered the amount of stress that they were likely under, and the personal impact associated with this. In many scenarios, the increasing workload of academics, alongside the lack of job security and the extensive demand to publish, has led to many academics suffering with some form of mental health disorder. A 2017 survey highlights this, wherein it was identified that 43% of academics (including senior and principal lecturers) exhibited symptoms of at least a mild mental health disorder1. This is nearly twice the level of prevalence in comparison to the general population. An Australian study further validates this, finding that the rate of mental illness amongst academic staff was up to four times higher2. 

Suffering with mental health difficulties will predictably hinder professional performance. Nevertheless, the support options available for academics remains rather limited. Many universities offer mental health services, but these are primarily aimed at students. Some services are available, such as the option to see an occupational nurse, but information regarding these services are often obscure and difficult to find.

The Stigma Survives

In 2014 a survey was carried out to determine the attitudes and experiences of students and staff surrounding mental health problems, which included the completion of a “stigma scale”. The study highlighted that “silence” surrounding mental health issues permeates throughout the university culture, impacting on help seeking behaviours alongside the support and recovery of affected individuals3. It is not surprising then, that only 6.7% of academic staff in the United Kingdom have ever opened up about a mental health condition4.

The Guardian online have a blog entitled Academics Anonymous, whereby academics can discuss work difficulties without disclosing their identity. One such post in 2015 suggested that HR departments within many universities remain unsympathetic and often fail to recognise a mental health disorder as a legitimate illness5. 

Overworked and Underpaid

Clearly more needs to be done to support our academics. Structural changes are desperately needed to address many of the factors associated with poor mental health, such as job security, pay and work load. Unfortunately, these changes are unlikely to happen quickly. The high costs of education put many institutions under extraordinary pressure to satisfy students and their parents with educational excellence, with this putting further stress on academics. In one example from 2017, some “overworked” lecturers at Queen Mary University London were caught sleeping in their offices overnight, before being threatened with disciplinary action6 – which would only result in further psychological distress.

Supportive Strategies

Like the work currently used to support the wellbeing of students, academics need more information surrounding mental health to help change their attitudes towards seeking support. One study emphasises the benefit of exercise, where academics were more likely to report lower levels of distress if they undertook 150 minutes of moderate to vigorous exercise per week1. Thus, the creation of physical activity options for staff, such as free exercise facilities and subsidised cycle to work schemes may provide some benefit.

Regardless of the strategies selected, we all need to be aware of the non-selective nature of mental illness. It affects men and women from all backgrounds, in all professions, and at all stages of life. We need to understand this before working together to provide strength and support when it comes to fighting back against mental illness. For students, I have previously written an article on the BPS blog talking about my personal experience of battling with mental illness whilst completing my PhD, which can be accessed here.

There is a heavy cost to getting a PhD that nobody talks about.

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Image: Tim Gouw

Embarking on a PhD is a journey of epic proportions. Initially filled with excitement and enthusiasm, students are compelled by the idea of pushing the frontiers of human knowledge.In time, this enthusiasm can fade. Devoting three to five years of your life to such a tiny subject niche has the ability to do that, even to the most devoted of individuals. Unfortunately, the long and winding road takes both a physical and psychological toll. Stress management will inescapably take centre stage, and your ability to manage it will be extensively tested.

In 2011, a study carried out by the University of Texas found that 43% of their graduate student participants reported experiencing more stress than they were able to handle, with PhD students expressing the highest levels. This likely explains the high attrition rate. In 2013, it was estimated that 30% of students who embark on a PhD in the UK leave university without finishing. This statistic was worse in North America, where in 2008, almost 50% of students left graduate school without their doctorate. However, research has shown that the majority of students who enter doctoral programs have the academic ability to successfully complete the degree. Therefore, it is likely that the culture of PhD programs are to blame.

My personal experience

I have suffered with depression for my entire adult life. Worryingly, the stigma surrounding the subject remains rampant. Enough so that it doesn’t come into the majority of people’s conversations unless a suspected suicide hits the news. In academia, the silence is even more deafening. For myself and many other PhD students, our thesis hovers over us like the sword of Damocles, even in supposed moments of rest.

For me, paranoia proliferates. I become so fixed on what my supervisory team think of me and my thesis progression that I sacrifice most of my outside interests. Now, I feel guilty when I take time off, regardless of how essential it is to avoid physical and mental exhaustion.

For a long time, I assumed that I was expected to maintain a false illusion of mental stability and confidence when interacting with others within the faculty. Not only emotionally taxing, it was isolating – something which is already an inevitability as a PhD student.

Further, none of my closest friends or family have been previously exposed to what a PhD entails. Of my immediate family, I am only one of two who went to university. Of course, they have been nothing but supportive.  But in the majority of cases, the advice they have provided has unfortunately fallen on deaf ears, and has sometimes further contributed to my anxiety.

Luckily for me, my supervisory team are fantastic. With their extensive support, providing advice through personal experience, they are helping me through the PhD process. But this isn’t the case for everyone. As an alternative, talking with other PhD students can also help alleviate mounting stress. For me, the latter has been the greatest way to help break the chains of isolation, as the more students I talk to, the more I began to realise that I am far from alone.

We need to break the silence

Why does the stigmatisation of mental health still exist, when approximately 1 in 4 people experience a mental health problem each year? Poor mental health within universities is an escalating problem. Not just because it affects how students learn, but it can also significantly contribute to whether students actually finish their degrees.

Disturbingly, in 2017 the All Party Parliamentary Group of Students found that 69% of students have felt depressed within an academic year, while 33% of students had experienced suicidal thoughts. The actual recorded suicide rate of students within higher education in England and Wales within 12 months ending in July 2017 was 4.7 deaths per 100,000 students, equating to 95 suicides. Although a relatively small number, this has increased on previous years.

Across the UK, universities are taking positive steps to help combat this growing problem. For example, the University of Bristol has spent £1 million on a new wellbeing service for students, following seven suicides within a six-month period. Such initiatives are to be welcomed, as are signs of coordinated leadership nationally, but much more still needs to be done. Hopefully raising awareness of students’ mental wellbeing, alongside emphasizing communication and increasing support can prevent the loss of life of more talented young people.

Keith Flint.

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Keith Flint, The Prodigy

Keith Flint.

In my opinion, the king of the misfits. I was introduced to The Prodigy when I was still in nappies. My brother has always mentioned to me that I used to dance around like I’d been possessed every time he played one of their records. Their influence on my life has stood the test of time. I have listened to the band practically every day for approximately twenty years. From ‘Music For The Jilted Generation’ and ‘The Fat Of The Land’ through to ‘Always Outnumbered, Never Outgunned’ and ‘Invaders Must Die’, their music has always been an instrumental part of my life, helping me pave my own path going forward. 

I remember seeing the Firestarter video when I was a kid. Keith wearing that oversized United States styled t-shirt. By societies standards, he was this freak. But to me, it helped me understand and conceptualise that being a bit different is more interesting and exciting than being like everyone else. That alternative look is probably why I never gave a shit about what others thought I looked like. Perhaps that is why when I grew my hair out to the point I looked like an unwashed willow tree, it still didn’t bother me.

As you may have now guessed, I was a fucking misfit in school. Alternative as hell, and not particularly liked as a consequence. Likely due to how weird I was… probably. When school became unbearable, music was both my defence and release. The Prodigy were the guys who topped that list. Often music that helped me lash out against the intolerable, it kept me focused on the bigger picture. As of right now, that focus has become slight overcast in shadow. Liam Howlett (Producer/Engineer of the band) has informed fans this afternoon that Keith killed himself. If I was in water, I think I would have sunk sixty feet. Keith, this enigma that I always considered to be larger than life, has now been engulfed by it. 

The best gigs I have ever had the pleasure to go to all had The Prodigy headlining the bill. Milton Keynes Bowl 2010, Brixton Academy 2012 and Creamfields 2013. All events that I will never forget. They have become pieces of my history which will inevitably shape my own future. The ‘we don’t give a shit’ attitude they repeatedly evoked towards negativity has been a driving force in my own life. The message helped stimulate movements to surround myself with people that actually matter, alongside changing and removing toxic parts of my life. Both of these actions helped to trigger movement onto the correct path for increasing my own self-worth and general happiness. You must think that I’m overexaggerating when I say that a band can have this ability, but they did. Re-listening to songs that I grew up with immediately induces memories. Happiness in some circumstances, and the feeling of growth in others. The latter particularly applies to the turbulent periods of my adolescence, wherein I would usually rinse either ‘Fat Of The Land’ or ‘Invaders Must Die’ on repeat if I had a shitty week. But that’s why it still invokes incredible emotions. It allows me to understand and accept just how far I have come, all the way back from starting out as an initially bullied, weird little kid, to now; wherein I am a successful young adult… and PROUDLY still a pretty fucking weird person.

Keith, you helped me pave my own way. I know the worth of being unique. I have embraced that, so thank you for being a core component to helping me identify and realise that fact. Rest in peace, you twisted instigator. 

If you haven’t really listened to The Prodigy before, please give some of their records a listen. If you wanted a top 10 list in terms of which songs impacted my life the most, I have left that below. I am sure that I’ll be listening to them over and over for another 20 years to come.

  1. Poison
  2. Voodoo People
  3. Breathe
  4. Firestarter
  5. Charly
  6. Their Law
  7. Serial Thrilla
  8. Diesel Power
  9. Smack My Bitch Up
  10. Out Of Space
  11. Bonus: Run With The Wolves

Untreated depression: It will damage your brain.

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Image: Kat Jayne

It is a scary prospect, but it is something that has accumulated serious momentum. From a scientific point of view, I have to admit I do find it fascinating. However, from a health perspective, this is rather worrying. The conclusions being drawn? Untreated depression may be causing brain degeneration.

Considering one in four people in the UK will experience a mental health problem each year, this might raise concern. It becomes even more alarming with the publication of a recent study highlighting that approximately 35% of people newly diagnosed with depression refused to seek treatment. Without professional help, how long can depression toxify and contaminate an individual’s identity? Easily an entire lifetime. Not seeking help for prolonged periods of sadness or emotional absence may not be just affecting your character, as was often thought for decades. 

The ‘all in the mind’ mentality is dead. The divide between physiology and psychology was clearly defined for many years. When patients were physically unwell – because of say, a broken bone or arthritis – any accompanying mental health instabilities were waived off. Depression often accompanied these ailments (and still does, of course), but the diagnostic significance of such was irrelevant. If a patient suffering from a chronic disorder like arthritis said they were depressed, the general consensus amongst medical practitioners was: ‘well you would be, wouldn’t you?’. The same conclusion was always drawn. The patient was simply depressed as a consequence of the pain associated with their arthritis, or their broken leg, and so forth. No real attention looked into the other potentiality; what if the depression causes physiological ailments? What if a psychological disturbance could be having serious negative effects on the body?

In the 21stcentury, the argument for this is strong. Chronic, untreated depression appears to have a degenerative effect on the brain, damaging it from the inside. Here I want to highlight some key pieces of research which link depression to neurodegeneration. The idea here is to help us all understand just how important seeking assistance might be if you think yourself or a loved one might be suffering from a chronic depressive episode. Trying out different methods to combat depression will be beneficial both for emotional stability and life fulfillment, but also for the health of our brains, too.

A major finding was published when discovering differences in the brain scans of depressed and non-depressed patients. Looking at cases of major (clinical diagnosis of chronic) depression which had lasted for more than a decade, the Centre for Addiction and Mental Health in Ontario, Canada identified that during episodes of major depression, the patients’ brains would show signs of inflammation. The study group identified that a key protein associated with the central nervous system (brain and spinal cord) inflammatory response was approximately 30% higher in the brains of people who lived with depression for more than a decade. However, this isn’t the only study to report such a finding. Another study published in 2016 looked at the whole-body levels of CRP (another biological marker of inflammation) in patients with depression and those without. The observational studyidentified that depressed individuals exhibited CRP levels more than 30% higher than those without depression.

The results presented here are startling, collectively indicating that we may need to change our thinking about depression and its effects. The evidence strongly affirms that depression truly is a biologically based disorder, rather than something that only exists in the field of psychology. But how does this link to degeneration of the brain?

Whilst inflammation is used to protect the body from infection amongst other functions, excessive inflammation can cause extensive cellular damage. Chronic inflammation within the brain has been linked to several destructive neurodegenerative diseases. One of which is Parkinson’s disease, which primarily manifests itself as a movement disorder, wherein patients begin to show signs of slowed movement (bradykinesia), until movement becomes practically impossible without medication. This primary symptom is caused by the destruction of neurons in the portion of the brain which is essential for movement. Unfortunately, there is currently no cure.

Whilst the contribution of inflammation to Parkinson’s disease does not appear to be the primary causation, in Alzheimer’s disease it may be a different story entirely. Alzheimer’s disease is the most common neurodegenerative disease in the world. In the United States alone, approximately 5.7 million peopleare currently suffering with the disease, which is primarily associated with progressive and severe memory loss. Again, there is currently no cure. Recent researchpublished in the Lancetnow appears to highlight neuroinflammation as a central cause of Alzheimer’s disease, with many otherstudies further supporting this idea.

Multiple lines of research therefore support the idea that ignoring a potential major depressive episode could have considerably devastating consequences for the long-term health of the brain. What can we do to fight back? Alongside seeking professional support, as little as 20 minutes of exercisecan reduce your bodily levels of inflammation. This is alongside the general health benefits of exercise, including reducing the risk of type 2 diabetes and cancer. Diet is the next big consideration. There are several foods which should be avoided due to their contribution towards inflammation, including red meat and refined carbohydrates. On the other hand, there are many foods which are considered to be anti-inflammatory, including green leafy vegetables such as spinach and kale, fatty fish like salmon, and a range of berries. A more exhaustive list of pro- and anti-inflammatory foods can be found here. Supporting this switch in diet, women whose diets include more foods which trigger inflammation and fewer foods which restrain inflammation have up to a 41% increased risk of being diagnosed with depressionthan those who mostly eat a less inflammatory diet.

Depression is a biological disorder and we all need to take this into consideration. Its link to inflammation and bodily damage cannot be underestimated, and it is something we must consider when either ourselves or a loved one is currently suffering a major depressive episode. If you are adamant about not seeing a professional (I highly advise you do, however), exercising more and switching up our diets may provide an answer that we desperately need.

A new year should never mean a new beginning.

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The new calendar year… a time associated with celebration yet often tainted with the thought of beginning anew. As January rolls in, many of us are overcome by feelings of starting over, in correlation with forgetting of the past. Whilst new year’s resolutions should often to be employed if you believe you have the ability to become a better person, trying to forget or ignore previous life experiences would be cheating yourself. Continue reading “A new year should never mean a new beginning.” →

Anxiety: How it links to our future.

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“After all, what is happiness? Love, they tell me. But love doesn’t bring and never has brought happiness. On the contrary, it’s a constant state of anxiety, a battlefield; it’s sleepless nights, asking ourselves all the time if we’re doing the right thing. Real love is composed of ecstasy and agony.”

― Paulo Coelho, The Witch of Portobello

This quote really stuck with me. Love is an incredible thing. Whether that feeling is for a significant other, or perhaps for work or even an environment, it is an emotional rollercoaster. You appreciate how fantastic that person/thing is. However, at the same time, it can cause a sense of worry and sadness. What happens if things change? How certain is the path that I currently walk on? What if change detrimentally alters my current position or relationships? Continue reading “Anxiety: How it links to our future.” →

It is time to crucify the self critic.

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Self-criticism. It can be one of the most disabling components of our psychological wellbeing. Unfortunately for most of us, we will always be our own worst-critic. Relationships, friendships, work progression; self-critical thoughts can make us second guess our ability and worth in all of these areas. Continue reading “It is time to crucify the self critic.” →

The disaster of getting inside your own head.

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I am sure we can all relate to this. Whether it’s insecurities which have built up as a direct consequence of our scrambled society, or perhaps due to previous exposer to a singular toxic perpetrator; self-criticism can cause undeniable havoc and internal conflict. The constant flux within our culture, alongside a concurrent addiction to unrealistic expectations has led to the manifestation of many young individuals feeling like they will never be good enough. Continue reading “The disaster of getting inside your own head.” →