The death of a child and the risk of cardiovascular diseases
I was in the middle of getting my doctorate 14 years ago when my son, Steven, 29, was killed in a brutal car accident and incompetent roadside care. I knew my world was turned upside down. I expected the endless tears, but I was surprised by my physical changes: large weight gain, high blood pressure, poor sleep and a major life-threatening infection. What I felt was so much bigger than sorrow and it crept into all areas of my physical life.
I was a researcher and began to do online searches on grief over the loss of a child. I searched mourning and illness, health outcomes from trauma, and health issues for parents living with the loss of a child. I found a field of study emerging on the impact of grief on our bodies and health. Evidence indicates that some grieving parents presented with cardiac issues within a year or two of the loss of a child. Although the data seemed to look at men’s health more than women, grief invaded our minds and bodies and our hearts were literally suffering.
I had heard about “Broken Heart Syndrome” and was told that someone in my extended family had a fatal heart attack within minutes of hearing a radio newscast of her brother’s murder. I knew that I became a cardiac patient within a few years of my own loss. It took almost seven years for me to take my physical health as seriously as I was taking my emotional health. Our COPE staff and programs help our families in so many ways and parents and siblings describe the emotional support and kindness found in our groups and programs as “life-saving.” We need to look at our physical health as well. That, too, can be life-saving.
Sandra R. Wolkoff, PhD., LCSW-R
The death of a child and the risk of cardiovascular diseases
By Dang Wei and Krisztina László
The death of a child is a devastating event and the subsequent grief is often intense and long-lasting. In addition to its psychological effects, losing a child could affect parents’ cardiovascular health, but knowledge in this field is very limited.
A research group from the Department of Global Public Health at Karolinska Institutet in Stockholm, Sweden conducted a series of studies on this topic and found that parents who lost a child had higher risks of acute myocardial infarction, ischemic heart disease, atrial fibrillation, heart failure, and stroke than their non-bereaved counterparts. The studies reported that these associations were observed regardless of the child’s studied cause of death, i.e. cardiovascular diseases, other natural causes, or unnatural causes. Further, the risks of atrial fibrillation, acute myocardial infarction and hemorrhagic stroke were highest in the first week after the loss, but the increased risk persisted throughout the 21-year median follow-up. The findings may suggest that stress-related mechanisms are likely to contribute to the development of cardiovascular diseases in bereaved parents.
The studies were conducted using data from the nationwide Danish and Swedish population-based registers and included in total 6.7 million parents of children born during 1973-2016 in Denmark and during 1973-2014 in Sweden. Information on demographic, socioeconomic and health-related factors for the parents and the children was retrieved through individual-level linkage between several nationwide registers.
Though the data did not allow to study the mechanisms underlying the observed associations, the researchers believe that the death of a child may induce psychological and behavioral changes, such as depression, anxiety, anger, disturbed sleep, increased smoking, alcohol use or sedentary behavior. These may result in changes in the neuroendocrine, metabolic, haemostatic and cardiovascular systems, which in turn may contribute to an increased risk of cardiovascular diseases. However, further studies are needed to understand the mechanisms.
The findings may call for increased awareness about the potential cardiovascular health effects of bereavement, for increased social support from family members and friends and for attention from family or health professionals concerning changes in health behaviors and cardiac symptoms in parents who lost a child.
More information about the studies may be found in:
- Wei D. Bereavement in adulthood and risks of incident and recurrent cardiovascular diseases. Department of Global Public Health, Karolinska Institutet, 2022. https://openarchive.ki.se/xmlui/handle/10616/47975
- Wei D, Janszky I, Fang F, Chen H, Ljung R, Sun J, Li J, László KD. Death of an offspring and parental risk of ischemic heart diseases: A population-based cohort study. PLoS Med 2021 Sep 29;18(9):e1003790.
- Wei D, Olofsson T, Chen H, Janszky I, Fang F, Ljung R, Yu Y, Li J, László KD. Death of a child and the risk of atrial fibrillation: a nationwide cohort study in Sweden. Eur Heart J. 2021;42(15):1489-1495.
- Wei D, Li J, Janszky I, Chen H, Fang F, Ljung R, László KD. Death of a child and the risk of heart failure: a population-based cohort study from Denmark and Sweden. Eur J Heart Fail. 2022;24(1):181-189.
- Wei D, Li J, Chen H, Fang F, Janszky I, Ljung R, László KD. Death of a Child and the Risk of Stroke: A Binational Cohort Study From Denmark and Sweden. Neurology. 2022;98(11):e1104-e1113.
The following is a list of appropriate expectations that you can have in grief. Evaluate yourself on each one and see if you are maintaining realistic expectations for yourself.
You can expect that:
- Your grief will take longer than most people think.
- Your grief will take more energy than you would have ever imagined.
- Your grief will involve many changes and be continually developing.
- Your grief will show itself in all spheres of your life — psychological, social, and physical.
- Your grief will depend upon how you perceive the loss.
- You will grieve for many things both symbolic and tangible, not just the death alone.
- You will grieve for what you have lost already and for what you have lost for the future.
- Your grief will entail mourning not only for the actual person you lost but also for all of the hopes, dreams and unfulfilled expectations you held for and with that person, and for the needs that will go unmet because of the death.
- Your grief will involve a wide variety of feelings and reactions, not solely those that are generally thought of as grief, such as depression and sadness.
- The loss will resurrect old issues, feelings and unresolved conflicts from the past.
- You will have some identity confusion as a result of this major loss and the fact that you are experiencing reactions that may be quite different.
- You may have a combination of anger and depression, such as irritability, frustration, annoyance, or intolerance.
- You will feel some anger and guilt, or at least some manifestation of these emotions.
- You may have a lack of self-concern.
- You may experience grief spasms, acute upsurges of grief that occur suddenly with no warning.
- You will have trouble thinking (memory organization and intellectual processing) and making decisions. You may feel like you are going crazy.
- You may be obsessed with the death and preoccupied with the deceased.
- You may begin a search for meaning and may question your religion and/or philosophy of life.
- You may find yourself acting socially in ways that are different from before.
- You may find yourself having a number of physical reactions.
- You may find that there are certain dates, events, and stimuli that bring upsurges in grief.
- Society will have unrealistic expectations about your mourning and may respond inappropriately to you.
Certain experiences later in life may resurrect intense grief for you temporarily.
In summary, your grief will bring with it, depending upon the combination of factors above, an intense amount of emotion that will surprise you and those around you.
Most of us are unprepared for the global response we have to a major loss. Our expectations tend to be too unrealistic, and more often than not we receive insufficient assistance from friends and society. Your grief will not only be more Intense than you expected but it will also be manifested in more areas and ways than you ever anticipated. You can expect to see brief upsurges of it at anniversary and holiday times, and in response to certain stimuli that remind you of what you have lost.
Your grief will be very idiosyncratic and dependent upon the meaning of your loss, your own personal characteristics, the type of death, your social support and your physical state.
Taken from Therese A. Rando, How To Go on Living When Someone You Love Dies. New York: Bantam Books, 1991, pp 79-80.
How to Keep Living When Your Child Has Died
Grieving the death of a child is a struggle that can seem overwhelming and impossible.However, when you choose to grieve, you can survive, heal, and even find joy again. Arleah Shechtman, who lost her fifteen-year-old daughter more than three decades ago, shares what she has learned about the grieving process over the course of a lifetime.
Kalispell, MT (August 2012)—Every parent has probably said (or at least thought) some version of these words: “If I lost my child, I don’t know how I could go on living.” It’s true: The death of one’s child is such a devastating prospect that the mind can hardly process it. When you dare to explore this most primal and terrifying parental fear, the best you can come up with are questions: Would I be able to function at work? Would my marriage hold together? Would I ever—ever—be happy again?
If you haven’t lost a child, you can’t know the answers. If you have lost a child—a month ago, a year ago, a decade ago—you still may not know them, says psychotherapist and executive coach Arleah Shechtman. That’s because the answers change depending on the choices you make and how far along you are: Grieving a dead son or daughter is a lifelong journey, and the grief manifests in different ways as the decades pass.
“Grieving makes life different from before,” says Shechtman, author of the new book My Beloved Child: My journey since the death of my daughter (Fifth Wave Leadership Publications, 2012, ISBN: 978-1-4750469-9-1, $13.95). “You cross an invisible force field and there is no way back. There is no way to plan for the road that lies ahead, or to fully articulate what you have experienced. Loss irrevocably changes the rest of your life, so the ‘process’ of grieving is never really completed—though its intensity and expression do change.”
Shechtman, who lost her fifteen-year-old daughter more than thirty years ago, has written a brutal and powerful book about what it’s like to make the choice to grieve—over and over again. Each chapter describes her experiences during a given five-year time block, ranging from the first five years to thirty-five years after the loss. The book is interspersed with Shechtman’s raw, moving, and beautiful poems, which played a large role in her healing process.
Grief does not always happen in easily identifiable stages, she notes, and it’s likely that you will never fully plumb its depths. However—and this is crucial for a grieving parent to know—there is hope for healing, rebuilding, and continuing love.
“All parents who experience the unthinkable—the death of a child—have many critical choices to make, and those choices truly do span the course of a lifetime,” she says. “There are no lesson plans for grieving: It’s a messy, nonlinear process that differs for each person. All I can do is share my own experiences, my own choices, and hope that others find them helpful as they struggle forward.”
From My Beloved Child, here are thirteen lessons and truths that Shechtman has learned since the death of her daughter:
Grief cannot be denied, only delayed. After losing a child, you might find that you are tempted to pack your grief away and ignore it as much as possible, because its sheer enormity seems overwhelming. Facing such strong and painful emotions—as well as admitting that you aren’t in control—is incredibly daunting. That’s why Shechtman says that choice number one on the long journey back from “destroyed” to “rebuilt” is simply to grieve. And, as she expresses throughout her book, it’s a choice you will need to make over and over again.
“Over the years, I have noticed that when people try to suppress grief, it shows up through physical symptoms—often upper respiratory illnesses,” she shares. “Exerting that much control over your emotions, thoughts, and body is very stressful and will impact your health. It might be helpful to know that choosing to grieve does not mean that you will be swamped with unmanageable feelings for the rest of your life. I have never known anyone who did the hard work of grieving who wasn’t able to get back to a normal, meaningful, and even joyful life.”
Grief “happens” in waves. They will pass. These waves, which surface at unpredictable times, are relatively short in duration but may be very intense. When you ride the waves to the crest and express whatever is there, the wave will ebb, and you will be able to go on living for awhile. And over time, the waves of grief happen further apart and are less intense and devastating. Realize, though, that if you ignore your feelings, you will never experience “normal,” because your intense emotions will always be trying to escape.
“Many bereaved parents are afraid of being stuck forever in the throes of intense grief if they allow themselves to feel it even once,” shares Shechtman. “I promise, that is not the case. I found that my most intense bouts of grief were relatively short—less than ten minutes. I also find that after each period of intense grief, it helps to do something mundane and normal. For instance, my husband and I went to Burger King for a meal after Sharon’s emotionally exhausting funeral. Those few moments allowed me to regroup enough to go on, and that incident was the beginning of a pattern that still works for me.”
Don’t stifle outbursts of grief. Grief is a primitive, primal experience that isn’t something we learn. It’s instinctive, and expressing it isn’t something that you can plan, script, or tone down—nor should you attempt to. The emotions you are feeling go beyond words, concepts, or thoughts. And only by fully expressing them can you begin to heal.
“Cry, scream, and allow yourself to ride the waves you’re feeling,” urges Shechtman. “I remember wailing, keening, and crying many times after losing Sharon. Years after her death, I found myself screaming and jumping up and down in anger while visiting her grave. All of these behaviors transgress the boundaries of ‘polite’ and even ‘acceptable’ behavior, but believe me, they are necessary—and society’s unwritten rules about the expression of grief are unhealthy and wrong. Trust your process.”
Don’t listen when people try to silence you with a Valium or prayer. The expression of grief is often deeply uncomfortable for others to witness. And after weathering the initial shock of losing a loved one (whether it’s a child or not), others want the bereaved to “move on,” to adopt a stoic attitude, or to medicate themselves—anything to avoid being reminded of and upset by fears they themselves don’t dare to contemplate.
“I found out in no uncertain terms that the world doesn’t sanction grief when the minister at my daughter’s funeral told me, ‘Okay, it’s over, now buck up and deal with it,’” Shechtman recalls. “Nevertheless, I grieved loudly and often for at least the first year, upsetting many folks who wanted me to shut up and take some pills. Please know that I’m not against medication or prayer in general—only when they’re used to prematurely and falsely stop the grieving process.”
Let yourself express anger. When Shechtman insists on the importance of expressing your grief, she means anger, too. This is often an especially thorny emotion to process because it involves the need to place blame, which can sometimes fall on the dead person and/or on the bereaved. These expressions of anger are seen as inappropriate and elicit protests such as, “It’s not fair,” “The dead aren’t here to defend themselves,” “They didn’t die on purpose,” “You’re being selfish,” etc.
“Nevertheless, it’s crucial to articulate your anger, which is one of those extreme feelings that needs to be let out in order for healing to take place,” Shechtman asserts. “I felt really guilty after screaming my anger while visiting Sharon’s grave, but that catharsis needed to happen. And, of course, while I felt anger that I had lost her, I didn’t and still don’t hold any type of grudge against my daughter.
“Remember, at its worst, not expressing anger can lead to bitterness and cynicism,” she adds. “And at its least, it still creates a distance between you, the dead, and the living that is unbridgeable, because you can’t be safe and intimate at the same time.”
Choose to risk loving again. After experiencing loss, it’s natural to want to do anything and everything in your power to avoid feeling such bitter pain again. You may want to wall yourself off from life, love, and relationships of all sorts. However strong the temptation is, though, please don’t make this mistake. Despite the guilt, anguish, and self-doubt you may feel, make the choice to risk loving again.
“In the years and decades after Sharon’s death, I was fortunate enough to have friends and loved ones who called me out on the fact that I was shutting myself away,” Shechtman shares. “Yes, these accusations caused conflict. But I’m glad I chose to engage these people, because the anxiety that accompanies fear of loss is still a much better alternative to the bitter loneliness of isolation. When you disengage, you doom yourself to emotional, physical, and spiritual shutdown.
“Best—and most surprising—of all was the aftermath of choosing to love again. Consciously choosing to lift my eyes, to see joy and possibilities, to build relationships, and to live instead of dying with my child have resulted in some of the happiest years of my life. And because I have been in both places—isolation and community—the contrast is startling.”
Expect your family to “die” along with the child. For obvious reasons, the loss of a child is very traumatic for everyone in the family. It’s hard to contemplate an event that would be more disruptive. And the statistics bear out this truth: According to Shechtman, around 90 percent of marriages are in trouble within months after the loss. And of that 90 percent, about half will make it through intact.
“It has been my experience that the tragedy of losing a child destroys the notion of ‘two being one,’” she explains. “Each partner must grieve in his or her own way, and the two will rarely be in sync. Furthermore, the person to whom each partner would normally look for solace is too upset to help. Often, blame and anger ensue. In my case, my marriage with Sharon’s father was already in serious trouble, and her death erased any hope of reconciliation. Please know, though, that many other families can and do reconfigure themselves despite the pain and loss, although doing so takes time and work.
“There is one more important point I need to make: When one child dies, any surviving siblings are especially adrift,” she adds. “They’ve lost a brother or sister and (for all intents and purposes) their parents, who are also grieving. Without talking about the loss, the impact on surviving siblings is even more destructive.”
Let people help you. As Shechtman has acknowledged, it’s all too easy to sink into a private, quiet, internal place that feels safe. The false bargain you’re making with yourself is, If I don’t think about her or talk about her, then she won’t be so gone. Asking for and accepting help is another conscious choice you will need to make.
“Once I allowed people to matter, I felt a persistent sense of being ‘held up’ by all the prayers, good wishes, and positive vibes sent my way,” recalls Shechtman. “I also learned to proactively build a circle of individuals who could and would help when I needed extra support. This happened after my husband told me that while he loved me dearly and understood my pain, he couldn’t listen any more, right then. I gradually developed a list of about ten people I trusted and whom I could call, one by one, to see if they were up for my grief at that moment. Invariably, someone was always there with comfort and solace.”
Funerals and gravesites are crucial to the grieving process. Funerals serve a very important purpose: saying the final good-bye and making the loss real. Without a ceremony or ritual, there is no closure (a truth that explains why the MIA-POW movement is so active). And as time passes, the gravesite is still a very important place to remember, grieve, and recover.
“Before Sharon’s death, I remember being very critical of funerals, cemeteries, and mourners,” shares Shechtman. “I thought it was all a lot of fuss about nothing. And I guess it is—for those who have not faced a death in the family. It is not really possible to convey bereavement, or the importance of tangible ceremonies and rituals, to the non-bereaved.”
Music, movies, art, and poetry can help you process your grief and move on. While healing happens differently for everyone, many bereaved parents find music, movies, art, and poetry to be often-unexpected sources of solace and comfort. Use any and all resources at your disposal to “get on with getting on.”
“The grandness of Beethoven’s ‘Fifth Symphony,’ written while the composer was going deaf, always inspired me to make it through one more day,” says Shechtman. “Other sources of help were Roberta Flack’s song ‘Jesse,’ the films Mask and What Dreams May Come, and writing my own poetry. Likewise, you’ll find songs, stories, and words that speak to your heart and hold special meaning.”
Grief has a way of clarifying values. As you begin to move on and heal from your loss, you will view, experience, and interact with the world in a different way. Shechtman remembers not understanding why she couldn’t be “like everyone else.” She eventually realized that the trouble she had relating to many others stemmed from a clash of values.
“I kept getting pushback for being too harsh or too blunt,” she explains. “I no longer had any tolerance for political correctness, and I considered my relationships to be more precious. I found myself more open with people I cared about, as well as more confrontational and demanding, since I didn’t want to leave anything unsaid or undone ever again. Essentially, I was choosing my values of growth and honesty over comfort. I decided that perfection was no longer a goal; being honest and authentic was.”
Honor the little-known sixth stage of grief. We have all heard of the five stages of grief: denial, anger, bargaining, depression, and acceptance. But according to Shechtman, the progression doesn’t end there. The sixth and final stage of grief is called “in memoriam.” It’s the need to do something creative, useful, and meaningful as a result of an event that once seemed (and might still seem) meaningless, needless, and/or absurd. For example, individuals at this stage might create a foundation or support group.
“Personally, my book—My Beloved Child—was a product of this stage of grief,” says Shechtman. “It was a way for me to try to put the pieces of my life and my experiences back together in a way that made sense to me, helped others, and honored Sharon.”
There is a surprising flip side to grief. While it may be difficult to believe or understand immediately following the loss of a child, there is a silver lining to grief. Keeping current with sorrow (i.e., allowing yourself to grieve naturally and whenever you need to) gives you new depths of appreciation for life, joy in small delights, and a richness in relationships you may not have known was possible.
“The biggest surprise I’ve had after Sharon’s death is that my grieving has opened me up to all that is beautiful and wonderful about this world,” Shechtman says. “My appreciation for others and their struggles is greater, and I stop to smell the roses more often—something I call ‘living from the gut.’ This is the ‘payoff’ for choosing to allow yourself to grieve: After experiencing the lowest of lows, your soul and your psyche can also stretch to experience greater highs.”
“After Sharon’s death, what stands out most to me is the difference between those who grieve and those who don’t,” Shechtman concludes. “The most important choice you can make for yourself in the midst of this terrible tragedy is to allow yourself to grieve, to feel, to express yourself, to be vulnerable and authentic, and eventually, to begin healing. I have deep respect for those who make that choice.”