Dear Dr. Sterling:
I had a much stronger reaction to Ronald Reagan's recent death than I thought would ever be possible. Every time I saw Nancy Reagan near Ronald Reagan's casket, I cried. Just the week before that, it was all about D-Day and Memorial Day. Funerals and observances of death and dying were everywhere and deeply affected me. Now, I worry about how I am going to handle it if my wife dies before I do. -- Signed: Worried About Life After Loss.

Dear Worried:
Thank you for writing! Like you, I found the television coverage of all the Reagan family members to be very heart-rending. Grief and the mourning process are very complicated emotional experiences that cannot be summarized easily. However, I will try to cover a few important issues about life after loss.

People do not usually experience grief without a real loss or an anticipated loss. In your situation, you may already be experiencing grief reactions based on an anticipated loss of your wife. Although most of us agree on what might constitute a loss, the perception of loss and the reaction to it are very unique and individual. You have a perfect right to have your feelings.

For us older folks, loss is a predominant theme in our lives. We are challenged by many losses: deaths of friends, colleagues, and relatives, changes in work status, prestige, and loss of physical abilities and good health. Due to this "loss-ridden" environment, it is very important to remember that losses may hit us much harder and may take longer than expected to resolve. Note to younger folks: give older folks more sensitivity and support in times of mourning than you might think you need. The impact of a loss on an older person can often be underestimated due to beliefs such as "aging prepares a person to cope better with losses." It doesn't.

The major myths about mourning are (1) there is a predictable, orderly set of stages to mourning, (2) it's best to move away from grief rather than toward it, and (3) following the death of a loved one, the goal is to "get over" it. It is significant to note that in 1927 Emily Post reported that a widow's formal mourning period was three years. Yet, in 1972, Amy Vanderbilt advised a bereaved person to pursue, or try to pursue, a usual social course within a week or so after a funeral. Current society tends to pressure for quick recoveries. Although three years is thought of as a bit lengthy, resuming regular social activities in a week is definitely too short.

How we handle losses (mourning) has much to do with our resilience. Factors that contribute to resiliency are flexibility, creativity, optimism, sociability, openness to learning, and the ability to redefine loss or failure in terms that allow for continued learning. Trauma and loss can give rise to personal transformations and growth. The Chinese symbol for "crisis" is identical to the symbol for "opportunity."

Victor Frankl, a psychiatrist and Holocaust survivor, wrote extensively about the "defiant power of the human spirit." He noted that there is a fundamental difference between pain and suffering in that "suffering" is how we choose to react to pain. "Conditions cannot completely condition us. Everything can be taken from us, but the last of human freedoms, to choose one's attitude, can never be taken away." Frankl called this the spiritual dimension.

Aging and the losses it brings may present us with our greatest opportunity to connect with our spiritual dimension and to defy conditions and choose our attitude. This may just be the ultimate meaning of growing older. I hope this is helpful. -- Best wishes.

Posted by:  Ron Sterling, M.D.  Read our Disclaimer.

The following links are to several resources, including a 16-page Adobe Acrobat article written by Dr. Sterling. For information about "complicated grief," please view the section further below.

Adobe Acrobat Article

• Click here to download a 16-page Adobe Acrobat article written by Dr. Sterling in May 2003, entitled "Understanding Grief and Loss."

Web Sites with Resources and Information
• Grief Words at Horan and McConaty. The Web site contains well-written information about the grieving process by Alan D. Wolfelt, Ph.D., the founder of The Center for Loss.

• From Stepfamily in Formation -- Free Up Blocked Grief, and Build a Pro-grief Family.

• From the British Broadcasting Web site -- Coping With Grief.

• From the British Broadcasting Web site -- Helping each other through grief.

• From Spiritual Care Program International -- The normal process of mourning.

• From Self Healing Expressions, an online course -- The First Year of Grief: Help for the Journey.

• At DrKoop.com -- Helping Children Cope With Grief.

• Grief Watch. GRIEF WATCH is a ministry of Metanoia Peace Community, a congregation of the United Methodist Church in Portland, Oregon. It is based at the 18th Ave Peace House, site of a variety of ministries focused on hospitality, community, peace-making, and care for the dying.

• Artilcle at Geranto.org -- Female Aging and the Mourning Process: -- A Psychological Perspective.

• Article at Western Caroline University -- Gender Differences in Mourning When Losing a Spouse -- Researching a State of Well-Being.

Books
• Life After Loss: A Personal Guide Dealing with Death, Divorce, Job Change and Relocation by Bob Diets.

• The Nature of Grief: The Evolution and Psychology of Reactions to Loss by John Archer (1999).

• The Healing Journey Through Grief: Your Journal for Reflection and Recovery by Phil Rich.

• The Resilience Factor: 7 Essential Skills for Overcoming Life's Inevitable Obstacles by Andrew Shatte and Karen Reivich.

• The Life Cycle Completed by Erik H. Erikson with new chapters on the Ninth Stage of Development by his wife, Joan M. Erikson, after his death.

• On Death and Dying by Elisabeth Kubler-Ross.

• Life Lessons by Elisabeth Kubler-Ross and David Kessler.

Mainstream Movies
• Last Orders (3/2002) -- starring Michael Caine, Tom Courtenay, David Hemmings, Bob Hoskins, Helen Mirren, and Ray Winstone. During a trip to scatter the ashes of their friend four friends bring their memories together to tell a story of love, life, and loss. This film shows the pain and struggle of dealing with death and the simple joys and wonders of living life.

• Moonlight Mile (9/2002) -- starring Dustin Hoffman, Susan Sarandon, and Jake Gyllenhaal. For anyone who has lost a loved one, Moonlight Mile will ring true with heartfelt emotion.

• About Schmidt (late 2002) -- starring Jack Nicholson and Hope Davis. This is not your average story about retirement and losses but it brings up some very significant issues about loss, community, and acceptance.

Educational Movies
• Do a search at Amazon.com using "grief." You will find several VHS format educational movies, such as: "Grief and Older People -- Speaking from experience, personal perspectives on medical and social issues."

Complicated grief (sometimes called "pathological grief") consists of maladaptive extensions of normal bereavement. These maladaptive reactions overlap mental illness disorders and often require different treatment strategies than uncomplicated grief reactions. Adjustment disorders (especially depressed and anxious mood, or disturbance of emotions and conduct), major depression, substance abuse, and even posttraumatic stress disorder (PTSD) are some of the more common diagnoses used to describe complicated bereavement. Grief that becomes complicated is often identifiable by the increased duration of symptoms, the increased disruption of psychosocial functioning due to the symptoms, or by the intensity of the symptoms.

For more information about complicated grief, see the following links.

• Dr. Sterling published an answer to a reader question about complicated grief in November 2004. To read the article, please click here.

• From MSNBC.com, posted May 31, 2005 -- Beyond depression: When grief doesn't go away.

• From Hospital Physician -- Pathological Grief (12-page Adobe Acrobat document). This is a February 2004 comprehensive review of complicated grief.

• Guidelines for the Assessment of Bereavement Risk in Family Members of People Receiving Palliative Care -- (this is a 100-page Adobe Acrobat document - 609 KB).

• From BioMed Central -- Bereavement care interventions: a systematic review.

• From the Canadian Journal of Nursing Research -- Loss and Bereavement: Perspectives, Theories, Challenges.

• From Postgraduate Medicine Online -- Coming to terms with grief and loss -- Can skills for dealing with bereavement be learned?.

• From the Canadian Psychiatric Association -- Bereavement in the Elderly: Clinical Considerations.

• From Humane Health Care -- The Gap Between Real Life Experience and Scientific Exploration, the Absence of Pattern and the Total Individualization of Grief: A Family Case Report.

Other Advice Destinations at DearShrink.com.

Other Advice destinations at DearShrink include:  AllAboutForgiveness.org, where you will find information and links about forgiveness;  MentalWellness.ws, where you will find information and links about understanding the factors involved in mental wellness -- self-appreciation, resilience, affiliation, negotiation, and mental and physical exercise; and SeniorMentalHealth.org, where Dr. Sterling provides comprehensive answers and information about senior mental health and caregiver support.

Thank you so much for visiting this DearShrink.com Web page. Please check back often for new links, resources, and information.