This has been a dreary series for some, I’m sure, so thank you to all the readers who are stubborn enough to get through it with me. For others, you understand that death and grief are part of the human condition. It’s worth closer examination. Sometimes it even helps.

Last week as part of The Psych Writer series, we took a look at the fifth phase of grief: anger. This week, we examine depression.

Remember (and for regular readers, say it with me): these phases are organized for the benefit of the clinician. They are not set in stone and the patient will likely not feel these things in order, or one at a time. They might, but they might not. Grief is individualized.

As clinicians we have a bit of a conundrum on the use of the term “depression” here, because depression is a clinical diagnosis. It’s more than just feeling sad. Depression is an illness that is typically long-term, can be lifelong, and can be hazardous to the patient. Yet we use the term here because depression not only means feelings of sadness, but a patient can develop Major Depressive Disorder in this phase. Not only that, those who already have MDD can face a downturn in mood or behavior. In other words, grief can push them further down the spiral.

Basically, you’ve got a lot of shit to do in this phase, too.

Depression from the Patient’s POV
Life is empty and pointless without X, where X is the source of loss. This is the phase most commonly associated with grief, so chances are, you’re familiar with it. Life is colorless. Bland. Some of the things I’ve heard from people in this phase have been soul-sucking. The depths of despair when facing a loss can be, well, depressing.

“I cannot live without them.”

“Not even food tastes the same.”

“I’ll never be able to listen to jazz again. It reminds me too much of my [loved one].”

“We used to go for walks together every day. Now I can’t even get out of bed. Without X, it’s just not worth it.”

“If I’m dead, then I can join them.”

Anything you can imagine that reflects the loss that’s depressing as hell can be found in this phase. It is utter disaster for a patient. Some believe they will never recover.

Sadly, some won’t recover. Some will spiral into MDD, and some will get worse if they already have MDD.

Depression from the Therapist’s POV
It is up to you to help the patient move away from this phase. It is not done quickly, and there is no efficient magic trick to make them better. Sometimes, you have to call in a psychiatrist’s consultation, particularly if the patient is already on medication for MDD, or they really should be on something for MDD. No, you’re not giving them a magic pill that will take away their pain of loss; nothing will do that. When you suggest medication, it’s because you are using a tool that may help pull them back from the abyss and give grief clarity.

In other words, you are helping them to just grieve, rather than get sucked down into the horrific abyss of MDD.

Remember some of the things I mentioned that I’ve heard from people in the depression phase? Let’s look at them through the lens of an ethical therapist.

“I cannot live without them.” (Silent warning bells. Find out if the patient is suicidal. Find out if they have the plans, and means. You may have to hospitalize.)

“Not even food tastes the same.” (Anhedonia is possible. Discuss what this means for the patient. Find out if they’ve had any unexpected weight loss. Note it. If patient has history of an eating disorder, consult with treatment team. Work with them and the patient. Work with the patient to help them find a way to remember their loved one through food, but in a healthy way.)

“I’ll never be able to listen to jazz again. It reminds me too much of my [loved one].” (Anhedonia is possible. Discuss the reasons. Let the patient talk and tell you a story about their loved one’s favored music. Help them remember this is a process and that over time it may become a positive way to remember the loved one.)

“We used to go for walks together every day. Now I can’t even get out of bed. Without X, it’s just not worth it.” (Loss of a physical activity can make depression worse. Discuss and explore alternatives, or how to get back to walking, etc.)

“If I’m dead, then I can join them.” (MAJOR ALARM BELLS BETTER BE GOING OFF IN YOUR HEAD. Patient has suicidal ideation. Check for plans and means. Hospitalization may be necessary.)

What this Means for You, The Writer
Of course it depends on where you’re going with the story. Usually when a writer examines grief in fiction, this is the phase that they start at because it’s the most recognizable and seemingly the one that gets the point across. Your character may have stopped eating. They may overeat. They stopped showering and grooming.

But consider writing from one of the different phases or combining a few instead of starting at depression. If and when you do choose to write this part, don’t forget the impact of show over tell. Show me the uneaten dinner in the fridge. Show me the ashtray full of cigarettes and the character lying in bed with a red face puffy from crying. Show me the dirty hair and stench of two-week’s worth of unwashed laundry, piled up in the corner and threatening to grow legs and walk off. Show me the guitar in the other corner just gathering dust. The darkened room. The unmade bed. The broken mirror.

Remember, it’s not the grief itself that’s interesting, it’s how the character faces it, doesn’t face it, or makes matters worse that is interesting to the reader.

If you came here looking for psychological assistance, please contact your local crisis line. Dial 2-1-1 in the US for the United Way, or contact the Samaritans in the UK. For a list of international crisis lines, click here.

Now go write. Go for a walk, too. Get a little fresh air.

Wow, just one more topic and you can breathe easier. We’ll move onto other subjects too, and I do take requests (you can ask via Facebook or Twitter). If you’re in need of some lighthearted diversions, check out my Facebook and Twitter. Or for some entertaining fiction that touches on grief and loss, grab a copy of Exit 1042.