back

A parent's loss

By Dr. Radha Shankar

The Hindu Times, March 11, 2001

HER sculpted but finely wrinkled face revealed little emotion; the voice was tightly controlled; the tremors of her hands, and the small shudders that shook her said it all. She was 65-years- old and was discussing the death of her 45-five-year-old son that had taken place two years ago. Every detail was recounted with painful clarity. Dinner had finished, as always, at 7-30 p.m. They had been watching television. The telephone rang, and the news was broken with brutal frankness. Her first son had died, an hour ago.

The tremors and shudders were clearly in evidence. "My younger son scolds me. He says that it is more than two years since his brother left us, and that I should stop talking about this to every person I meet. I really don't want to, but the words seem to come out on their own. Can you give me something that will make me sleep at night? I can manage in the daytime, but in the stillness of the night, I am flooded with the happy memories of his growing up. And then I realise, that I am left only with those memories, and nothing else."

Mrs. A had been referred to me by her physician who was puzzled by her many complaints, and his inability to find anything seriously wrong with her.

Mr. V was in his early 70s. Persistent problems with his sleep was why his general practitioner referred him to me. "I am fine, doctor" were his opening remarks. "My wife feels that I am not sleeping enough, and you know how women are." Behind the jocular facade, the tense body language conveyed the truth. His 35-year- old daughter had died in the United States of leukemia.

"I am no stranger to death," he said. "My parents, uncles, aunts. But they were all older, and I could accept their death as an inevitability." He half smiled. "Strangely enough, I went for some pre retirement workshops so as to mentally prepare myself for retirement and old age. "But nothing can prepare you for this. In spite of my increasing physical frailty, I felt that I was strong because of my children. But when I lost my child, it was as if I been bled completely, leaving me hollow and empty inside. To lose your child is the final denouement for an elderly parent."

Mr. And Mrs. V lived alone with only the bi-weekly telephone calls from their two other children in the U.S., and the slow ticking of the clock to keep them company. Mr. V was obviously struggling with his unresolved grief.

The contrast between Mr. V and Mrs. A could not be more striking. Mr. V was urbane, sophisticated, the much travelled city dweller. Mrs. A was rustic, earthy, living in the ancestral home of her husband, tucked away in small town in Tamil Nadu. Unknown to each other, they were united with the searing pain of long, weary sleepless nights. They were bonded in their futile quest for answers to two questions that never seemed to leave their minds: Why was my child taken away? What did I do to suffer this loss in my old age?

Both stories had a frightening similarity about them. In the period immediately following the bereavement, their families had rallied around them. However, soon thereafter, the younger members of the family left for their respective homes. The grieving elders were left behind, alone and defenceless. Mr. V and Mrs. A were merely two old people unable to cope with their loss, with no one to comfort them other than their equally bewildered spouses.

To mental health professionals, they represent much more than routine case histories or "a difficult-to-find-a-solution human interest story." They are an ominous indicator of the psychological problems likely to be faced by the elderly as the social fabric and demography of urban India undergoes rapid changes.

It can be argued that dealing with death is one of the tasks of the elderly. Coming to terms with the death of adult children is a less explored and qualitatively different issue. One for which solutions are hard to come by.

Since death is the only certainty in life, the process of grieving, or coping with death, is regarded a "normal response". Most people go through stages of shock, sadness, searching for the loved one, and finally reach mental stability in six months when they come to terms with their loss, but may grieve especially at anniversaries. When the grieving process is delayed, prolonged or distorted, it is known as abnormal grief. In these situations, the survivors fail to accept the finality of the loss, and are unable to rebuild their lives after the event. This occurs in about 15 per cent of cases.

Abnormal grieving often occurs in situations when the death is unnatural (suicide, homicide or accidental), or when the death is premature, or occurs at an inappropriate time in the life cycle of the human being. People with poor social support, emotional or health problems, are regarded as more vulnerable to abnormal grieving.

Old age is a period potentially fraught with several stresses. Physical frailty, lack of economic security, reversal of parental roles and increasing emotional dependence on the younger generation often tax the capacity of the elderly to cope. In these circumstances, the unnatural and premature death of one's adult offspring is often too heavy a burden to bear.

In addition to mourning the loss of a child, the elderly may have to deal with renewed fears of financial and emotional insecurity, and having to adjust to change in living circumstances. For some senior citizens, the well-being of the grandchildren becomes a source of great worry, coupled with the belief that they are too frail to impact the situation. An untimely demise, especially in the autumn of one's life, may generate tremendous despair in parents because of the uncertainty related to the perpetuation of one's vamsham (family name).

Having to confront and deal with one's own mortality is likely to be an unstated but prime concern for many elders, and they may lament the loss of their offspring who is needed to perform the last rites for them. At all ages, an individual deals with the death of a loved one in the belief that the future holds promise for better times. For many elderly, the ominous ticking of the clock means that they do not have the luxury of time or expectations of the future. In modern times, the bereaved elderly have become vulnerable not only because of the loss of traditional supports like a joint family and close knit neighbourhoods, but also erosion of traditional and religious beliefs.

A striking example of this is the progressive shortening of mourning rituals. While the spiritual sanctity of these rituals is best left to religious leaders, it is now recognised that these rituals provide some form of psychological support by bringing the family together for a defined period of time. However, today, they have become perfunctory. This also means that an important source of comfort and support for the elderly (especially those who are religious minded) is being diminished.

In the absence of strong emotional and social support, some often fail to recover. The story of Mr. K is a graphic illustration. A retired government official, in his mid 60s, he was enjoying his retirement, when his eldest son died in an accident. Mr. K was unable to summon the strength to perform the funeral rites. Soon, his health began to deteriorate rapidly. His other son was settled in England, his daughter was concerned and loving, but had to cater to the needs of her own family. A few days after his son's first death anniversary , Mr. K. suffered a stroke. The fortnightly phone calls from his son and occasional visits from his daughter were not incentives enough for Mr. K to pull himself out of his depression and continue to meet the challenges of living.

Do all senior citizens experience abnormal or distorted grieving? Although the death of a progeny is a hard loss to bear, many senior citizens cope with the situation admirably, often serving as a source of strength to the middle-aged and younger survivors. These elders reconstitute the remainder of their lives with a wide variety of coping mechanisms. These include drawing strength from spiritual and religious sources, purposeful activity within the limits of their physical ability, reasserting their moral authority as the elder in the family and providing courage to their younger relatives.

There are no simple solutions for helping the elderly cope with losses because they could experience a wide range of emotional and behavioural responses, ranging from florid depression to carefully masked stoicism. And there are no ready-made answers to dealing with this challenging but most basic of human emotions.

The first step in providing assistance is to recognise their vulnerability, and attempt to support them actively, not just immediately following the loss but well after that. It is also important to acknowledge the right of the elderly to mourn, and not expect them to snap out of it as quickly as do younger people. However, this should be moderated by efforts towards resumption of a normal routine, and encouraging the person to reassert his or her moral authority as the senior in the family.

Younger family members are often alternately amused and concerned about the proclivity of the elderly to talk about the past. In the context of bereavement, this is seen as a morbid preoccupation with the deceased. Allowing the person to reminiscence about the dead child has a soothing effect, and should not be regarded as abnormal. But it should not become the predominant activity.

Focussing on the strengths of the elderly and encouraging them to draw from their experience and guiding them to assist a more needy person helps mitigate their brooding about the injustice of fate.

As a psychiatrist, my efforts to deliver optimal care and support to elderly citizens seeking assistance to deal with such trauma has often represented a professional challenge. Medical training equips us to prescribe antidepressant medication, provide counselling and supportive therapy and help people get on with the business of living. Many of these interventions are effective, and it is important for families and caregivers to initiate the process of seeking professional assistance as soon as they recognise that the person is suffering from abnormal grieving.

However, I am conscious of the limitations of these medical approaches, which may not always help create a meaning and purpose in life for the bereaved. This can result only through societal interventions that emphasise not the frailty but the dignity of senior citizens and the recognition that there are several stakeholders in the well-being of our elderly. These could include the immediate family, neighbours, social service organisations, religious leaders and the younger generation.

Copyright © 2002 Global Action on Aging
Terms of Use  |  Privacy Policy  |  Contact Us