When the trees start to blooming
The mem'ries start to flooding
And my heart takes a trip to yesterday
When we walked 'neath the moon
And our love was in bloom
Now we're two lovers drifted apart
The story of a broken heart ...

The pain of love lost is obviously the focus of this Johnny Cash song, "Story of a Broken Heart." Perhaps just as apparent -- at least to some fans -- is the country music star's deep love for his wife, June Carter Cash, and his devastation at losing her in May to heart surgery complications.

The legendary recording artist died of a broken heart, fans say of his Sept. 12 death, even though official reports indicate complications of diabetes.

"Can you die of a broken heart?" ponders one fan in an online message board. "You always hear stories ... about a husband and wife who were together for many, many, many years, and then one of them dies."

Stories do, indeed, abound of spousal grief turning deadly. Health experts say the phenomenon does happen, but the bereaved do have some control over what happens to their life.

The Mind-Body Reaction to Grief

Many people feel shock and numbness in the first few days after a beloved passes away. They may also experience shortness of breath, tightness in the throat, difficulty concentrating, hallucinations, and lack of or too much sleep and eating.

"A lot of it comes from stress and the anxiety that happens to people after the death of a loved one. It all sort of wreaks havoc on our natural defense systems," says Kathy Wood, a spokeswoman for AARP's "End of Life" program.

After the initial shockwave of hurt, Wood adds it is not uncommon for grievers to lack energy and have headaches or tension. These physical symptoms often share center stage with the magnified emotions of sadness, confusion, fear, guilt, anger, and sense of emptiness.

Besides experiencing the strain of stress, of emotional overload, and of not taking care of oneself properly, it is also possible for grievers to be at higher risk for health problems.

Various studies have shown that surviving spouses may have increased odds of suffering heart disease, cancer, depression, alcoholism, and suicide, says Dan Leviton, PhD, first president of the Association for Death Education and Counseling. He notes, though, that not everyone has higher risk for disease because they may cope well with loss.

The mind-body connection in mourning has reportedly been well-documented in scientific research, but the link isn't as clear-cut as it seems.

"It is a fact that grief can lead to death. It is also true that a loss, or grief, or depression can lead to changes in the immune function," explains says Robert Ader, PhD, a distinguished university professor at the University of Rochester School of Medicine and Dentistry's department of psychiatry. "Those two facts, however, do not lead to the conclusion that the reason there is an increased mortality is because there was a change in immune function."

It's difficult to find a simple cause-and-effect relationship between grief, changes in the immune function, and death because no tools exist that directly measure the health of the immune system, says Ader. There are different aspects of immunity that can be tested, but they may not all necessarily be connected.

What scientists do know is that stress can suppress the immune system, and the lack of basic things like sleeping and eating could not be too good for a person's general health.

When a Spouse Dies

The sting of loss can be even more acute for those who lose a husband or wife, which can have harmful health effects.

"When your spouse dies, you lose your present tense," says Tom Golden, LCSW, author of Swallowed by a Snake: The Gift of the Masculine Side of Healing.

The severe shock and sorrow can be enough for someone to want to follow their companion into death, to make them disillusioned with the medical profession so as not to seek care when needed, to manifest the same symptoms as experienced by the deceased, or perhaps be prone to accidents since they lose focus of the everyday world.

These scenarios are, of course, just examples of the cost of death to some surviving spouses. Not everyone experiences them because they may have the resources necessary to channel their anguish, or they may adjust well to major change.

There are grievers who actually find relief in a companion's death, especially after a prolonged period of sickness. In that case, death may be a respite not only for the patient, but also for the caregiver, which, in many cases, was the surviving spouse.

Yet the caregiver role that many spouses undertake may also contribute to health problems because under the position, many people neglect themselves and experience a tremendous amount of stress.

Another added source of stress could be the anticipation of major changes that survivors have to make in their daily lives. Without their partner around, the day to day will never be the same again.

This is when the widow or widower has to find a new meaning of "normal," say grief counselors, who note how difficult the task is given that many people do not always know how to fully and appropriately express their grief, and they feel pressured by family and friends who think they should recover at a much faster pace.

With good intentions, loved ones may also try to comfort mourners with phrases like "Time will heal all wounds," or "He is now in a better place." Such words offer little comfort, says Russell Friedman, executive director of the Grief Recovery Institute based in Sherman Oaks, Calif.

"Maybe the dead person is in a better place, but the living person isn't," says Friedman.

Nonetheless, it is typical for the nearest and dearest to want to see the griever feel better, especially if they see him or her neglecting their health and everyday life.

Dealing With Grief

Merrill and Ethel Puerner died within 10 hours of each other on Valentine's day in 1997. He died in his sleep after suffering from emphysema, glaucoma, prostate cancer, and a hernia. Shortly after, Ethel succumbed to stomach cancer. They were both 94 years old.

The Janesville, Wis., couple had been married for 72 years and had clearly shown their affection for each other until the day they physically could not.

"They would always sit on the davenport and talk," recalls their daughter, Barbara Warner. "I never saw two people more in love in my life."

Warner says she believes that her father knew that his wife was in a terminal state with her cancer and wanted to join her in death.

"Mother had a life of illness, and one time after she came home from the hospital, he said, 'I don't ever want you to ever leave me again,'" says Warner.

As touching as the story may sound, it does not necessarily have an ending that would thrill the family and friends of a grieving spouse. Plus, no matter how acute the pain of loss, the griever may want to continue to live a healthy life.

For mourners who do need some help in dealing with their loss, here is some advice from the experts:

1. Accept that there is no timetable for grieving.

The bereaved may wonder why they're still hurting months or years after the passing of a partner, especially since people around them may say things like "It's time to move on" or "Get over it."

The mourning process is a complicated matter, say grief counselors. The ache does not heal in linear fashion like a flesh wound -- in fact, Golden compares the loss more to an amputation.

Everyone has different ways of dealing with the pain, say grief counselors, and the best way to deal with the pressures of recovery is to either seek people who will listen, and let you grieve on your own schedule, or to let family and friends know what you need from them.

"Tell them you need to talk, a hug, or an open heart, not someone who will try and fix you," says Friedman. At the same time, he says it's important for the griever to talk more about the relationship with the deceased, and less about the hurts associated with the loss so as to not make the session a "litany of pain."

2. Stick to the basics: Eat well, sleep well, hydrate, and exercise.

Though there are no studies indicating that these activities will ease the effects of grief and prevent death, Ader says they probably will help with overall health.

There may be some times when living well, or an activity associated with it could be a way to honor a fallen loved one.

Joy Johnson, founder of the grief resource center, The Centering Corporation, shares the story of a woman whose only child died after a horse kicked him. She says the woman forced herself to get up every morning and walk 5 miles in tribute to her son.

3. Find a way to express your grief

Grief experts say it's vital for the bereaved to be able to channel their pain in some way. Women tend to want to talk, connect with a loved one, or cuddle. Men, on the other hand, tend to want to do something active, like pace, punch a bag, or build something.

The differences in the way men and women cope has to do with the different hormones that are released during grief, but that doesn't mean people mourn only along gender lines, says Johnson. She points out how active the widows of Sept. 11 were in calling for investigations and change.

People have found hundreds of ways to express their grief, says Golden, noting the following high-profile examples:

• Singer Eric Clapton wrote the song "Tears in Heaven" as a tribute to his young son, Conor, who was killed after falling out of a window in a high-rise Manhattan apartment.
• Basketball star Michael Jordan dedicated a season in honor of his fallen father. When the Chicago Bulls won the championship that year, Jordan reportedly fell on the court crying, because he was overwhelmed that the victory happened on Father's Day.
• Officials have filled places like Washington, D.C., with memorials as a tribute to national heroes and fallen soldiers.

A person does not have to be a celebrity or a government official to be able to honor a loved one's memory. The tribute only has to come from the heart, says Golden.

4. For family and friends: 'Shut up and Listen'

The best way for concerned people to comfort and care for a grieving spouse is to just be there for them, says Johnson.

"You don't have to say anything," she says, noting that asking things like 'What can I do?' only puts the burden on the griever to try and figure out something. Instead, Johnson recommends taking initiative and offering to do things that may help the griever, like doing the laundry or cooking.

SOURCES: Kathy Wood, spokeswoman, AARP's "End of Life" program. Dan Leviton, PhD, president, Association for Death Education and Counseling. Robert Ader, PhD, distinguished university professor, the University of Rochester School of Medicine and Dentistry's department of psychiatry. Tom Golden, LCSW, author of Swallowed by a Snake: The Gift of the Masculine Side of Healing. Russell Friedman, executive director, Grief Recovery Institute, Sherman Oaks, Calif. Barbara Warner. Joy Johnson, founder of the grief resource center, The Centering Corporation. Jennifer Stevens, certified thanatologist; bereavement services coordinator for the Northern Illinois Hospice and Grief Counseling Center.