Feb 02

Ambiguous Loss, Lack of Closure: Pauline Boss

Pauline Boss coined the term “ambiguous loss” and invented a new field within psychology to name the reality that every loss does not hold a promise of anything like resolution. Amid this pandemic, there are so many losses — from deaths that could not be mourned, to the very structure of our days, to a sudden crash of what felt like solid careers and plans and dreams…Krista Tippett, Onbeing.org

Ambiguous loss is a concept coined by (now retired) therapist Pauline Boss decades ago when she was a graduate student. Her book Ambiguous Loss: Learning to Live with Unresolved Grief was a solid introduction. Her newest, The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change, was just released in December.

What is closure all about anyway? As Graison Dangor reports (NPR), “People may long for closure, which psychologists define as the act or sense of completing or resolving a problem we’re suffering from… In fact, [Boss] argues, not feeling closure is actually healthy as we seek to move forward with life.”

Selected Quotes from Boss’s NPR Interview

Ambiguous loss is a situation that’s beyond human expectation. We know about death: It hurts, but we’re accustomed to loved ones dying and having a funeral and the rituals. With ambiguous loss, there are no rituals; there are no customs. Society doesn’t even acknowledge it. So the people who experience it are very isolated and alone, which makes it worse.

Many people in this world have been forced to live with it: families with missing loved ones such as soldiers missing in action or children kidnapped, as well as people with loved ones who have dementia. What I’ve learned over the years is that most of them continue living a relatively good life with the ambiguity of loss. They do that by holding two opposing ideas in their mind at the same time: My loved one is here and also gone. That way of thinking shakes us loose from thinking with certainty, you know: “You’re either dead or alive.” Well, sometimes we don’t know.

You can’t continue to hope that we’re going to go back to how our society was before the pandemic. Changes have already taken place. And they won’t go back once it’s over. You should move forward with something new to hope for.

Selected Quotes from Boss’s Books (Goodreads):

Ambiguous loss makes us feel incompetent. It erodes our sense of mastery and destroys our belief in the world as a fair, orderly, and manageable place.

To regain a sense of mastery when there is ambiguity about a loved one’s absence or presence, we must give up trying to find the perfect solution. We must redefine our relationship to the missing person. Most important, we must realize that the confusion we are experiencing is attributable to the ambiguity rather than something we did – or neglected to do. Once we know the source of our helplessness, we are free to begin the coping process. We assess the situation, begin revising our perceptions…We feel more in charge even though the ambiguity persists.

Mixed emotions are compounded when a separation involves the potential of irretrievable loss. When there is a chance that we will never see a loved one again, we protect ourselves from the prospect of losing that person by becoming ambivalent– holding our spouse at arm’s length, picking a fight with a parent, or shutting a sibling out even while he or she is still physically present. Anticipating a loss, we both cling to our loved ones and push them away. We will resist their leaving and at the same time want to be finished with the goodbye.

Dec 01

“Permission to Grieve” Your Own Way

Permission to Grieve: Creating Grace, Space, & Room to Breathe in the Aftermath of Loss (2019) by Shelby Forsythia, Certified Grief Recovery Specialist, preceded last year’s Your Grief, Your Way: A Year of Practical Guidance and Comfort After Loss by the same author. (These are two of many notable books on grief.)

I. Permission to Grieve

“Drawing on her experience as a grieving person and two years’ worth of interviews with grief experts like Megan Devine, Kerry Egan, and Caleb Wilde, Shelby Forsythia makes the case for radical, self-honoring permission—free from personal judgement and society’s restrictive timelines and rules” (from the publisher).

Selected Quotes

The solution to grief is not a pain-free existence. It is allowing ourselves to grieve and witnessing ourselves in that process. Permission and presence are the remedies for agony and isolation.

When we grant ourselves permission to grieve, we make the experience of grief something we recognize, something we welcome into our lives. We allow it to show up the way it wants to through feelings, identities, and actions. We write our own expectations and stories. Our grief becomes ours again and we become more ourselves again because we actively choose to experience grief.

Grief looks, feels, and shows up differently to each person. Just like no two losses are alike, no two griefs are alike, either. You cannot know the full depth of another person’s experience and they cannot know the full depth of yours.

II. Your Grief, Your Way

Every day of the year has its own page. A reader can take it day by day or can skip around. Some examples of tips and style that Goodreads reviewers appreciated:

I think my favorite suggestion was to add a phrase to everything I do when I feel I’m not doing enough. Just add – ‘while grieving’ to whatever you’re doing. It makes a difference and helps one realize we’re doing the best we can.

I loved the exercise where you are asked to take 5 random words and take them to describe the person.

It doesn’t preach at me, allowing my own worldview to remain at the center where I prefer it. It doesn’t tell me how to grieve, or why I should or shouldn’t feel a certain way, or anything else inappropriate. It simply sits with me and gives me permission to think, or to feel, or to cry, or to laugh, or to wonder, or to ache. It is brief and accessible, moving and graceful, without being terse and inadequate.

Selected Quotes from Your Grief, Your Way

With a loved one’s death, we step into a liminal space – we’ve stopped living our old life, but we’ve not yet stepped into our new one.

Grief is less like a predictable sequence and more like an amorphous blob of uncertainty. You can’t forecast your way out of grief, because there’s no way to determine when the next wave is coming. This may seem disheartening at first, but when you recognize that there is no structure for grief, you can stop trying to pinpoint exactly where you are on your journey. If there’s no road map, it’s impossible to be lost.

There is so much more to grief than just death. In losing someone, you lose their presence in every single moment and milestone that appears after their death. Every hope, dream, and expectation you had for the future must now be reworked, because the person you love can no longer be there. It’s normal to feel like you’re grieving multiple losses when someone dies.

Oct 20

“The Etiquette of Illness” by Susan Halpern

Although I’ve already addressed a related topic (see “Someone’s In Crisis: What Not to Say, What to Say“), when it comes to how to be with a sick or grieving loved one there’s more to add.
One of the main things I took away from reading Will Schwalbe‘s 2012 The End of Your Life Book Club (see previous post) was his use of info from therapist Susan Halpern‘s 2004 The Etiquette of Illness in his ongoing frequent conversations with his terminally ill mom.

Here’s what Halpern suggests when relating to someone who’s sick:

#1 “Ask: Do you feel like talking about how you feel?”

#2 “Don’t ask if there’s anything you can do. Suggest things, or if it’s not intrusive, just do them.”

#3 “You don’t have to talk all the time. Sometimes just being there is enough.”

Taking Number One to heart in his regular encounters with his mom, Schwalbe knew that rather than keep asking her how she was feeling he could ask if she even felt like talking about how she was feeling. There’s a significant difference.

Halpern really gets the struggle: “Of course we don’t know what to say…There is no training program for what to say, and some of us, happily, have very little experience. Some people I have met have felt abandoned in hard times by good friends. Sometimes people who are ill and feeling abandoned will call their friends, but that is rare. It is the role of the ‘well person’ to reach out. While it can be hard to initiate contact, doing so brings pleasure and solace to both parties.”

Additional quotes from The Etiquette of Illness:

When people are suffering, they’re not open to hearing horror stories about others with similar maladies. There is less capacity for compassion at such moments.

When we help, we are in a potentially overpowering position.

Compassion occurs when we open our feelings to the feelings of another person, without judgement, pity, or a need to fix. It is an act of holding the fullness of feelings of another in our awareness and feeling suffering or joy with him or her; without becoming lost in the feeling.

Publishers Weekly‘s summary of Halpern’s contributions: “…[She] believes that what we say depends on the individual, the relationship and one’s own self-consciousness. So long as the words come from the heart, it is the expression of true compassionate feeling that will be remembered by the recipient.”

Dec 02

Grief Books Plentiful: 5 Among the Newest

If anyone doubts that loss is a hot topic these days, look no further than Amazon’s pages and pages and pages of upcoming grief books slated for publication well into 2021.

Five recently published grief books are described below.

I. David Kessler, Finding Meaning: The Sixth Stage of Grief 

As expert David Kessler‘s Finding Meaning: The Sixth Stage of Grief has already been covered in a broader post, I’ll simply provide a few pithy quotes:

Your loss is not a test, a lesson, something to handle, a gift, or a blessing. Loss is simply what happens to you in life. Meaning is what you make happen.

Healing doesn’t mean the loss didn’t happen. It means that it no longer controls us.

When someone dies, the relationship doesn’t die with them.

II. Fred Guttenberg, Find the Helpers: What 9/11 and Parkland Taught Me About Recovery, Purpose, and Hope  

Notably, Fred Guttenberg, whose daughter was killed in the Parkland school shooting, reports that Joe Biden’s empathy, understanding, and emphasis on finding purpose served as powerful influences for the author. But he’s just one of the helpers Guttenberg knows.

As reported in The Columbus Dispatch, the author has said, “I never thought of the people who surround me as helpers until after Jaime died. Now that I understand that we all have our helpers; we only need to be willing to look for them and accept the help.”

III. Shelby Forsythia, Your Grief, Your Way

Shelby Forsythia previously wrote the 2019 Permission to Grieve: Creating Grace, Space, & Room to Breathe in the Aftermath of Loss. As she stated then, “Grief looks, feels, and shows up differently to each person. Just like no two losses are alike, no two griefs are alike, either. You cannot know the full depth of another person’s experience and they cannot know the full depth of yours.”

IV. Maggie Smith, Keep Moving: Notes on Loss, Creativity, and Change

Well-regarded poet Maggie Smith, after going through a painful divorce, turned her focus toward assisting others with their grief processes.

From an interview with Mary Louise Kelly, NPR:

I sort of say that hope was like a garment that I tried on every day. And at first it was very oversized and itchy and misshapen and uncomfortable, and it didn’t fit at all. The idea of finding optimism in your darkest moment seems very counterintuitive, and it felt really strange, even though I knew it was probably what was best for me. But something really strange happened, which is that the more I tried it on for size, the better it fit, and also the more that I told myself it’s going to be OK, and told myself that publicly — being vulnerable in front of thousands of people — the response I got from people who were going through their own struggles, whether it was divorce or a diagnosis, the comfort that other people were receiving from what I was writing actually gave me a sense of purpose and made me feel better in that moment, which was completely unexpected.

V. Hope Edelman, The AfterGrief: Finding Your Way Along the Long Arc of Loss

In her highly popular (1994) Motherless Daughters, Hope Edelman stated, “Someone did us all a grave injustice by implying that mourning has a distinct beginning, middle, and end.”

Kirkus Reviews:

‘I wish there were a foolproof method for ‘getting over’ the death of someone we love,’ she writes in the lucid preamble. However, ‘everything I’ve experi­enced, learned, and observed over the past thirty-eight years has taught me otherwise’….(V)aried perspectives coalesce to show how grief endures longer than most people ever realize. Edelman emphasizes that while we may never truly outlive the fallout from loss, it becomes an element of life that can be integrated into our own unique versions of felicity.

Nov 24

“After Life”: If You’re Wondering About That Therapist…

I recently finished both seasons of the British TV series After Life, a dramedy conceived by and starring Ricky Gervais. A  review excerpt from Jyotsna Basotia, meaww.com, feels like an apt setup:

Ricky Gervais has hit the right chord with his latest show on Netflix, ‘After Life’, which is packed with a pinch of sarcasm and dollops of humor. The series revolves around Tony Johnson, who is depressed after his wife’s death. Soon after he loses the love of his life, he adopts a devil-may-care attitude and calls it his ‘superpower’. He decides to do what he wants and say what he feels with the final plan to kill himself when he gets tired of it all.

Warning: this post is particularly for those who are interested in major spoilers.

Therapy scenes are plentiful in both seasons of After Life. In Season One Tony knows the psychiatrist (played by Paul Kaye) is totally insult-worthy but hangs in there anyway, painfully too long. It’s such a relief when Tony eventually decides to fire him. Indeed, by the end of the first season, our protagonist “finally finds out that even simple conversations with Anne, an older widow, and Emma, his father’s forgiving nurse, have better healing powers than his traumatic sessions with the therapist.”

But then in Season Two it’s another main character who regularly meets with this shrink! The writer at What Culture makes a sharp observation:

As odious and offensive as Tony’s psychiatrist was last season, there could be an argument made for his existence because at least he served a purpose. The egotistical narcissist was a sounding board for Tony, yes, as the grieving man could tell him how he was feeling about the world, why he hated people and, in the process, ultimately realise that the man sitting in the chair opposite him was one of those people.

The funniest thing about the character was Tony’s bewildered reactions to the dreadful stuff he spouted, so the mind really does boggle as to why he needed to return for the second offering when Tony had left him behind.

This time, he’s paired off with Tony’s brother-in-law Matt and the result is far less appealing, resulting in boring monologues with offensive commentary that might (at a stretch) have been funny in the first episode. We didn’t need the five that followed.

So, what exactly are this psychiatrist’s transgressions? Dan Peeke, Screen Rant, lists ten areas of fault, spanning both seasons. They include the following:

  • not paying attention
  • describing “a brutal description of exactly what he would do to Hitler if he had the chance”
  • telling Tony “just stop feeling sad” and Matt (dealing with marital separation) “don’t worry about it”
  • prescribing “sleeping around” to help the grief process
  • no apology or remorse when he gets the axe from Tony
  • open and crude obsession with sex
  • breaking confidentiality

Basotia (meaww.com) also takes on the “clumsy and dim-witted” shrink in her piece titled “Paul Kaye may be funny, but here’s why he’s everything Tony’s therapist should NOT be.”

Furthermore, critic Matt Roush, TV Insider, labels this unappealing guy “the world’s most inappropriately vulgar psychiatrist,” and Allison Shoemaker, Rogerebert.com, nails it when she says he’s “one of the worst mental health professionals in television history.”

Other than After Life‘s off-the-charts caricature of the therapist from hell? Actually, this poignant series is well worth seeing. (And earns an 8.4 on IMDB.)