Can Last Years, Show Many Faces : Phases of Widowhood Grief Are Defined in 5-Year Study

As a teen-ager, Steven Shuchter had become aware of the months, if not years, of grief and adjustment that follow the death of a spouse, having observed his mother’s reactions after his father died.

Later, after beginning his own practice as a psychiatrist, Shuchter supplemented his personal experience with those of many patients who encountered both emotional and physical problems learning to cope with being alone after years of togetherness with their husband or wife.

But the UC San Diego doctor wanted to define the process of widowhood grief--how grief changes over time, if it ever completely disappears, in what ways can it be lessened--in greater detail than it had been described previously.

And so was born the idea for his just-published book, “Dimensions of Grief,” the result of a five-year study of 80 men and women from one month after their spouses died to five years later.

“Everyone knows that something happens (to the survivor),” Shuchter, director of the UCSD Psychiatric Outpatient Services, said in an interview, tracing examples back to the literature of antiquity. “But only in the 1960s did (the medical profession) begin to look at the issues of death and dying to any great degree.”

With the help of several social workers in the San Diego community, Shuchter identified a group of men and women willing to endure the intrusiveness of questions about their widowhood.

“It was clear just from preliminary questionnaires that a lot of people appeared to still be grieving over a long time,” Shuchter said. “So we saw the need to do a prospective study.”

During the first part of 1978, 25 men and 55 women volunteered to participate out of a larger pool of persons approached individually after death records showed that their spouses had recently died. The people were interviewed every four months for the first two years, and then yearly into the fifth year. The average age of the survivor was 50 years old, and the cause of death of the spouses was evenly divided between sudden causes and prolonged health problems.

Shuchter and his associates asked about all aspects of widowhood: What was their grief? What impact did it have on relationships with their families, with friends, and in making new friends? What mechanisms did they use to cope? What happened to their relationship with their spouse in terms of remembrance?

The answers are not simple, Shuchter said.

The major thrust of his findings show that bereavement can last several years and exhibit many different facets over time but that much of what takes places should be considered normal and not looked upon as pathological by friends and acquaintances, which can make matters worse for the survivor.

“Things go on at many, many different levels in recovering from the loss of a loved one,” Shuchter said.

He pointed to the early numbness and shock that many survivors go through immediately after death of a spouse. The reality of death may not set in for several days, Shuchter said, with the widow or widower walking around in a fog as though detached from the scene.

“But then suddenly, like a strong knife in the gut, there is a wave of emotion that will continue with regularity, rising and falling as every reminder of the dead spouse sets it off again,” Shuchter said.

Though the emotional tide will usually diminish in frequency over a period of months, it can still be triggered by music that the spouse enjoyed, or by running into an old friend who asks about the survivor’s health, or by numerous other ways.

The emotional recalls set up what Shuchter calls “dynamic tension,” a battle between the survivor’s attempt to avoid the constant reminders that bring back overwhelming grief and the desire to retain a link to the spouse.

“You want at the same time to protect yourself from pain and loss, but also to hold on to certain things to embrace the spouse,” Shuchter said. “You have to measure how far to distance yourself, how far to avoid being reminded of the past by not talking to friends, by discarding all belongings, by moving away and hoping that emotions won’t catch up.”

People who are still working, or have daily activities they attend, are better able to avoid being overwhelmed by intensive grief. “It’s the ability not to get so much caught up in one’s own mind,” he said. “Even television is a help. You turn on a TV in an empty house and it has sound, a picture, and staves off loneliness because it is a distraction.

“A lot of people end up watching television for the first time.”

Confusion, anger and guilt as well as intense grief also come to the fore in the early periods.

“Many people feel out of control emotionally and cognitively, (so) that they find their short-term memory goes, that it is hard to concentrate,” Shuchter said. “A lot of this is normal.” But if carried to extremes, he said, the emotional stress can lead to physical health problems.

Other survivors lash out in anger at their loss, trying to find someone to blame, be it God, a doctor, or even fate. The anger can be accompanied simultaneously with feelings of guilt over the death, with widows or widowers replaying events to try to create new, more satisfying endings in their minds.

Those persons whose spouses die at the end of a long illness can feel relief that extensive physical suffering ended, but nevertheless they cannot have prepared themselves fully for being alone, Shuchter said.

“I don’t think there is such a thing fully as anticipatory grief,” he said.

Coping with the grief, anger and guilt--all of which are normal reactions--takes many forms over an extended period, Shuchter said, to lessen the dynamic tension.

“An important point to understand is that the relationship (between the survivor and the dead spouse) goes on, in a lot of ways, and that it is not going to be substantially weakened during the process of mourning,” Shuchter said.

“People said (during the study) that they could hear, feel, even touch their spouse, and these seemed to be true hallucinatory experiences, which might be called psychotic in others but are normal here.

“They show the power and strength of the bond.”

Shuchter declined to use the evidence to make a case for parapsychology, but he conceded that others might.

Over time, the widow or widower will take on different aspects of the spouse’s personality. “Physical symptoms, certain traits will be taken on by the survivor in the same way as children who take on parental qualities as they grow up,” Shuchter said.

“Such communication can go on a long time.”

The clinical focus for psychiatrists and family friends should allow for normalization of the loss.

“If the survivor is talking to the spouse as though (he or she) were alive two or three months after the death, that’s normal, and don’t worry about it,” Shuchter said. “If five years down the line, the survivor still cries at the mention of certain things, that’s normal and healthy. Don’t undo it.

“But if two years later, there is still a significant depression--which as many as one-third go through during the first year--and the person can’t get out of bed day after day, then something needs to be discussed.”

Shuchter said that a widow once approached him, distraught, at a meeting and said a friend had told her that she should not be wearing her wedding ring eight months after her husband’s death. Shuchter said the woman looked at him like “manna from heaven” when he said she had a perfect right to wear the ring as long as she wanted to.

“Everyone has their own way to grieve and their own timetable,” he said.

For that reason, many survivors find new friends among people who have experienced similar losses. “It’s sort of an ‘It takes one to know one’ situation,” Shuchter said. “They often are amazed to find out that what they are feeling or going through is not unique, that it happens to others, and that they aren’t going off the deep end.”

Often, other family members believe the widow or widower is not “acting properly,” frequently because the pattern of grief or coping conflicts with that of the sons or daughters.

Shuchter said that a survivor must set his own timetable for coping with grief and undergoing the changes in their identity that come with widowhood. But they can be encouraged to talk about problems of depression or anger to avoid taking to unhealthy extremes the normal reactions to the death.

“And, I’d say that family and close friends, and people who have gone through a similar experience, can be as helpful as the psychiatrist,” Shuchter said. “That’s why the book is intended as much for the general public as for the clinician.”