Psychological aspects of widowhood and divorce.

Despite advances in standard of living of the population, the condition of widows and divorced women remains deplorable in society. The situation is worse in developing nations with their unique social, cultural and economic milieu, which at times ignores the basic human rights of this vulnerable section of society. A gap exists in life expectancies of men and women in both developing and developed nations. This, coupled with greater remarriage rates in men, ensures that the number of widows continues to exceed that of widowers. Moreover, with women becoming more educated, economically independent and aware of their rights, divorce rates are increasing along with associated psychological ramifications. The fact that widowed/divorced women suffer from varying psychological stressors is often ignored. It has been concluded in various studies that such stressors could be harbingers of psychiatric illnesses (e.g., depression, anxiety, substance dependence), and hence should be taken into account by treating physicians, social workers and others who come to the aid of such women. A change in mindset of the society is required before these women get their rightful place, for which a strong will is needed in the minds of the people, and in law-governing bodies.

Introduction

Despite rapid advances in the standard of living of people worldwide, the condition of a section of our population still remains deplorable, namely, that of widows and divorced women (UN Division for the Advancement of Women, 2000). Death of the spouse, or separation (legal or otherwise), appears to affect both the sexes in different ways and the psychological effect of these events is immense.

It can be said that no group is more affected by the sin of omission than are widows. They are painfully absent from the statistics of many developing countries, and they are rarely mentioned in the multitude of reports on women's poverty, development, health or human rights published in the last 25 years (Ibid). Growing evidence of their vulnerability, both socioeconomic and psychological, now challenges many conventional views and assumptions about this “invisible” group of women.

With womenfolk becoming increasingly economically independent and more aware of their rights, there is a growing trend of refusal to continue in an abusive or unsatisfying marriage, and divorce rates too are on the increase (Thara, 2002).

Widowhood and its Psychological Aspects

In many developing countries, the exact numbers of widows, their ages and other social and economic aspects of their lives are unknown. Almost worldwide, widows comprise a significant proportion of all women, ranging from 7% to 16% of all adult women (UN Division for the Advancement of Women, 2000). However, in some countries and regions, their proportion is far higher. In developed countries, widowhood is experienced primarily by elderly women, while in developing countries it also affects younger women, many of them still rearing children (Ibid). In some regions, girls become widows even before reaching adulthood.

Women are more likely than men to be widowed for two reasons. First, women live longer than men (a fact highlighted by worldwide data regarding differences in life expectancies of men and women). In addition, women tend to marry older men, although this gap has been narrowing. Because women live longer and marry older men, their odds of being widowed are much greater than men's (Lee, 2002).

Loss of spouse is one of the most negative life events, next only to the loss of a child (Bennett et al., 2005). Ironically, the disorganization and trauma that follow the death of a spouse seem to be greater in women than in men whenever either looses their spouse (Fasoranti et al., 2007).

Widowhood presents a myriad of economic, social and psychological problems, particularly in the first year or so after the death of the spouse. A major problem for both sexes is economic hardship. When the husband was the principal breadwinner, his widow is now deprived of his income and the nucleus of the family is destroyed (Fasoranti et al., 2007).

Many studies (e.g., Amoran et al., 2005; Abdallah and Ogbeide, 2002) have concluded that a higher rate of mental illness exists among the widowed than their married counterparts. Even a study conducted by Chen et al., (1999) concluded that widows had higher mean levels of traumatic grief, depressive and anxiety symptoms (compared to widowers).

Another problem associated with widowhood is loneliness. Many widows live by themselves. They suffer the fear of being alone and loss of self-esteem as women, in addition to the many practical problems related to living alone. They feel the loss of personal contact and human association; therefore, they tend to withdraw and become unresponsive (Fasoranti et al., 2007).

The greatest problem in widowhood is still emotional. Even if it had been a bad marriage, the survivor feels the loss. The role of spouse is lost, social life changes from couple-oriented to association with other single people; and the widowed no longer have the day-in, day-out companionship of the other spouse that had become a intrinsic part of their lives.

People respond differently to loss and overcome grief in their own time. Frequently, the most difficult time for new widows is after the funeral (Scannell, 2003). Young widows often have no peer group. Compared to older widows, they are generally less prepared emotionally and practically to cope with the loss. Widowhood often causes financial stress because a major income source is lost with the death of a husband.

There has been considerable controversy as to whether widowhood is a more difficult experience psychologically for men or for women. Widowhood is generally a greater problem financially for women than men, and economic difficulties can lead to lower psychological well-being. Several studies (e.g., Schuster and Butler, 1989; Thompson et al., 1989; Davar, 1999; Reddy, 2004) have indeed found that widowhood has a greater adverse impact on the psychological well-being of women. Other studies, however (e.g., Lee et al., 2001; Umberson et al., 1992; Jason et al., 2002), have reported stronger effects on men. Still others have found no gender differences at all (Li et al., 2005).

The Indian Perspective

India has the largest recorded number of widows in the world-33 million (10% of the female population, compared to only 3% of men), and the number is growing because of HIV/AIDS and civil conflicts. “Fifty-four per cent of women aged 60 and over are widows, as are 12 per cent of women aged 35- 39. Remarriage is the exception rather than the rule; only about 10 per cent of widows marry again.” (Chen, 2000). India is perhaps the only country where widowhood, in addition to being a personal status, exists as a social institution. Widows’ deprivation and stigmatization are exacerbated by ritual and religious symbolism. Indian society, similar to all patriarchal societies, confers social status on a woman through a man. Hence, in the absence of a man, she herself becomes a non-entity, ultimately suffering a social death. Sati (widow burning) is the ultimate manifestation of this belief (UN Division for the Advancement of Women, 2000).

Widow remarriage may be forbidden in the higher castes; and remarriage, where permitted, may be restricted to a family member. Further, a widow, upon remarriage, may be required to relinquish custody of her children as well as any property rights she may have. If she keeps her children with her, she may fear they would be ill-treated in a second marriage. Indian widows are often regarded as “evil eyes,” the purveyors of ill fortune and unwanted burdens on poor families (UN Division for the Advancement of Women, 2000; Fuller, 1965).

Thousands of widows are disowned by their relatives and thrown out of their homes in the context of land and inheritance disputes. Their options, given a lack of education and training, are mostly limited to becoming exploited, unregulated, domestic labourers (often as house slaves within the husband's family), or turning to begging or prostitution (Bill I, 2006).

The sexual and economic exploitation of widows, abandoned by their families to the temple sites such as Mathura, Varanasi and Tirupati, has been sensationally documented in the media (Bruce, 2005; Damon, 2007). Thousands of India's widows live in abject poverty and degradation in these centers. It is reported that in Vrindavan alone, an estimated 20,000 widows struggle to survive (UN Division for the Advancement of Women, 2000). Younger widows are forced into prostitution, and older ones are left to beg and chant for alms from pilgrims and tourists. Older widows may have lived the greater part of their lives in these temples, having been brought there as child widows many years before. The ordeals of the temple widows and the occasional sati are publicized in the international press. But, the day-to-day suffering of Indian widows, who are emotionally, physically and sexually abused by relatives, or who migrate to cities to live on the streets and beg, remains largely hidden (Bruce, 2005; Damon, 2007; UN Division for the Advancement of Women, 2000).

Widows, through poor nutrition, inadequate shelter, lack of access to health care and vulnerability to violence, are very likely to suffer not only physical ill health but stress and chronic depression as well (UN Division for the Advancement of Women, 2000). Widows may be victims of rape. This is further compounded by the fact that widows, in common with many women, are very often unaware of their rights, and encounter insuperable barriers to accessing justice systems, such as illiteracy, expenses and threats of violence (Ibid).

Psychiatric Aspects of Widowhood

A large number of studies have been done focusing on the psychiatric aspects after death of the spouse. Zisook and Shuchter (1991) and Niaz and Hassan (2006) concluded that depressive episodes were common after the death of a spouse. A high index of suspicion should be maintained by clinicians for the possibility of depression, particularly in cases of the young widows and widowers with such a history. Those who experience full depressive syndrome soon after the loss may better be considered to be suffering from depression than bereavement. Zisook et al . (1994) noted the existence of subsyndromal symptomatic depression contributing significantly to morbidity in widows and widowers during the first two years of bereavement. It is hence very important that existence of such entities be kept in mind; and rather than viewing altered behaviour among the bereaved as socially or culturally acceptable, psychological aspects too should be considered. The predisposition to develop anxiety as well as substance abuse disorders also increases (Collins, 1999; Barrett, 2000).

Divorce and Women

Divorce rate the worldwide has been increasing steadily (Wikipedia, 2008). As women become more independent financially, their acceptance levels come down in direct proportion to their financial stability (Dobson, 2006). They become more vocal and are willing to sacrifice their family for the sake of independence. Although it is not a good sign for the society as a whole, which has to depend on family structure, it is inevitable. However, it would be wrong to even hint that only women are responsible for this alarming trend. Many a times continuing in an abusive and unsatisfying marriage has had greater effect on the psyche of spouses and children rather than opting to be parted amicably or through court (Goldstein, 2008).

Several reasons have been cited for opting out of marriages these days–increasing violence, cruelty, character assassination, alcoholism, problems of adjustment especially in a joint family, growing individualism of the wrong type, extramarital affairs and the undesirable impact of the outside world in terms of falling values and lack of role models (Thara, 2002).

From a large number of potential life events, divorce has been rated as one of the most stressful, with a large general impact on the life situation of those who experience it (Dohrenwend et al., 1978; Holmes and Rahe, 1967; Gahler, 2006). Empirical studies also repeatedly show that marital dissolution is associated with a number of social problems. For example, divorcees have smaller social networks and are more likely to lack social support (Gahler, 2006). Also, they more often experience negative life events and physical and psychological ill-health. Furthermore, divorced women are likely to be exposed to economic hardship (Johnson and Wu, 2002; Lorenz et al., 1997).

Women report more marital complaints and report them earlier than do men. It has been shown that men are more likely than women to remarry, and they do it quicker (Bernhardt, 1995; Cherlin, 1992; Whitehead and Poenoe, 2006).

Divorcees have been shown to exhibit substantially higher admission rates in psychiatric clinics and hospitals than individuals in intact couples, and they more often suffer from anxiety, depression, anger, feelings of incompetence, rejection and loneliness (Gahler, 2006; Kendlar et al., 2003). The divorced also exhibit a higher mortality risk, particularly behaviour-related mortality such as suicide, motor vehicle accidents and homicide; and they more often die from coronary disease and cirrhosis of the liver, a cause of death that is often a consequence of alcohol abuse (Weitoft et al., 2004).

Although Booth and Amato (1991) and Lorenz et al . (1997) show that the level of psychological distress was significantly higher for individuals immediately after divorce than in the following years, Mastekaasa (1995) found no difference in psychological distress whether the divorce took place 0 to 4 or 4 to 8 years earlier, and concludes that divorce implies “permanent strain” in the individual (Avison et al., 2007).

Furthermore, studies repeatedly show (Daniels-Mohring and Berger, 1984; Rands 1988; Terhell, 2004) that divorcees, in addition to the lack of a partner, generally have smaller social networks (i.e., a smaller number of potential providers of social support) than do individuals living with a partner. This is an important finding given that network size seems to be positively correlated with the emotional adjustment of divorcees (Wilcox, 1981; Terhell, 2004.

Divorce affects the well-being of women and men in different ways. For example, men have higher incomes after divorce, which would predict lower levels of distress. Women's lives are also changed in other ways that may affect their psychological well-being in a more negative way; they have the main custody of children, if any, and are more likely to experience task overload (Gahler, 2002). It has also been argued that women invest more in the family, take larger responsibility for the marriage, and therefore perceive divorce as a greater failure than do men (Kurdek, 1990; Hung et al., 2004). In contrast, others argue that traditional gender roles (e.g., the unequal distribution of unpaid household work) would predict single women to be better off than single men (Gove, 1972; Iverson and Rosenbluth, 2006).

Women are also more likely to have access to social support outside the family, whereas men are more dependent on marriage for social support. Results from studies on gender differences in psychological health following divorce are, hence, far from conclusive. Although some studies have found that women's psychological well-being is more negatively affected by a divorce (Kurdek, 1990; Siu-Kau, 1999; Williams and Dunne-Bryant, 2006), others have found the opposite (Gove, 1972; Lillard and Waite, 1995; Walker, 2005), and yet others have found no gender differences (Johnson and Wu, 2002).

Thus, reviews often conclude that the empirical evidence on gender differences is inconclusive or inconsistent (Kitson et al., 1989; Kitson and Morgan, 1990; Raschke, 1987; Kalmijn, 2005). Simon (2002) notes that the conclusion depends on the indicators of mental health. Although women exhibit higher levels of depression following divorce, men report a significant increase in alcohol abuse.

Following divorce, women more often receive custody of children, and they lose a resource (the partner) who previously contributed to the household maintenance. According to the “role accumulation” (Moen, 1992) or “role expansion” perspectives (Cohen et al., 1990), gainful employment improves women's psychological well-being (Azar and Vasudeva, 2006). Work experience may be positively correlated to self-confidence, and fellowship with colleagues increases the social network and gives a broader anchoring in life. Employment is also assumed to be a source of personal identity and fulfilment (Frankenhaeuser, 1993; Moen, 1992; Azar and Vasudeva, 2006).

However, despite gainful employment, women are still expected to contribute significantly to domestic work. The fact that gainful employment often does not imply a corresponding decrease in domestic obligations, however, has given rise to competing views, that is, the “role strain” (Moen, 1992) or “role overload” (Cohen et al., 1990) perspectives. Here, it is assumed that employment has an injurious effect on women's psychological well-being because it demands time, energy and concentration in addition to what is already used for domestic tasks. It is reasonable to assume that the combination of market and household work is particularly difficult for single mothers (McLanahan and Adams, 1987; Moen, 1992; Stoltz, 1997; Robbins and McFadden, 2003).

The problem is further increased by dismal rates of remarriage among women in developing states (Lee, 2002). Remarriage rates are mostly lower for women because there are very few available men in the appropriate age ranges. This is exacerbated by the fact that older widowed men who remarry frequently marry younger women, while marriages of older women to younger men are much less common (Ibid). Nonetheless, remarriage is uncommon among widowed individuals, particularly when they are widowed late in life (Ibid).

Conclusions

Widowhood and divorce are significantly distressing events in the life of an individual, with associated psychological ramifications. These problems are further compounded among women owing to particular social and cultural aspects, which lead to increased feelings of guilt, remorse and aloofness. There is also a tendency to reject depressive symptoms as something socially and culturally acceptable, whereas significant distress associated with these events could be harbingers of psychiatric illness often requiring attention (medical or otherwise). The need of the hour is to create awareness among public in general through various means of mass media.

NGOs and other such self-help groups who come to the aid of such women should be appraised of the possibility of such entities so that proper attention and early intervention can be initiated. It would also be beneficial if women who themselves have undergone such an experience come forward to help others. This would serve the twin benefits of rehabilitating these women as well as providing the much needed care and support to the distressed among them.

An increasing need is being felt for more strict implementation of existing laws regarding women's right to the deceased husband's property and other belongings, pension benefits, alimony to divorced women, visitation rights (for women who do not have custody of their children) and laws regarding custody of children after divorce or after remarriage of a widow.

Take Home Message

Behavioural changes are often observed in women after divorce or bereavement. These changes are often overlooked and assumed to be a normal reaction to an adverse life event. It is now known that the changes may be due to an underlying psychiatric disorder. This issue needs to be highlighted so that the suffering women may receive appropriate care and treatment. Care givers and NGOs working in this field need to be educated about these facts.

Questions That This Paper Raises

Are psychiatric disorders more prevalent in divorced women/widows or is it only a reflection of disorders prevalent in these age groups?

Is there a difference in psychological sequelae in men and women following divorce?

If psychiatric disorders are more prevalent in women following divorce/widowhood, which women are more susceptible? (e.g., those with or without possession of children, those who were in a relationship for short period or longer).

What are the differences, if any, in the reactions to divorce/widowhood across cultures?

Is the increasing prevalence of divorce a result of changing cultural acceptability?

Do women invest more in relationships than men, and hence suffer more when such relationships break?

What is the impact on social network (short term and long term) after divorce/widowhood? Does it really differ between men or women? If yes, what could be the possible reasons?

Principal and Corresponding author

This is to certify that there is no conflict of interest of any kind, regarding the paper amongst authors.

About the Author

Dr. Jitendra Kumar Trivedi is a professor in the Department of Psychiatry, C.S.M. Medical University, U.P., (Formerly King George Medical University, Lucknow, India), since 1995. Dr. Trivedi completed his medical graduation (MBBS) from the King George Medical College, Lucknow University, Lucknow, in 1973, and later MD in Psychiatry from the same institute in 1977. He was appointed in the faculty in the Department of Psychiatry, K.G. Medical College, Lucknow, in 1978, and since then has been working at the same institution in various positions. He has been a principal investigator for more than 25 multinational clinical trials as well as ICMR and WHO sponsored projects. He has approximately 200 publications in national and international journals as well as chapters in books. He has made presentations on various aspects of mental health in both national and international conferences. He has been the Editor of Indian Journal of Psychiatry (IJP) for 6 years and has been associated with IJP for more than 18 years in various capacities. He was President of the Indian Psychiatric Society for the year 2004. Currently, he is the Zonal Representative for Southern Asia - Zone-XVI of the World Psychiatric Association. He is also on the Honorary International Editorial Advisory Board of MSM.

E-mail: Jitendra.trivedi@gmail.com, jktrivedi@hotmail.com

Dr. Himanshu Sareen (Co-Author) is currently pursuing his master's degree in Psychiatry, from Department of Psychiatry, CSM Medical University (Formerly KG Medical University), Lucknow. He has completed MBBS from Dayanand Medical College & Hospital, Ludhiana, and has been a meritorious student throughout. He is academically and clinically oriented and has been an active participant in various national and zonal conferences. During his tenure of residency, he received training in the fields of general adult, child and adolescent, geriatric, sex clinic and de-addiction psychiatry. Address correspondence to: Himanshu Sareen, Junior Resident, Department of Psychiatry, C.S.M. Medical University (Formerly King George Medical University), Lucknow, India.

E-mail: sareenhimanshu@hotmail.com, himanshusareen@aol.in

Dr. Mohan Dhyani is currently working as a Research Associate in the Department of Psychiatry, CSM Medical University (Formerly KG Medical University), Lucknow. He completed his medical graduation from R. G. Kar Medical College, Kolkata. He has been a bright student and was awarded a gold medal in pathology during his undergraduate training. He is currently associated with a number of ongoing clinical trials and is also pursuing his master's degree in Psychiatry. He has co-authored numerous posters and scientific presentations for a number of national and international conferences. He has also co-authored various research articles published in national and international journals.

E-mail: dhyani.mohan@gmail.com