Recognizing the Signs

When an event or situation triggers chronic sorrow, parents or caregivers may exhibit symptoms similar to depression including profound sadness, anger, frustration and guilt. However, chronic sorrow is not clinical depression. Chronic sorrow is a normal grief response to an ongoing living loss.

The grief associated with chronic sorrow is not the same as the well-known theory of the five stages of grief first identified by Elisabeth Kubler-Ross in 1969. Kubler-Ross identified the stages as Denial, Anger, Bargaining, Depression, and Acceptance. Once the person ultimately accepts the loss situation, emotional pain is lessened.

Chronic sorrow does not work this way. It was first described in 1962 by S. Olshansky, director of the Children’s Developmental Clinic in Cambridge, MA. Olshansky observed that parents of mentally handicapped children demonstrated periodic, recurrent grieving he called “chronic sorrow.” He believed that ongoing caregiving burdens were powerful enough triggers to bring about chronic sorrow.


Anger in chronic sorrow

Anger, frustration and confusion are common emotions expressed by parents or caregivers experiencing chronic sorrow. While the presence of anger is recognized in bereavement, it is often not understood in chronic sorrow. As a result, when parents exhibit anger suddenly, and out of character, healthcare professionals, friends and family members may withdraw and judge the parental behavior as inappropriate. This can lead to an adversarial relationship. When professionals and others understand the role that anger plays in chronic sorrow, they can give support and guidance to help parents or caregivers better manage the anger component of their recurrent grief.


Chronic sorrow and depression

There are differences between chronic sorrow and depression. In medicine, depression is described as a pathological reaction that may occur without a specific loss. It is a mood disturbance that can interfere with everyday functioning. Depression can also be temporary and improve over time.

Conversely, chronic sorrow is described as a natural reaction to an ongoing loss. It generally doesn’t interfere with daily functioning. However, it is a pervasive and profound sadness. It requires a trigger to re-emerge and may be permanent, periodical, and potentially progressive.

Medication may be helpful in depression disorders, but it isn’t usually effective in chronic sorrow unless the person is also clinically depressed. Labeling parents with chronic sorrow as depressed may lead to ineffective management of their pain and sorrow.

When chronic sorrow is treated as a pathologic condition instead of a normal reaction to a tragic situation, parents’ needs are often not met to help them cope with their life-long loss. By recognizing the difference between chronic sorrow and depression, those who work with parents of chronically ill children can help bring comfort to their lives.


Gender and chronic sorrow

Parents or caregivers may feel as if they are on an emotional roller coaster. The normal ups and downs of family life are magnified by the child’s chronic condition. Family relationships can suffer because mothers and fathers experience chronic sorrow differently.

Mothers often feel sadness and guilt. In some studies, mothers report an increased frequency of recurrent sorrow and experience more ups and downs. Fathers tend to adjust gradually and may show recurrent feelings of frustration leading to resignation. In mothers, chronic sorrow is most likely triggered by a health management crisis. In fathers, comparison with social norms often brings on feelings of sorrow.

The gender differences in dealing with chronic sorrow can be misinterpreted as fathers being less interested in the child causing more strain in family relationships.

Parents or caregivers should remember that the amazing part of dealing with chronic sorrow is that they so often are able to meet their work and family demands even while in the midst of recurrent pain and sorrow.