Cuban Medical Research

Family Loss: Characteristics of a Family Crisis

Clara Pérez Cárdenas¹
Armando Sebazco Pernas, MD.²

ABSTRACT: We conducted a descriptive study aimed at determining what happens when one of the members of the couples who gave origin to the families studied died (period of dissolution or family loss). For this we reviewed the family medical records, kept at the neighborhood family doctors' offices of the population served by the Dr. Mario Escalona Reguera Teaching Polyclinic in Alamar, in Havana. The scope of our work consisted of 62 family units who we interviewed in their homes following an interview guide. Families with a member confronting widowhood were included in the study, giving special attention to the development of good rapport. Our motivation for carrying out this study comes from the fact that this period in the vital cycle of a family has not been explored in previous published research We paid special attention to how well the interviewee was prepared to cope with the event (the death of his/her partner), his/her feelings during mourning, the social support network at the time of the event and of the interview, current conflicts, and the restructuring of his/her social and sexual life. The results obtained reveal that in the majority of family units studied, the loss of a family member was an unexpected event. Furthermore, they were not prepared for it. Even at the moment of the study they still expressed suffering and grief. Special emphasis is placed on the role of the family unit in providing emotional support when such a loss occurs.

A family is a social group that has been subject to modifications based on the changes that have taken place in the society in which they live. The definition of "family" has proven to be very difficult for researchers. However, all of them agree on two basic elements: the existence of consanguinity, and the affection among the members of this social group. We have given great importance to this latter element. (Pérez Cárdenas C. La familia y sus crisis transitorias. Compilation of research results at the Dr. Mario Escalona Reguera Teaching Polyclinic, Havana. Calixto García Medical School, 1995).1

Our concept of family crisis refers to a situation that promotes changes, either favorable or unfavorable, in the dynamics of this group. 2 According to Galperin, these are situations that imply structural ruptures and restructurings of the entire family system. These situations can be the result of either intra-familiar factors or external factors. 3 Family crises have been divided into transitory and non-transitory phases. Transitory crises are those modifications that are observed in the dynamics of a family due to events that occur in the normal course of their life, that is, things that cannot be avoided. The second type includes those alterations that are observed in the dynamics of a family due to events that are external to the family: natural disasters, accidents and illness, to name a few (Pérez Cárdenas C. La familia y sus crisis transitorias. Compilation of research results at the Dr. Mario Escalona Reguera Teaching Polyclinic, Havana. Calixto García Medical School, 1995). 2

We will use the term family loss period to refer to the time in the life of a family following the death of one member of the couple that has given origin to this social group. This period has also been termed "dissolution period" in medical literature. Considering the family as a system, it is evident that the death of one of its members implies, in the first place, disorganization of family dynamics (a crisis), and then, reorganization in its dynamics to adjust to the role changes and to the new forms of communication and interaction posed by the loss of that family member. 2,3

According to Isa Fornega, 4 mourning is precisely the process of adaptation that follows any important loss in our lives. It is a very painful process through which we must all pass since it implies undoing the bonds and the relation we had with the loved one who is no longer with us, and restructuring our lives. The nuances of this process may vary in terms of the reactions of family members, depending on their culture, education, the characteristics of their personality and the type of bonds with the deceased. Our study is an approach to the conflicts and experiences expressed by the family members we interviewed from the perspective of their active role in this period of their family life. We hope our findings will be useful in promotion and prevention efforts developed at the primary care level.

Development

We reviewed the family medical records in 21 of the neighborhood family doctors' offices served by the Dr. Mario Escalona Reguera Teaching Polyclinic in Alamar, in Havana, where the authors of this study work. The study covered 62 family units, specifically 42 women and 20 men who were confronting the loss of their partners, after having gone through all the stages of creating a family. We interviewed these people and explored general variables such as age, sex, occupation, education, and time elapsed since the loss, as well as specific variables relevant to the reaction of the spouse or partner of the deceased person.

These were the members of the families that we chose to interview, since they had had the longest relationship with the deceased. Furthermore, they were the family members who had been more closely involved in the activities and events we wanted to explore. We gave special importance to the establishment of good rapport, given the emotional implications of the phenomenon investigated.

We divided the participants' answers into categories that made it possible for us to formulate results. We used the method of percentage analysis. The most general objective of our research was to describe the behavior of some behavior variables that we considered influential in this period of each family unit's evolution.

Results revealed that participants were a group of individuals with an average age of 62 years, for both sexes, and who had completed primary education. Among the female population interviewed housewives prevailed; however, among men, the majority were retired, with an important number of them still on the job.

The duration of marital relations in the case of men, was between 31 and 40 years, and in the case of women, between 16 and 20 years. Almost all the interviewees had lived with their partner in marriage; women reported having lost their spouse 5 years ago; but in the case of men, this loss was more recent.

In general, our group had not expected the loss of the family member and had not been prepared for it. Men, although apparently more surprised by the event, said they were better prepared to cope with it. This could be explained by the idiosyncrasy of "manhood", men who tend to present an image that keeps them from freely expressing emotions and conflicts.

Overall, we found that the majority of people we interviewed identified grief and nonconformity with the loss of their family member, which was followed by a feeling of resignation. For all those interviewed, this event was shocking, and very few expressed tranquility. More health problems were found in women than in men. In general, all the subjects interviewed expressed some kind of post-event alteration. Women showed psychological disorders such as anxiety, depression, apathy, abulia, etc. Arterial hypertension appeared as the only nervous alteration in the group of men who admitted to having any.

At the time of loss, the support received by participants from their family was valued as positive. We observed, however, that the appreciation of family relations is not always as gratifying as expected. This includes expressions of interference in communication and negative interpersonal relations, mainly with the partners chosen by the children of the family for the creation of their own families.

The family has been the fundamental pillar in the emotional support received by the interviewee at the time of the study, and acquaintances may play more of a role than friends. This is explained by the average age of our subjects, which implies a reduced number of friends due to physical loss. Another element which may favor support relationships in our society is the urban architectural tendency towards apartment living, which facilitates a face-to-face relationship among neighbors as well as a higher degree of sympathy at the loss.

We also studied the social conduct adopted by the interviewees after the loss of their partner, with domestic chores in general becoming the most common activities adopted, especially by the women.

The current conflict of the interviewees is the suffering at the death of their partner. No other event has such an alarming aftermath. Among the women, we were impressed by the detailed memories they had of their lives with their partners. This may be due to the fact that culturally, they have been prepared to be the natural "love providers" in the family, and so this element is always present when they refer to the various stages of their family lives. Men were found to be more likely to consider their present life as a conflict, which is also related to the above-mentioned cultural trends.

Many of the participants said they had not entered into any new relationships, and in fact said they did not wish to restructure their lives in this sense. This feeling was more prevalent among women. The majority of our subjects tended to point to their age as a reason not to enter new relationships. They also expressed feelings of solitude and desires to devote their remaining years to their families. The majority did not feel the need to find a new sexual partner. Differences were found in the explanations given: women tended to feel that the deceased was their only love; men, while most did not wish to begin sexual life with a new partner, reasoned that this was so because they did not want to incorporate strangers into their family unit, or because they feared causing problems with their children by adopting a new sexual partner at their age.

Conclusions

In our study, persons had been married between 16 and 40 years before the death of their partner. All of them were living together as couples at the time of death. In the majority of cases, this event was unexpected and consequently, they were not prepared to confront the loss. Most of these people expressed rejection at the death of their partner, and said they were still grieving.

Women were more affected by anxiety and depression, which were less prevalent among men, who referred primarily to episodes of arterial hypertension.

A family unit is perceived as a social support group before and after the loss of a spouse. The women interviewed have resorted to housework and to senior citizen's clubs to alleviate their feelings of sadness, while men recommence their working life in search of a refuge for their emotional state. In most cases, these persons do seek a restructuring of their sexual lives, and the suffering from the loss of their spouse is still seen by participants as their central problem in their lives.

References

1. Dahm I, Geissler A, Hulter H. Sociología para médicos. Havana: Ciencias Sociales, 1990.
2. Pérez Cárdenas C. Crisis familiares no transitorias. Rev Cubana Med Gen Integr 1992; 8(2):144-151.
3. Zigman D´ Galperin C, Jeroz D´ Alicia A. El ciclo vital familiar. Buenos Aires: El Ateneo, 1992.
4. Fornega Jaramillo J. Cuando se muere el ser querido. El Jueves 1987.

This article originally appeared in Spanish in the Revista Cubana de Medicina General Integral, vol. 16, No. 1, pp. 93-7, 2000.

1. Masters in Clinical Psychology. Specialist in Health Psychology. Assistant Professor, Calixto García School of Medicine.
2. Specialist in Comprehensive General Medicine.