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DEATH OF A SPOUSE.
Term Paper ID:24195
Essay Subject:
Effects on surviving spouse (depression, suicide), special problems of aged, Alzheimer's, stages of dying, interviews with survivors.... More...
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Paper Abstract:
Effects on surviving spouse (depression, suicide), special problems of aged, Alzheimer's, stages of dying, interviews with survivors.
Paper Introduction:
INTRODUCTION
The objective of this research is to consider the manner in which the death of a spouse affects the surviving spouse, how people cope with the strain, and what sorts of services and professionals are available to help them through this difficult time. Various theorists have noted that there are stages of grief, and research has shown that these stages can be found not only in a situation where the spouse has died but also in situations where the spouse is facing death or otherwise triggers a grieving process and a sense of loss, as happens with older couples when one partner has Alzheimer's and is thus being effectively taken away without actually dying. Everyone will have to experience this sense of loss someday. For most people, if they are the surviving spouse, the death of a spouse will be a
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Alzheimer's: A Caregiver's Guide and Sourcebook. It seems that it is not the loss itself thatis the key factor but the unexpectedness and swiftness of its occurrence,the reaction of the individual to the loss, and the synergistic effect ofthe loss when combined with existing problems. [4]M. Two of the men had cared for their wives for some years. Gallagher-Thompson, M.Gilewski, and L. The stages serve as a guide formedical personnel first to understand the process themselves and tocomprehend what a patient is going through and second to help patients maketheir way through the grief process to the final stage of acceptance andunderstanding. She alsodiscusses some of the specific problems that will be encountered. They are identified by Kübler-Ross as denialand isolation, anger, bargaining, depression, and acceptance. The stages of grief that thefamily goes through are like the stages of grief upon a death. The stages detailed by Kübler-Rosshave been derived from discussions with dying patients and show what hasbeen learned from these patients in terms of coping mechanisms at the timeof a terminal illness. One researcher felt that mostof the suicidal elderly suffered from psychoses that are either organicdementias or one of the depressive states. The stages need not be consecutive and canexist side by side, but in order to cope with the situation the patientmust pass through all of the stages. CONCLUSION The death of a spouse or the long-term illness of a spouse produces aseries of stages for the surviving spouse, and these stages of griefconstitute a process the individual must go through in order to adopt. For this reason, a rapidsuccession of losses can be devastating.[4] Miller also considers studies that have indicated some mental oremotional problems for geriatric suicides. The effect of onepartner's deterioration on the other partner will vary from situation tosituation, but it is certain that there will be considerable stressinvolved, that the healthy partner will have to contend with his or her owninfirmities as well as being the bulwark for the other, and that the straincan have numerous consequences over time. [8]Ibid., 5-6. Thesurviving spouse after a death will come to a point of acceptance and canbe helped in this process by a supportive family or social network. The effect was therefore stronger and more real to him. The three older women interviewed all had families and thus a supportgroup to help them through the death. Carter and M.McGoldrick (New York: Simon and Schuster, 1989), 463. Her thesis is that when people areforced to face death either in terms of coming to grips with the death of aloved one or even with their own imminent death they pass through certainstages in their thinking. Each woman remembered feeling lost, helpless, andfrightened at the enormity of the change as well as at its suddenness.Each also had a family support group that helped greatly. One of the moredevastating forms of deterioration is seen in Alzheimer's patients as theygradually lose mental ability and even physical functioning. INTERVIEWS Several people were interviewed for their experience of the death ofa spouse. In fact, the loss of a spouse issomething everyone who marries will one day experience, and that experiencewill be the same for everyone in certain essentials. These stages are repeated in every instance aspart of the grieving process. Brown, "The Impact of Death and Serious Illness on the FamilyLife Cycle." In The Changing Family Life Cycle, B. Most were elderly people found at alocal center for the elderly where they would meet, get help with theirproblems, and socialize. Farberow, D. The man whose wife hadAlzheimer's talked at some length about how lost he had felt as her illnessprogressed, for the person he had known all his life was no longer thesame. Thompson,"Changes in Grief and Mental Health of Bereaved Spouses of Older Suicides." Journal of Gerontology (1992, November), 357-366. Kübler-Ross indicates that the family will have tocope with the issue for a long period of time, even after the death of theloved one, and that this will take a good deal of energy. Various theorists have noted that thereare stages of grief, and research has shown that these stages can be foundnot only in a situation where the spouse has died but also in situationswhere the spouse is facing death or otherwise triggers a grieving processand a sense of loss, as happens with older couples when one partner hasAlzheimer's and is thus being effectively taken away without actuallydying. Death at an older age is viewed as a natural process. McGoldrick(eds.), 463. Their losses are thus economic(loss of job or income), physical (loss of a limb or good health), social(loss of a friend or a cherished neighborhood), psychological (loss of self-esteem or confidence), emotional (loss of a spouse or child), or anycombination of these losses. One researcher links geriatric suicides to the lossthat older people experience as friends and relatives die and as they nolonger have jobs to take up their time. In the broadest sense, theauthor says that these stages are something through which individuals passwhenever they are faced with tragic news. DEATH AND DYING One of the more influential works on the subject of death and dyingis that of Elisabeth Kübler-Ross. All three expressed the same basic feeling whenthese deaths occurred, that their husbands were too young, that the deathswere thus a shock (including the death of the man with cancer, for the timebetween the onset of the disease--or at least its discovery--and his deathwas relatively short). [3]N.L. The patient denies that there havebeen any behavior changes, and delusions will develop. "Changes in Grief and Mental Health of Bereaved Spouses of Older Suicides." Journal of Gerontology (November 1992), 357-366.Gruetzner, H. It is likely that all suicidalpeople are depressed, which can also result from loss, grief, or despair.Depression also commonly follows illnesses, and the elderly are often ill.The loss of a spouse on top of this can be devastating.[5] The grief andloss felt by a spouse can be increased when that spouse has been caring fora husband or wife for some time, as is often the case with older couples.Miller says that those who attempt suicide do so because they cross a "lineof unbearability" after which they either call out for help or seek to endall their problems at once. Itis noted that the caregiver for a spouse with Alzheimer's experiences thesame stages of grief as one whose spouse has died. Most of the feelings decrease over time with varyingcourses of treatment by the end of 3 months of bereavement. New York: John Wiley & Sons, 1988.Kübler-Ross, Elisabeth. The healthier of the two willbecome the parent to the other's child in the relationship, and this may bea shift from the pattern the relationship has always enjoyed. However, thecoping process for survivors of suicide victims seems to be a moredifficult one as compared to survivors of those who died by natural causes. Carter and M. The patientdisplays uncharacteristic behavior, neglecting household chores or otherwork activities and personal hygiene. The research will consider relevant literature on the topicand also will consist of interviews with several older people who haveexperienced this problem in their own lives and who now gather at a seniorcenter to be with others their own age, others who have had much the sameexperience and who can now help with their own transition. On Death and Dying. The inevitability of the five stages does not mean thedeath of hope, and it could even be argued that reaching the level ofacceptance places the patient in a better mental state to have real hopeand to understand his or her options in evaluating treatment and mattersrelated to treatment. The death of a spouse early in life is unexpected and createsparticular tensions as a consequence. New York: Springer, 1979.----------------------- [1]Elisabeth Kübler-Ross, On Death and Dying (New York: Macmillan,1969), 168. In fact coming to grips with one's mortality is a developmental task for the aged.[2]However, there is considerable evidence that the loss of a spouse is aparticular stressor for the aged and can produce harmful effects, evenleading to the suicide of the surviving spouse. The stress of caring for a deterioratingpartner, for instance, can add to a host of other problems facing theindividual and can push some people over that line, and indeed after caringfor a loved one for some time and then losing that loved one, many commitsuicide as a result of the sudden removal of what many see as a burden andthey may see as their reason for continuing to live.[6] THE PROCESS OF DYING There are various levels of deterioration possible in aging, and itis likely that the experience of the caretaker-partner depends to a greatdegree on the level of deterioration in the other partner. The type of deathinvolved in the loss of a spouse can make a difference in terms of how longit takes the surviving spouse to come to terms with that loss. They are applicable to the grieving relatives aswell as to the person who is terminally ill. [5]Ibid., 11-12. Age plays a role in the reaction to the death of a spouse, thoughthere is no age at which the loss is not felt keenly by the survivingspouse. The death of aspouse results in grief, depression, tension, anxiety, confusion, and asevere sense of loss. The experience of losing a spouseleaves the individual feeling as if he or she were facing somethingdevastating and personally painful, often to the degree that they believeno one else can understand how they feel. [7]H. Gruetzner writes: Alzheimer's disease is a condition of unknown origin that causes gradual loss of abilities in memory, thinking, reasoning, judgment, orientation, and concentration. [6]Ibid., 8-9. She says that they are defensemechanisms in psychiatric terms and coping mechanisms to deal withextremely difficult situations. Gruetzner, Alzheimer's: A Caregiver's Guide and Sourcebook (NewYork: John Wiley & Sons, 1988), 1. [9]Ibid., 24.----------------------- 1 New York: Macmillan, 1969.M. The Impact of Death and Serious Illness on the Family Life Cycle." In The Changing Family Life Cycle, B. Gallagher-Thompson, M.Gilewski, and L. BibliographyBrown, F.H. Each had lost other relatives and noted that the death oftheir husband was much the most devastating. It is proposed that the death of a spouseis a particularly traumatic event for the surviving spouse and that it canbe especially unsettling for the older population as the surviving spousecomes to feel more and more alone as the survivor of another time as wellas a marriage. Formost people, if they are the surviving spouse, the death of a spouse willbe a particularly traumatic event. The ageing of the American population has been noted forsome time as Americans live longer than they did several decades ago.While this creates many problems for the elderly and for those who mustcare for them, it also appears that longevity can reduce some stresses: Generally the farther along in the life cycle, the less is the degree of family stress associated with death and serious illness. Everyone will have to experience this sense of loss someday. The disease itself is characterized by adeterioration in mental activity and in consequent behavior. The loss of memory inAlzheimer's makes the caregiver view the disease more like a death than anyother disease. Gruetznerdiscusses the experience of the caregiver under these circumstances andstates: "The caregiver experience is characterized by the adjustment of theAlzheimer's patient and his family to the illness."[7] There is helpavailable to assist in this process from family members, communityresources, and medical personnel. No one interviewed had lost a spouse more recently than 2 years ago.All had achieved the state of acceptance by this time and were able todiscuss their feelings somewhat objectively. Alzheimer's disease is not the result of normal aging, but it does occur more frequently in persons who are 65 years of age or older.[8] Research shows that adjusting to Alzheimer's disease in a spouse isprecisely like adjusting to death, since Alzheimer's is a fatal disease andone that often involves a lingering death. The death was thus not just the death of the individual but of anentire mode of life, and one of the women stated that at the time, she feltshe had died herself. One of thewomen had Alzheimer's, and the other cancer. The elderly people interviewed had lost their spouses at an advancedage. Shenotes: "Family members undergo different stages of adjustment similar tothe ones described for our patients."[1] They also experience a stage ofdenial, a stage of anger, and a phase of preparatory grief. Miller, Suicide after Sixty. Kübler-Rossexamines each of these in turn and relates them to the grieving processboth for dying patients and their families. The man with the wife who had died of cancer offered similarsentiments, but his helplessness came from not being able to help her moreand not from any sense of loss of his past. INTRODUCTION The objective of this research is to consider the manner in which thedeath of a spouse affects the surviving spouse, how people cope with thestrain, and what sorts of services and professionals are available to helpthem through this difficult time. Thesestages include denial and isolation, anger and resentment, bargaining,depression, and acceptance.[9] It is likely that these steps occur with other debilitating diseasesas well, and the elderly person who takes on the role of caregiver for anafflicted spouse thus experiences these stages twice, once for the onsetand progression of the disease and once for the death itself, though thelatter process may be somewhat easier given the acceptance that has alreadycome to the disease and so to the fact of dying if not death itself. Each had been married for atleast 3 years at the time of the death, and one had been married for 52years. The death of a spouse at an olderage adds to a variety of burdens faced by the elderly, and increasedlongevity means that while the experience of losing a spouse may be put offlonger, it might be thought that it would come at a time of greatervulnerability. Two of the younger women hadlost their husbands in accidents, while the third had lost her husband tocancer at the age of 4 . Thompson. The spouses of suicides are thus more prone to become suicidesthemselves.[3] The loss of a spouse can thus create a dangerous situation for thesurviving spouse, and this seems especially true among the elderly for avariety of reasons. New York: Simon and Schuster, 1989Farberow, N.L., D. She begins with an assessmentof the fear we have of death and dying and a discussion of some of theattitudes that prevail on the subject. Miller, Suicide after Sixty (New York: Springer, 1979), 7. They all stated something to theeffect that they had no idea what they would have done if they had not hadthat support. She also reported that the details of dying onlymake matters worse, by which she meant the need to arrange for a funeraland even to attend it. One of the aspects of these interviews that should be noted is thatcertain themes and ideas were repeated. He had resigned himself to her death, hesaid, but the death itself was still traumatic and much more final than thedisease had been. She became more and forgetful and often did not now who he was.This placed great stress on him that his family could do little to reduce.He depended greatly on the shared memories of himself and his wife and wasnow losing touch with that past. It is beneficial for them to understandthe nature of their feelings before this occurs and to understand how longthe process takes, what the stages of the process will be, how others havemanaged to cope with the situation, and what they might do to make thetrauma easier in their own case. These were informal interviews rather than surveys with aquestionnaire or a research design. This site was chosen precisely because a largenumber of older people were present and because more of this population hasexperienced the death of a spouse than the population at large. Threeyounger women were interviewed because they were known to the researcher,who also knew that they had experienced this loss. [2]F.H. Farberow,Gallagher-Thompson, Gilewski, and Thompson studied the impact of the deathof an older person on the mental health and psychological status of thesurviving spouse and assessed this element using five self-report scalesand a one item self-rated mental health questionnaire.
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