Grief: A mediating process between a loss and illness

Conjugal bereavement has ranked high among other losses and life events when rated by adults on a continuum of life stress.^1,2 A review of the literature on the mortality of bereaved spouses subsequent to a conjugal loss leads to the conclusion that such a loss is, in fact, a severe stressor and a significant public health problem.³There remains the question of how this loss affects the bereaved spouse. Loss of a conjugal partner is a well defined event that is followed by complex emotional, behavioral, and social reactions. At what point and in what manner grief itself becomes pathologic or leads to medical complications is not established. Yet, it is reasonable to postulate that the behavioral and physiologic responses of the organism to a conjugal loss may lead to complications. For this reason, the emotional, behavioral, and social changes produced by conjugal loss hold considerable interest as mediating variables in explaining the high risk of the bereaved.This paper will review modern thinking about the process of grief. It will relate that knowledge to several postulated pathogenetic mechanisms that lead to illness and death among the widowed. The goal is to determine if our knowledge of grief as a mediating process will enhance our understanding of the etiology of the psychological or bodily illness that may occur after a conjugal loss.