The loss of a spouse, especially after many years of marriage, can be extremely painful and disrupt normal living.

My dad passed away five months ago and mom is not doing well. They were married for 50 years. Now, mom seems to be depressed. She says it is normal. I am unsure it is.

Signed,

Waiting for better

Stats Canada reports there are about 1.8 million widowed individuals living in Canada in 2016. The vast majority of them are women. Clearly the loss of a spouse is a very traumatic and difficult experience and mom’s sadness is natural.

Loss of a loved one is also known as bereavement. The loss of a spouse, especially after so many years of marriage, can be extremely painful and disrupt normal living. It can set off a whole range of events and emotions. This question often comes up when family or friends are concerned about whether the sadness or grief is going on too long.

To understand the process, one must know that ordinary grief is a universal human experience. Some people believe there are stages to this grief process, but this has not been well supported in the literature. People seem to grieve on their own timetable and in their own way (or as some say, “two steps forward, one step back”). For some, it is a raw and difficult experience that devastates them, while others suffer it in silence and their grief is imperceptible to the people around them. Most individuals who grieve are preoccupied and often living in a state of disbelief. They have memories and thoughts of longing and sadness, and can also experience a range of emotions from guilt to shame to anger.

Some people may have a renewed appreciation for life and begin to feel some personal enjoyment while coping with their loss. This type of grieving person often transitions to what is considered “integrated grief” — when the acute pangs of grief become more bearable.

Dr. Cindy Grief, psychiatrist and grief specialist at Baycrest Health Sciences in Toronto explains: “People are incredibly resilient. Over time, it becomes easier to accept the loss and find ways to cope and even have rich lives. They say grief is timeless, because there will always be birthdays, holidays, anniversaries, celebrations and special family events, which can sometimes trigger painful feelings or ‘bittersweet’ memories.”

It is common to have rituals that can help individuals mourn and these can help manage the loss whilst ensuring that the loved one is not forgotten.

Different cultures and religions usually prescribe these grieving rituals to mark the passage of time.

Some individuals have a more difficult time healing and this is what has to be differentiated with respect to your mother. A process called “complicated grief” may mean an inability to accept the loss. Feelings of anger, avoidance or guilt can be pervasive and can mean that the person is not able to function day-to-day. This person may be stuck in this state and cannot move forward. They may not be able to manage to care for themselves properly or may be so preoccupied with feelings of sadness that they are severely depressed. Some people can become depressed in the aftermath of loss, so this is important to monitor.

Researchers have found that grieving individuals are vulnerable to adverse health/medical outcomes. Much like other stressors, someone with an anxiety disorder is also more likely to become ill. It is no surprise that substance abuse can also be a risk for those suffering a loss, especially if the death was not expected.

As a family member, it is crucial to watch your mother carefully. Does she take on more activity over time? The difficult periods should become less intense and shorter as time goes by; but it may take mom time to work through the loss. If you are concerned that things aren’t progressing in the right direction, seek an assessment from a qualified therapist.

Remember, most people do recoup and manage to move on with their lives, but for some it is a complicated process and they may need treatment and more formal supports to find their comfort. A good resource is bfotoronto.ca.

Nira Rittenberg is an occupational therapist who specializes in geriatrics and dementia care at Baycrest Health Sciences Centre and in private practice. She is co-author of Dementia A Caregiver’s Guide available at www.baycrest.org/dacg Email questions to caregivingwithnira@baycrest.org. This article originally appeared in The Star.