Subject: gay widowers
From: MShernoff <[email-masked]>
Date: Fri, 27 Mar 1998 16:50:33 EST

Gay Widowers: 
Grieving in Relation to Trauma and Social Supports
                        Michael Shernoff, MSW
Published in the Journal of the Gay & Lesbian Medical Association, 
V.2, No.1, March, 1988

      1998 PLENUM Publishing Corporation

    Permission is granted to copy or reproduce this article either in full or
in part, without prior written authorization of the author on the sole
condition that the author is credited and notified of reproduction, and that
the publisher's copyright, and place of publication appear.

Abstract
Even though gay men experienced the death of partners before the onset of HIV
disease, and the AIDS epidemic has brought increased attention to the plight
of gay male widowers, there is very little research on the specifics of how
gay widowers mourn and what is required for them to adjust to their bereaved
state in an adaptive way. Objective: To describe the psychosocial issues
relevant to gay widowers, and how social support is central for them  to
resolve their grief in a functional way, and to offer some comparisons
between heterosexual and gay widowers, thus assisting health care
professionals in best serving this population and illuminating areas for
further research.  Design: The findings are primarily from empirical clinical
practice with support from the literature. Results: The lack of recognition
for male couples in general and for the status of a gay man as a widower in
particular, complicates the grieving process. Conclusions: Gay men whose
partners die exhibit the constellation of classic symptoms manifested by
survivors of other traumatic events. Mental health professionals can play
important roles in providing support and healing during the mourning process
of gay widowers.

Introduction
When a gay man's partner dies, his trauma is often exacerbated by the lack of
mainstream culture's recognition of his relationship, his loss, and being a
widower. All surviving partners regardless of sexual orientation experience
certain psychosocial and intrapsychic reactions. In addition, gay men face
unique stressors that complicate bereavement. This article is based on
fifteen years of clinical work with gay widowers and addresses their
psychosocial issues, the impact that  absence of social supports has on their
grief and how mental health professionals can help facilitate mourning. AIDS
has brought focus to gay widowers. "The bereavement process experienced by
gay men who experience losses due to HIV/AIDS must be understood as a chronic
state of mourning. The implications of overlapping losses where the onset of
mourning for one loss overlaps with the end stage of mourning for another
loss are significant. Complicating this chronic state are post traumatic
stress, loss saturation, unresolved grief, survivor guilt, and fear of
infection with HIV."(1)   The experience of many urban gay men is similar to
that of  a survivor of a major catastrophe, and must be assessed and
addressed within this context.

Literature Review
Most research on grieving spouses focuses on heterosexuals, especially
elderly widows and widowers(2, 3, 4, 5, 6,7,8). Research documenting and
describing the intimate relationships of gay men began to emerge in the late
1970s,(9, 10, 11, 12,13, 14).  McWhirter & Mattison(15) estimated that there
are over one million male couples living in the United States,  arriving at
this figure using a conservative extrapolation from Bell & Weinberg(9); Jay &
Young(16) and Spada(17). "In the last decade an extensive literature has
evolved about grief, but until very recently, little or no recognition has
been given to the grief of homosexual men who survive the death of a partner
or friend. Recent theoretical and clinical attention to AIDS and the special
problems of homosexual partners of persons with AIDS has resulted in interest
in the needs of survivors in relationships that continue to lack social
approval"(18). Prior to AIDS there were only two professional articles that
specifically addressed bereavement issues of gay individuals (19, 20). With
the onset of HIV disease, articles and books pertaining to gay men, grief and
mourning began to appear (1, 18, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31,
32, 33). As Martin (22) noted "most current knowledge of bereavement is
derived from research on conjugal loss and, to a lesser extent, on the loss
of a child or parent. The extent to which these findings generalize to gay
men who have lost lovers and close friends is unknown." Thus the mental
health needs and responses of  gay widowers is largely uncharted territory.
Even as the numbers grow, there has not been sufficient research and
literature exploring the clinical implications for gay widowers.

General Dynamics of Being a Widower
For all men, widowerhood needs to be viewed as both a social and intrapsychic
phenomenon. Rubinstein described widowerhood as: "a social role, produced by
the transition from married status to nonmarried by the death of a spouse.
The transition to widowerhood as a purely social role can be painful and
awkward, with inadequate role modeling and little direction. 
Intrapsychically, the adjustment to any loss is extraordinarily painful and
stressful"(34). Prior to AIDS few young or middle aged gay men knew any other
gay men whose partners had died.  Identifying as a gay widower has often been
complicated by the absence of visible role models. Bowlby(35) lists three
phenomena typical of adults to the loss of a spouse.  These are persistence
of the tie to the deceased by the survivor, emotional loneliness, and ill
health.  While Rubinstein and Bowlby only discussed heterosexual men, their
observations are equally applicable to gay widowers.  Glick et al(36) found
that men whose wives died tended to define what happened to them as a
dismemberment rather than an abandonment.  Gay widowers often speak in terms
of having lost a part of themselves after the death of their partner.  One
man said: "His death felt as if a part of my soul had been amputated."
Another told of "feeling as if both of my legs have been cut off and having
to learn how to walk again, but only this time with a prosthesis."
Rubinstein(34) characterized elderly widowers as either successfully or
unsuccessfully reorganizing their lives following the death of their wives. 
The successful group of men functioned well, appeared happy and had detached
themselves from the continued participation in the former marriage.  The men
unsuccessful at reorganizing their lives admitted various degrees of
unhappiness and appeared to be still married, psychologically, even after the
passage of years and were unable to reconstruct a full new life. DSM-IV(37)
states: "The duration and expression of 'normal' bereavement varies
considerably among different cultural groups. The diagnosis of Major
Depressive Disorder is generally not given unless the symptoms are still
present 2 months after the loss."  Heyman & Gianturco(5) found that long term
adjustment to bereavement was generally characterized by emotional stability,
stable social networks, few life changes and few bereavement-related health
deficits. All these constructs are equally relevant to gay widowers.
Glick et al(36) found that widowers moved more quickly than widows into
dating and eventual remarriage.  Some gay widowers begin dating soon  after
the death of their partner and others do not.  All widowers who resumed
dating described needing to be able to talk about their deceased partner.
    "Brad, the first man I dated after Chris' death was not threatened by
Chris. Possibly because Chris' death was relatively new, and my grieving
process was integrated into the development of our relationship."
The issue of comparing the deceased lover with the man being dated frequently
arises.
    "Michael knew that there were times I compared him to John.  He also knew
that John's death had become a part of who I was."
For men who want to partner again, the ability to begin a new relationship is
one indication they are working through their grief. Glick et al(36) suggest
it is not wise to correlate social recovery from the death of a spouse with
remarriage. Yet establishing a new primary love relationship is one
indication that the gay widower is reorganizing his life.

Issues Specific to Gay Widowers
Issues for all widowers include: How long does one remain a widower?  What is
entailed in developing an identity as a widower?  How does a bereaved man go
about adjusting in healthy and adaptive ways to the trauma of a partner's
death? Does he still consider himself a widower even after falling in love
with someone new and moving into a new relationship? Is there any resolution
to the enormity of this kind of loss?  Issues unique to gay widowers include:
How does where he is on the continuum of "coming out" and developing a
positive gay identity(38) affect his grieving and ability to ultimately
resolve his mourning? Since the onset of AIDS many urban gay men have
experienced multiple AIDS-related deaths.  How does the death of a partner
trigger the grieving process for other deceased friends or loved ones? If the
grieving widower is himself HIV-positive, how does his health status further
complicate the process of his mourning? If the couple did not draw up the
necessary legal documents giving the survivor clear civil and medical power
of attorney and an ironclad will, a gay widower may be subjected to
indignities and other losses immediately following the death of his partner
that a heterosexually married man would not encounter. Some think of being a
widower as a transient identity that ends once they feel that their period of
acute mourning is over, or they have entered into a new romantic
relationship. For others, being a widower becomes integrated into the
totality of their personhood which is one  example that they have entered a
very advanced phase of grieving that Bowlby(39) describes as reorganization,
characterized by getting over the loss and building a new life.
 Helsing, Szklo & Comstock(2) demonstrated that male survivors have a higher
rate of mortality after widowerhood than do women.  As the following case
illustrates,  gay men with AIDS, may be at increased risk for dying following
the death of a partner, especially if most or all of their friends have
predeceased them.
    Joe and David had been partners since they met as undergraduates,
fourteen years earlier.  When they began couples therapy they both had been
diagnosed with AIDS for three years and each had Kaposi Sarcoma,
Cytomeglovirus in their eyes and intestines, and severe weight loss.  After a
period of slow decline, Joe died in January, 1993 with David at his side. 
Immediately following Joe's death, David's health, which had always been
stable, began to rapidly deteriorate, and he died in June of the same year
saying that a broken heart and not AIDS had killed him.

Homophobia and Gay Widows
"Society offers little opportunity for the overt expression of grief and
bereavement in general, and even less opportunity for gay men. Even as gay
men grieve, they are subject to homophobia."(18) Sexual orientation has
nothing to do with the dynamics of grief, though as the following case
illustrates, the ramifications of homophobia can greatly complicate the
grieving process of a gay man.
        Ralph, a thirty nine year old man who sought therapy shortly before
the death of Emmanuel, his partner of eight years,  described feeling
overwhelmed by sadness. He had been confident of his ability to weather this
emotional storm until Emmanuel's parents told him that he was not welcome at
the funeral and that he would have to move out of the apartment he and
Emmanuel had lived in for the past five years since it was owned solely by
Emmanuel and there was not a will bequeathing the apartment to Ralph. "Not
only have I lost my lover," he told me during one session, "but I am faced
with the prospect of being evicted from my home at the same time.  This is
more than I can bear."
The additional stress of being forced to move out of his apartment
contributed to Ralph's distress, depression and anxiety following Emmanuel's
death. The fact that Ralph was faced with the reality of becoming homeless
was for a few weeks of greater urgency than dealing with the death of his
beloved partner.
One dynamic unique to the surviving partner of a same sex relationship is
that his or her relationship is not universally recognized, validated and
valued. "The heterosexual widow or widower who loses a mate receives a tacit
level of social support and condolence. Gay widowers may be more apt to
encounter scorn, ostracism, fear or blame."(40) Thus many gay widowers'
mourning is complicated by the fact that theirs is a "disenfranchised grief."
Doka(41) explained that disenfranchised grief  occurs when 1) the
relationship is not recognized, 2) the loss is not recognized, and 3) the
griever is not recognized.
Not all gay widowers experience disenfranchised grief. When an individual has
not hid his sexual orientation he is more likely to have a viable friendship
network of supportive individuals who will play a crucial role in his
mourning. The widower pretending not to be gay and that his live in lover was
"just a room-mate" is infinitely more susceptible to experiencing
disenfranchised grief than his peer who has access to sympathy and support at
least within the gay community. "All of these factors must be taken into
account in redefining the process of grieving and identifying the coping
mechanisms and interventions appropriate for responding to the needs of
today's gay men."(1) Disenfranchised grief may contribute to keeping the
widower's relationship with the deceased active as a defense from having the
relationship negated. For some gay men the trauma of losing one's partner has
the potential to reawaken previously resolved internalized homophobic
feelings that include shame about being gay. One indication that internalized
homophobia has combined with disenfranchised grief is the minimizing or
devaluing of the relationship by the surviving partner. If heightened levels
of homophobia are left unchallenged by the psychotherapist, the widower is at
risk of regressing to a less developed stage of gay identity formation.(38)
"With their experience of repeated loss, gay survivors often struggle against
being identified as blameworthy."(18) When blame is internalized and becomes
merged with homophobia some widowers feel they did something to deserve the
pain they are in the midst of experiencing.  "If I were not gay perhaps then
I would not be feeling this way." While true that if the man were not gay he
would not have fallen in love with the man who died and who he is now
mourning. The problem in this line of thinking is that it merges being gay
with the pain which is an indication of internalized homophobia, rather than
recognizing that the pain is an appropriate response to having loved and lost
the beloved. If a survivor is HIV positive, the concept of being
"blameworthy" can complicate his bereavement as he struggles with "Why am I
still alive while my spouse died from this disease?"
Siegal and Hoefer(19) and Richmond and Ross(33) highlighted problems such as
hostility from families and exclusion from the planning of funeral
arrangements, or even from the service itself as unique stressors and a focus
of distress that a gay man may be forced to face immediately after the death
of his partner. It is not unusual for a gay man to be denied the same
bereavement leave from his place of business that any heterosexually married
individual normally receives. When his performance is less than stellar after
returning to work following the death of his lover, the survivor often is not
given the same latitude as a heterosexually married man would receive. This
can have the effect of reenforcing self doubt or lowered self-esteem that the
widower may already be experiencing.

Trauma Theory and Gay Widowers
Gabriel(42) stated that "people living with AIDS and their survivors are
emerging as the newest group of persons experiencing psychological trauma." 
Green(43) listed exposure to the grotesque, violent/sudden loss of a loved
one as an event that is considered trauma-inducing.  A common denominator of
all psychological trauma according to Herman(44) is "a feeling of intense
fear, helplessness, loss of control and threat of annihilation." Among the
signs of turmoil Gabriel(42) listed that surviving partners may exhibit are
distressing emotional reactions such as anxiety, dread, horror, fear, rage,
shame sadness and depression; intrusive imagery of dying; nightmares;
flashbacks of images of the stressor; numbing or avoidance of a situation
associated with the images; somatic complaints including sleep difficulties;
substance abuse; impaired social functioning; interpersonal difficulties;
sexual dysfunction, hyper sexuality and difficulty sustaining intimate
relationships. Gay widowers who have experienced the death of their partner
from any cause can attest to the presence of these elements in varying
degrees of intensity in their everyday lives.
DSM-IV(37) notes: "As part of their reaction to the loss, some grieving
individuals present with symptoms characteristic of a Major Depressive
Episode or Post Traumatic Stress Syndrome." DSM also states that the bereaved
individual typically regards the depressed mood as normal. Experiencing vivid
recall of the  traumatic event is one symptom seen in most trauma survivors.
All widowers the author has worked with are able to recount in minute detail
the actual moment of his partner's death, or the moment of learning of the
death of his partner, even many years later. Surviving partners need to be
worked with therapeutically in a way that validates the traumatic nature of
the loss in order to help them regain emotional equilibrium.  Dworkin and
Kaufer(1) instructed professionals consulted by gay widowers to remember that
bereavement interventions must be gay affirmative in addressing lowered
self-esteem, personal identity and questions about body image, and need to
address the reestablishment of meaning in one's  life.

Social Support and Recovery from Grief
There is abundant research demonstrating that inadequate support can
contribute to the development of a traumatic stress reaction following any
life trauma and that a deficit in social support has been associated with
poor outcome in bereavement.(45, 46, 47, 48) Vachon et al(49) found that
absence of social support was directly related to continued high distress two
years after the death of a spouse. Though the above cited researchers'
samples were (presumably) exclusively heterosexual, the author's clinical
experience supports that their findings can be extrapolated as pertinent for
gay widowers. Supporting this assertion is  Lennon et al's research(26)
documenting that the amount of social support available to a gay man
following the death of his partner from AIDS directly correlates to how he
recovers from this event.
Studies of survivors of non-AIDS related traumatic situations suggest that
the response of the larger community, outside of the kinship group, is an
important emotional resource for those surviving a traumatic experience.(44,
50, 51)  When a widower is a member of a sexual minority denied visibility
and social supports his trauma has the potential to be exacerbated.
Herman(44) found that community support in the face of a traumatic event can
be of enormous assistance in helping repair the injury inflicted by the
traumatic event. Many cities now have bereavement programs geared
specifically for gay men who have lost a loved one to AIDS. Gay specific
bereavement groups also need to be developed for individuals whose partners
have died from a cause other than AIDS.

Moving Through Grief  
The predominant theoretical models in the area of grief and loss are stage
models. (52, 53) describing several phases of emotional response as mourners
attempt to come to terms with the loss of a loved one.  Bowlby(35, 39, 54)
proposed four phases of mourning, including shock, searching, depression and
reorganization and recovery. Wortman et al,(53) researched whether there was
any empirical evidence to support a stage theory of recovery from the death
of a loved one.  They discovered that the available data did not support, and
sometimes contradicted, the stage approach. While some people may in fact
follow expected patterns, many do not. Most men do not necessarily proceed in
their development as widowers in a linear fashion, but often experience
aspects of more than one stage simultaneously, and frequently move back and
forth between stages.
The death of a partner is often the reason why people begin psychotherapy or
counseling.  Many men find their need to talk about their evolution and pain
is more than their friends can tolerate. It is important to note that
traditional individual psychotherapy while certainly useful is by no means
the only appropriate way that a health care professional can be of assistance
to a gay man during the period following the death of his partner. Referring
gay widowers to a gay specific bereavement group is another intervention.
Psychiatrists, psychologists and social workers have to be prepared to assume
a therapeutic role of support and bearing witness while offering faith and
hope for a future that is less filled with pain that may need to transcend
traditional psychotherapy or counseling. This becomes a therapeutic necessity
especially if  the widower is the last surviving member of a friendship
and/or support group and the therapist is one of very few people with whom
the widower shares a history. One understandable characteristic typical to
burying one's partner is intense anger(55), whether it be at the unfairness
of life, at God, at the cause of death, at the deceased or just being in the
unenviable position of having to pick up the pieces and rebuild a life.
Recognizing that there are numerous good reasons to be angry, expressing and
integrating this rage are essential components of  adjusting adaptively to
widowerhood. Gay widowers' anger is only fueled by homophobic reactions and
insensitivity to their mourning, and needs to be validated by all clinicians
who work with them.

Conclusion
Invariably, each widower ponders am I doing this correctly? Mental health
professionals need to remind grieving gay clients that there is no right or
wrong way to go about the process of moving on after the death of a partner.
The only incorrect thing to do is to try to avoid the painful feelings that
must be experienced. In our society there are powerful cultural myths,
usually unspoken, about how to mourn "correctly." "These myths touch on many
aspects of grieving--how long to mourn, what to feel, what not to feel, how
to behave, how not to behave, when to show certain responses, with whom to
share your feelings, and so on. Mourners face many implicit directives about
how to conduct their grief."(40).
The myths pertaining to how to grieve correctly are not always true.  Wortman
& Cohen-Silver(56) suggested that many of our most basic, unquestioned
assumptions about how people cope with loss may not match people's actual
experience. Among the assumptions they questioned are: 1)Is depression an
inevitable consequence of loss?; 2) Does the absence of depression indicate a
pathological response? and 3) Do all significant losses need to be "worked
through" in order to be healed? This author's clinical experience confirms
that depression is often but not always an inevitable consequence of losing
one's partner and that the absence of depression by no means indicates a
pathological form of mourning, and that all significant losses do need to be
worked through in order to be healed. There is a necessity to resolve, or at
the very least, make significant emotional accommodations to a traumatic life
event, in order not to be permanently crippled by it.
Schwartzberg(40) suggested that in western culture many people follow a
similar path in grieving a major loss.  The individual responds with
depression and pain for a discrete period that can last upwards to a couple
of years, and then gradually returns to his previous level of functioning.  
He notes that a sizable minority do not follow this path. Mental health
professionals need to be aware of and remind grieving clients that there are
a multiplicity of ways that people mourn the death of a partner.  Some people
have a very prolonged grief reaction, while others grieve for a very
abbreviated time, regaining full momentum of their lives quickly. Reacting
differently from the cultural norm, by grieving too long, for example, or too
little, needn't mean that a response is unhealthy.  "People vary greatly in
how they respond to a significant life upheaval; the absence of  turmoil may
simply reflect another style of 'normal' response."(40)
"For most bereaved people, to keep going after the painful life changes
caused by death is the most difficult task of all.  When a lover dies, the
loss plunges the bereaved person into a world where many of his known and
habitual structures of daily life disappear into a world more full of
confusion, disorganization and anxiety than it was prior to the death of his
partner.  A new order has to be constructed."(18) Surviving the death of a
partner is a potentially devastating emotional experience. Yet some people
emerge from their grieving process with unexpected gains. "By weathering
emotional tribulations thought unendurable, they have a deeper, surer sense
of their strength. By facing despair, and not succumbing, they know their
inner capacities in a more complete way."(40) Ultimately widowerhood is a
period simultaneously of crisis and of resolution,  a time of transition and
reflection on both the past as well as the future, and a time for sowing the
seeds for new beginnings. Often it is full of new, exhausting, and
potentially thrilling challenges. When the unique stressors and dynamics that
face gay widowers are correctly assessed and responded to in culturally
sensitive and appropriate ways, mental health professionals have the
potential to be invaluable resources during this period of enormous change,
self-discovery, emotional and social upheaval.
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Michael Shernoff, MSW is in private practice in Manhattan and is adjunct
faculty at Hunter College Graduate School of Social Work.  He edited Gay
Widowers: Life After the Death of a Partner, 1997: Harrington Park Press.  He
can be reached via his web site at http://members.aol.com/therapysvc or via e
mail at [email-masked]

Key Words: Gay men, homosexual, widowers, grief, mourning, HIV/AIDS.