Are All Losses the Same?

Loss in Older Adults

References

Talking About Sad Events

Web Sites: Loss and the Recent Terrorist Acts

RESPONSES TO LOSS

ARE ALL LOSSES THE SAME?

No, not all losses are the same. Although the word "grief" generally is reserved for the feelings and behavior associated with death (e.g., bereavement), the same sort of reaction is seen after any loss considered important by the individual.

Examples are stillbirth and miscarriage, loss of a job, failing health, disability, amputation, loss of home, or divorce. Indeed, divorce, especially when dependent children are involved, can lead to some of the most tumultuous and persistent grief reactions.

Sometimes a loss that seems trivial to the outside observer, such as the death of a pet or a favorite celebrity, or losing an object of sentimental value, is followed by a severe grief reaction because the loss has a disproportionate significance.

The grief also can occur when the loss in intangible, such as after a stroke or cataract, when the loss is a function of a part of the body.

In each of these examples, the individual loses someone or something that is emotionally or physically "part of themselves." The meaning of such losses, the intensity of the grief, and the way people ultimately cope with the changes in their lives vary from person to person.

WHY IS LOSS MORE SIGNIFICANT IN OLDER ADULTS?

Grief is the emotional suffering experienced in reaction to loss. Late life is characterized by increasing numbers and severity of losses. The death of a spouse is perhaps the best known cause for grief in older people--and one of the most devastating.

However, many other major losses also are common. Parents, siblings, and, as more people live to a more advanced age, children also die. Friends may die in fairly quick succession.

Older people lose relationships through retirement, changes in residence (by themselves or others), and inability to congregate for social activities because of loss of transportation or failing health. Grief may also be triggered by material loss, such as loss of home and possessions (when one must move to a smaller place). A move also may necessitate loss of a beloved pet.

Finally, one may grieve for loss of body parts or functions, such as eyesight, hearing, or mobility. Avid readers, for example, may feel desperate when they no longer can see. Loss of hearing isolates one from others as communication becomes more and more difficult.

Loss is often instrumental in precipitating major depressive episodes. Although antidepressant medications are often helpful and may be necessary, psychotherapy may be at least as important. Sometimes a depressive episode represents the culmination of a series of losses so close together that one is not dealt with before the next comes along, overwhelming individual coping capacity.

Anger and resentment are also common reactions to loss, especially losses that undermine the sense of self-esteem, such as loss of physical function and opportunities. Anxiety and fear may underlie the anger or be frank expressions of loss. Suicide may be considered or threatened as a way of gaining a feeling of control over one's body and life.

The deficit model of loss and grief is helpful in guiding intervention. A loss leads to deficits in the sufferer's life. Grief will not be erased until other resources are found to compensate for such deficits. For example, loss of a spouse leads to loss of help with basic activities of living (e.g., "he always balanced the checkbook"), validating responses that enhance self-esteem, and emotional supports. It also leaves a deficit in social identity. Older people with a greater number of social contacts and a diversity of roles fare better than those who functioned mainly as a spouse, with few outside contacts.

Jacobson, J. & Jacobson, A. (2001). Psychiatric Secrets. Philadelphia, PA: Hanley & Belfus, Inc.