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Grief and the Elderly

Article from today’s NY Times Op-ED about Grief:

Grief Unedited
by Ruth Davis Konigsberg

EVER since Joan Didion’s book “The Year of Magical Thinking” began its lengthy run as a bestseller in 2005, a number of first-person accounts of losing a husband have been published. Among them were Kate Braestrup’s “Here If You Need Me,” Anne Roiphe’s “Epilogue” and Kay Redfield Jamison’s “Nothing Was the Same.” This week, they are being joined by Joyce Carol Oates’s “A Widow’s Story,” which recounts the death of her 77-year old husband, Raymond Smith, from complications following pneumonia in 2008. While these memoirs are often moving, they are also highly subjective snapshots that don’t teach us much about how we typically grieve, nor more importantly, for how long.

In the past decade, social scientists with unprecedented access to large groups of widows and widowers have learned that, as individual an experience as grief may be, there are specific patterns to its intensity and duration that are arguably more helpful in guiding the bereaved in what to expect. They have found that most older people who lose spouses from natural causes recover much more quickly than we have come to expect. In fact, for many, acute grief tends to lift well within six months after the loss.

This discovery and subsequent work in the field has been driven primarily by George Bonanno, a clinical psychologist at Teachers College, Columbia University. Before he began his research, few bereavement studies had ever looked at what percentage of widows and widowers recovered quickly, and what percentage were still mired in sadness years later. And none had managed to evaluate the respondents before their loss to get a sense of their overall emotional well-being.

But by tapping into an existing, long-term survey called the Changing Lives of Older Couples Study, done at the University of Michigan, Mr. Bonanno was able to obtain baseline measurements of more than 1,000 married individuals. Participants in the study who subsequently lost a spouse were then invited for follow-up interviews at intervals of 6, 18 and 48 months after the death.

The single largest group — about 50 percent — showed very little sign of shock, despair, anxiety or intrusive thoughts (the hallmark symptoms of acute grief) even six months after their loss. Those subjects were also screened for lethargy, sleeplessness, inability to experience pleasure and problems in appetite — the classic symptoms of clinical depression — and came up clean on those as well. That didn’t mean that they didn’t still miss their spouses, but that they had returned to somewhat normal functioning, contradicting the popular maxim of widowhood that “the second year is harder than the first.”

Mr. Bonanno summarized the surprising phenomenon in a 2004 article in the American Psychologist: “Resilience to the unsettling effects of interpersonal loss is not rare but relatively common, does not appear to indicate pathology but rather healthy adjustment, and does not lead to delayed grief reactions.”

As for the remaining participants, about 15 percent exhibited grief symptoms that were moderately high at 6 months but almost completely gone by 18 months. For another 10 percent, those who were still having problems at 18 and 48 months, grief had become chronic.

There were two additional groups that had never been considered in the literature: people who were depressed before and after their loss whose troubles seemed to be a pre-existing condition (about 10 percent), and people whose depression improved following the loss (also about 10 percent), suggesting that the death of a spouse actually alleviated stress.

Loss is forever, but thankfully, acute grief is not. Yet we rarely come across books (or plays or movies) about women who begin to stabilize after six months and start dating after a year or so because, perhaps, that narrative conflicts with our romantic fantasies that each of us is meant to spend our time on earth with only one soul mate. Ms. Didion’s situation was highly unusual, with her husband’s death compounded by her daughter’s fatal illness, but Ms. Oates’s followed the more common trajectory, and in 2009, she remarried, although that event is not mentioned in her book.

When Mr. Bonanno published his findings, they were initially met with disbelief, along with criticism that his sample had simply not included the worst cases. But he has since replicated the results in other data sets of bereaved individuals and gradually, his trajectories have become the standard among clinical researchers who measure how people respond to loss compared to the statistical norms. Perhaps we will begin to update our own popular notions about grief as well.

Ruth Davis Konigsberg is the author of “The Truth About Grief: The Myth of Its Five Stages and the New Science of Loss.”

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