Esther, who is eighty and checks the obituaries daily, reported to her therapist that in the last month three people she had gone to elementary school with had died. She said she couldn’t remember so many people dying so often since World War Two.

A single death can leave us sad and bereft for years; repeated multiple losses are devastating. And death is only one of the losses we face. Partners and close family may become chronically disabled and require care. Your stability may be particularly tested if you have been depressed in the past. Research shows that a strong, intimate relationship with the sick person before the illness may protect you from the strain. Staying in contact with friends and neighbours also helps.

If you lose your partner, grieving is a natural response. You may cry, feel agitated and anxious, have trouble sleeping and lose your appetite. The pain and the yearning for the dead person can be overwhelming. You may even feel you are losing your mind. About 20 per cent of widows and widowers develop depression within the first year of their loss. This depression can be medically treated. Sometimes a self-help group with people who have experienced similar losses is helpful. Staying involved in activities and asking for support from friends and family can also help you cope.
Carlos had nursed his wife, Sonia, through the last three years of a severe and progressive Alzheimer’s dementia. At first her doctors had thought Sonia was neurotic, but finally Carlos had convinced them that she needed to see a neurol­ogist, and her condition had been diagnosed. Their children were estranged and offered little help – Sonia and their daughter-in-law did not get along – so Carlos continued working during the day and nursing his wife at night. She woke often, and became demanding and unreasonable as the illness progressed. Carlos managed to stay calm, but he felt increasingly alone and angry.

When Sonia died, Carlos felt some relief, but then immedi­ately started to feel guilty. He questioned whether he had done enough to help her. He started to have difficulty sleeping, and began to lose weight. He took early retirement and stayed home and drank most evenings. Finally, a neigh­bour suggested he attend a bereavement group that another friend had found helpful.

Carlos went to his first session reluctantly; he wasn’t sure the others would understand how he was feeling. When an older woman talked frankly about how difficult her husband had become before he died, Carlos realized with great relief that he could describe how he felt without hiding his less charitable feelings. Eventually, he was able to share with the group how much he missed Sonia, and what fun they had had before she became so ill. He even cried the third time he attended, with a mixture of pain and relief, when he talked about how amusing Sonia could be. He slept well for the first time that night. He began planning to visit his son and daughter-in-law and the grandchildren. He was coming to accept the fact that it was fine for him to find joy in his life, even though Sonia was dead.