COPING WITH LOSS

HARVARD MEN’S HEALTH WATCH,  December 2000

Loss is part of every life.  The death of a loved one is perhaps the most dreaded loss, but there are others: the loss of good health, the loss of a physical or mental capability, the loss of a job, the loss of a relationship, even the loss of a treasured possession.  No loss is welcome, and all are painful.  Still people recover from loss, though for some the recovery is protracted and difficult.  And with recovery come the opportunity to learn and grow, to be wiser if sadder.

Grief is the inevitable reaction to loss; it is a painful state that can lead to psychological and physical disorders, even to death, but it can also prepare a bereaved individual for the changes that invariably follow.  Grief can be the doorway to recovery and rehabilitation.  More than 200 years ago, the poet William Cowper said that “grief itself is a medicine.”  He was right; like all medicine, grief can be bitter, but it can also promote the healing process.

The work of grieving is difficult but crucial. Since all people will experience loss, all of us should understand the process of grieving and should be prepared to help others—and ourselves— to cope with loss.

Doctors have rated the loss of a spouse as the most painful and stressful of all losses. That seems debatable, since the loss of a child cannot be far behind.  Still the loss of a spouse is surely the most common cause of severe grief and bereavement.  And it is common:  about 12 million Americans have been widowed, and about 800,000 men and women join their ranks every year.  By age 65, 10% of all men have been widowed at least once–and because men die at a younger age than women, more than half of all 65-year -old women have lost at least one husband.

The loss of a spouse is more common for women, but it’s more serious for men.  A 1995 investigation from California suggests just how serious it is.  Researchers measured not the enormous psychological and socioeconomic burdens of bereavement but the mortality of the surviving spouse.  The study tracked 12,522 married couples from 1964 to 1987.  During that time, 1453 men and 3294 women lost their spouses.  Subsequently, 30% of the bereaved men died themselves while only 15% of the women succumbed.  Healthy men who lost a wife were 2.1 time more likely to die than healthy men who were not bereaved, even after age, education, and other predictors of mortality were taken into account.  For men who already had medical problems, bereavement boosted the risk of death 1.6 times.  The risk was greatest from 7 to 12 months after the loss, but an elevated death rate persisted for more than two years.  Shakespeare was right when he wrote of “deadly grief.”

Why do widowers face an increased risk of death?  Doctors can only speculate about several possible explanations.  The loss of a caregiver could be part of the answer–but since the impact is substantially greater in healthy men than in ill men (who may depend on a spouse for care), that can’t be the whole story.  Most likely, intense grief adversely affects the body’s stress hormones, nervous system, and immunologic apparatus; it’s the same way extreme fright and natural disasters can trigger sudden cardiac death in men (see Harvard Men’s Health Watch, Oct. 1996)

The California researchers were unable to determine if men who died of broken hearts had been experiencing excessive or abnormal grief before they died.  Doctors do know, however, that there are both normal and abnormal ways to grieve.

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