"..we have to make a difference between depression and sadness"

There is so much that is good in Krista Tippett's discussion with Pauline Boss that the only way to do it justice is to listen to the entire, unedited thing.  Here are a couple of things from the transcript that are especially good.

... DR. BOSS: That's part, again, of a culture of mastery, a culture of problem-solving and wanting to move on with things. Elizabeth Kübler-Ross found those five stages to be relevant to people who are dying, who are fading into death.

MS. TIPPETT: Right. Not someone who's at the loss end of that death.

DR. BOSS: No. She did not mean that for the family members, but, in fact, it blurred over into that. And I don't know if that was her, or I think it was more so her followers. Today, the new research in grief and loss does not recommend linear stages. We like linear stages, though — and the news media really likes it — because, in fact, it has an ending. It has a finite end.

MS. TIPPETT: Right.

DR. BOSS: If you start with stage one, and you move on through stage five...

MS. TIPPETT: You'll finally get to acceptance.

DR. BOSS: ...you're done. You're no longer grieving. Well, we now know that this is not true and that human beings live with grief and, in fact, are able to live with grief. They don't have to get over it. They don't obsess with it five years down the road, but they occasionally remember and are sad, or go to the grave, or have some thoughts about the person who died. And this is normal. So, we now know that living with grief is more oscillations of up and down. And those ups and downs get farther apart over time, but they never completely go away, the downs of feeling blue, of feeling sad.

MS. TIPPETT: Mm-hmm.

DR. BOSS: And in order to understand this, though, we have to make a difference between depression and sadness.


MS. TIPPETT: Right, right. To say that sadness is not depression.


DR. BOSS: And so far, that hasn't been made. [laughs]

MS. TIPPETT: Right.

DR. BOSS: Yes. Depression is an illness that requires a medical intervention. It's the minority of people who have depression. And yet, with the ambiguous loss of let's say Alzheimer's disease and 50-some other dementias, caregivers are said to be depressed. Most of the caregivers I have met and studied and treated are not depressed; they're sad. They're grieving. And this should be normalized. And sadness is treated with human connection.

[When is the last time you heard someone admit to being sad instead of depressed?   You have to wonder how we were talked into medicalizing our every day, non-pathological experience and what the motive for us accepting that was.]


MS. TIPPETT: Mm. So, one of the things that you say — and this makes so much sense, but it's the kind of thing that makes sense — we have to say it — that people can't cope with the problem until they know what the problem is.

DR. BOSS: Yes.

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I think there is some really awful aspect of the worship of science that we try to fit stuff into the language of science that doesn't fit and never will fit into it.   We have learned to feel uneasy and dissatisfied and scared of things that we can't stow away into neat categories.

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... DR. BOSS: Yes. We just have to stop pressuring people to get over it. It's cruel, actually, to do that. I was critical of the news media about their yearning for closure. They like the word “closure.” But I have to say that once, listening to CNN, Anderson Cooper stopped the other reporters and said, “That's a bad word. There is no such thing as closure.”

And I just loved him for that. And I know from his own biography that he knows what loss is, and he understands that there is no closure. So he's the only reporter I've ever heard explain that in the line of his work. And I think the rest of us have to do a better job of it too.

MS. TIPPETT: Mm-hmm.

DR. BOSS: There is no such thing as closure. We have to live with loss, clear or ambiguous. And it's OK. It's OK. And it's OK to see people who are hurting and just to say something simple. “I'm so sorry.” You really don't have to say more than that.