My client, Janice, is 62 years old. She suffers from late-onset diabetes and rheumatoid arthritis. She is a neatly dressed, silver-haired woman with gnarled hands and feet. The thick lenses of her glasses sit heavily on her pleasant, open face. She is of medium build and walks with a cane. Janice has the shy, nervous demeanor of a young girl, often absent-mindedly fidgeting with the buttons on her favorite mauve sweater. She is a Red Cross volunteer and a recent widow. Though Janice was raised a Methodist in Alton, Illinois, she currently has no religious affiliation. “I miss not having a church to attend,” she tells me. “At least the social part of it.”
Her husband, Albert, died 18 months ago due to congestive heart failure. His sudden death dramatically changed Janice’s life. She was forced to give up the comfortable home they shared for three decades, and she now lives alone in a subsidized senior housing complex.
She says she is often lost in her profound grief. “Our marriage was a traditional one, the kind that was popular fifty years ago,” she says. “Albert was solely responsible for the family finances. He shared little of the intricacies of these things with me, and I’m afraid that he kept me completely in the dark about all of it.”
Albert withheld their troubled financial situation in order to shield her from the unpleasantness. He died without a will or an estate plan, leaving Janice lost and befuddled.
He also died in intensive care, and Janice was unable to be with him. She has a great deal of guilt about this, and she now claims that her biggest fear is “dying alone in some awful hospital, hooked up to a bunch of beeping machines.” However, she’s just as anxious about becoming dependent on strangers. She’s losing her eyesight.
I ask her why it’s so difficult to ask for help. She tells me she’s afraid.
“When Albert was alive, we used to look after one another- and now I don’t want to be a bother,” she says. “I’m embarrassed to admit it, but there have been times that I have gone to bed hungry because I couldn’t open a can of soup– my arthritis being so bad. But would I call a neighbor and ask for help? No! I wish I had family to count on.”
I ask Janice about her relationship with Albert.
“I’ve been with only one man my entire life, and our sex life was very conventional,” she replies. “There wasn’t even much of that, and I always wondered if I disappointed him. I guess I’ll never know.” Janice grows clearly uncomfortable.
I tell her there are many of us who make a distinction between sex and intimacy. “Perhaps you don’t miss the sex, but I’m guessing you miss the intimacy,” I say.
“I don’t miss it at all– the sex, I mean,” she says. “But I do miss the companionship, because I’m so lonely now. You get pretty attached to a person after forty years together. The senior center is filled with widows who are starving for affection, and it is so unfair.”
It is criminal, so many lonely people being lonely alone. Many seniors don’t know how to form intimate relationships after the death of a spouse. I tell Janice they are often self-conscious about needs and desires– like sex, dating, or even forming close relationships. Rather than put themselves out there to find fulfillment, they follow the path of least resistance. Their intimacy need shrivel and die long before they do because they lack an outlet. In turn, they sometimes become cranky.
Janice tells me she has a cranky tendency herself. However, she has an overpowering fear of dying alone.
“I don’t mean alone as in solitary,” she says. “I would feel just as alone if the only people attending me were people I didn’t know. So it’s not about care, really, it’s about being loved.”
Janice says she’s never had much of an interest in sex, and she doesn’t see that changing at her age. But she is interested in friendship, and she wonders if it’s too late to find it again.
I ask her if she takes hormone replacement therapy.
“I went through menopause years ago, but I’ve never taken hormone replacements,” she says. “Why do you ask?”
I tell her that many women find that their libido, or interest in sex, disappears after menopause. It’s a chemical thing that happens with age. Many post-menopausal women don’t know about the option, and so they go through some of the best years of their life without knowing the joy of sexual intimacy unfettered by pregnancy concerns.
I was once an advocate of natural hormone replacement for all post-menopausal women, but now I encourage women to talk with their doctors about pros and cons. There is a known connection between hormone replacement therapy and breast cancer; breast cancer survivors who took therapy to relieve menopausal symptoms had more than three times as many breast cancer recurrences as survivors who did not.
Janice doesn’t know whether she should ask her doctor about such a thing.
I remind her that there is sex, and there is intimacy. Maybe she has no interest in one, but it sounds like she still wants the other. Janice may find that hormone replacement therapy can help her overcome barriers preventing her from forming new and life-affirming relationships. She could obtain the information she needs to make an educated decision on her own, and she could establish a relationship with her doctor to discuss her intimate life.
She agrees to start the discussion.
In the meantime, I encourage her to meet her neighbors in the senior complex, strike up conversations, and join in the planned activities. Take a class. Volunteer. Acquaintances are friends waiting to be discovered. A friend could become a companion, and a companion could even become a lover or a partner. It will take time and energy.
“I always have the best of intentions, and I leave our sessions full of hope and plans for getting out of this rut I am in,” Janice says. “But, by the time I get home, all the wind goes out of my sails, and I feel like such a failure.”
But there is no need for Janice to be self-defeating. She has the will to make the changes she wants, but she must develop a strategy for accomplishing these goals. So many lonely senior women share her plight, and she may first seek out another woman as a companion. Intimacy is not a gender issue. It’s a human one.