Speaking of Psychology - Ambiguous loss and the “myth of closure,” with Pauline Boss, PhD

Episode Date: March 9, 2022

March 11 marks two years since the World Health Organization declared COVID-19 a pandemic. With another variant waning, many people are hoping, yet again, to close the book on COVID and move on. But what if there’s a different way to think about life after loss? Pauline Boss, PhD, author of “The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change,” talks about what we have learned about grief, resilience and moving on after two years of pandemic life. Links Pauline Boss, PhD Speaking of Psychology Home Page Learn more about your ad choices. Visit megaphone.fm/adchoices

It's been two years since the World Health Organization declared COVID-19 a global pandemic. Sometimes it's hard to believe it's been that long, while on other days it feels even longer. Nearly everyone has lost something over these past two years. Many losses were tragic, especially the deaths of loved ones from COVID-19. But even the smaller losses have added up. Graduations, birthday parties, and weddings that were rescheduled and rescheduled again, and finally canceled. Friends and acquaintances whom you can't see or who have fallen out of touch. People who have lost jobs and businesses and maybe even their confidence in the future.

Now, after two years and with, we hope, the latest variant receding, many people are hoping yet again to close the book on COVID and move on with regular life. But what if closing the book is an elusive goal? What if closure is not what we should be aiming for? And instead, there's a different way to think about life after loss. What have we learned about grief and resilience and moving on after two years of pandemic life? Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills. Our guest today is Dr. Pauline Boss, a professor emerita in the Department of Family Social Service at the University of Minnesota. Dr. Boss coined the term

ambiguous loss in the 1970s. Coming from the discipline of family therapy, she originally implied the term to family's mourning a loved one whose loss was in some way unresolved, like a soldier missing in war. In the years since, she and other researchers have expanded the scope of ambiguous loss, using it as a framework through which to view any number of personal, communal, or global losses, from the pandemic to racial trauma to climate change. Her new book, The Myth of Closure, ambiguous loss in a time of pandemic and change addresses these topics and more. Thank you for joining us, Dr. Boss. It's my pleasure.

Let's start with the title of your book, The Myth of Closure. Many of us tend to think that we want closure after a death or a divorce or a breakup. Why do you believe that closure is the wrong thing to be looking for after we lose something or someone? Well, closure has a definition meaning finality. It means closing the door on something that has happened. It's a perfectly good word in the business community for closing a contract, for closing a real estate deal, or for closing a road after a flood has occurred. But it is a harmful word in human relationships. It indicates that even though we have had attachment to someone or something like a pet, that once they are gone, we can close the door on that.

That's not true. There are continuing bonds, as has been now declared in the grief literature, and that we don't close the door. We live with loss and grief. Do you think this desire for closure is culture-specific? Is it something that Americans are particularly invested in, or is it even a more universal desire? It's not a universal desire. It is, I think, more American than anywhere else. perhaps because we're a very mass-oriented culture. We believe in fixing things, finding cures. We do that very well, by the way, and we have put people in outer space and helicopters

on Mars and a camera into deep space. We are really good at solving problems and precision and fixing things. But now and then something happens in human relationships that can't be fixed, a terminal illness, or in this case, a pandemic, that at first we didn't understand. We couldn't master this enemy that was unseen, the virus. Eventually, by the way, the scientists did master it, which was wonderful. But nevertheless, that virus still lurks out there somewhere. Can't be seen.

It's very ambiguous. It's an ambiguous enemy. that is still with us. And even when the pandemic is over, it apparently will turn into an endemic, which means the virus will still be here, as is the virus of 1918. Only, we just have an annual flu shot for that. So if not closure, you talked about living with the loss, how do people do that? What's different about saying it's over and done with and saying, this is still with me? Well, the difference. is that what people really want is finality, is clarity. What they really want is certainty about what's going on.

I understand that totally. We have a little more certainty now about the pandemic than we had before, thanks to the scientists and the medical people who have learned along the way and who built on previous research, by the way. And so what human beings want is not closure after, loss. What they want is certainty of what that loss was, if it's a human loss or even a pet loss, where the remains are, and that they're not just missing in action. That ambiguity is very, very stressful on top of a loss. In other words, it exaggerates the pain of the loss.

It freezes the grief, and it freezes the family processes, the couple and family processes that could go on. No decision-making happens. People wait. And of course, sometimes they wait for decades, which is not functional in families and couples. The family and couples system has to move on without the missing person. And so I recommend both-hand thinking, whereby they both hope for a good outcome, either finding remains or having the person return, they hope for certainty, but they also move forward with their daily lives. It has to be both. It can't be one or the other. So let's talk about the term ambiguous loss, which you coined in the 1970s, in the context of family therapy.

And you define two different types of ambiguous loss, loss in which A loved one is missing physically and loss in which a loved one is missing psychologically. Can you talk about that early work and what led you to study this phenomenon? Well, what led me to study this phenomenon is that when I was studying from my doctorate at the University of Wisconsin and Madison, I was observing Dr. Carl Whitaker in the Department of Psychiatry, who was teaching family therapy at the time. And families would come in with the child as the identified patient. What I noticed was that the fathers were always angry at being there, know that this was the 1970s.

And the fathers would say, why am I here? I should be at my job. The children are mother's business. And so I wrote a paper as a grad student about the psychological absence of the fathers in an intact family. So I was about to study psychological father absence in an intact family. That was my first publication. And meanwhile, I was studying over in sociology, a theory construction. And the professor said, that's a good term psychological absence.

But it's about more than fathers, Pauline. He said, think about a more general term. And so I went home and pondered about it a long time, but eventually came up with the term ambiguous loss. so it could be anyone in the family. I was studying families at the time, and so I had it at that level that a person could either be physically missing. An extreme example would be soldiers missing in war, loved ones kidnapped. A more common example comes from divorce and adoption and so on, or the person could be

psychologically absent, and the most common use of that now is for caregivers who are taking care of a loved one who has dementia, Alzheimer's disease, or the over 80 other kinds of conditions that cause dementia. But it also could be used for a traumatic brain injury. It could be used for severe depression and other severe mental illnesses. More common examples, of psychological ambiguous loss would be preoccupation with work so that you're not available to your family or your partner. Or it could be the preoccupation with our devices so that, you know, you see a couple at a restaurant having a lovely dinner together and both have their heads in their telephones.

So that's a more common problem right now, I think. So that's how it all got started. And then more recently in the new book, I have raised the ambiguous loss theory to a higher level to include society. And globally, such as the pandemic, caused ambiguous losses for everyone on this world. And then it made me think about racism here because I lived very near to where George Floyd was killed here in Minneapolis. and my eyes were opened with that videotape that that young woman took, Adela Fraser, and for some reason it opened my thinking in a way that should have been open before, but wasn't.

Perhaps because we were locked in at the time, we were more reflective, I'm not sure what. But at any rate, I believe that across generational transmission of transnational transmission of trauma from slavery started with the ambiguous loss of slavery when families were torn apart on the auction block sold off parents, one from the other, and parents from children. And that that heinous crime of slavery has, in fact, not gone away. That is still the stress and the trauma of it is still with us today. And then I also also. mentioned more as a proposition for other people to study and not me, I propose that climate change is causing ambiguous losses, the loss of clean water, the loss of fertile lands, the loss of

a life as we knew it. And that will be for future generations to test. We actually did a podcast not long ago about climate change in which we talked to a couple of experts who discussed ecological grief. And I think that's kind of what you're talking about, that you're grieving losses due to what's happening to our environment. How is that connected to the same feelings that we have with respect to, say, the pandemic or racism? Well, again, it's a loss you can't see. When someone dies, at least in normal times, we'd have a funeral, we'd have a ritual, there'd be a notice in the paper, there would be a death certificate, there would be certainty about a loss with death,

but there's also some other losses that have certainty, such as loss of money during the COVID, loss of your retirement savings during COVID, loss of your house during COVID. Those all can be quantified. But I'm talking about losses that have no quantification. They're so uncertain, they're so unclear, that in fact, we don't,

list them, or we list them as deaths, as they did in the Civil War and in other wars, they are different because the family has no assurance of death. And now and then a few people came walking out of the jungle, or after 9-11 in New York, a few people were found in psychiatric institutions without remembering what happened to them. What makes this different is that we have all these ambiguous losses that if, happen to us. And so the general population is talking about mental health issues. Come on, there's stress issues. And we're causing, we're calling too much a mental health problem that needs psychiatric help or psychological help. We're pathologizing a normal reaction to an abnormal situation.

I'm going to repeat that. We cannot pathologize normal reactions to a pathological situation. We have just had two years of a pathological situation, literally a pathogen out there where we can't see it, causing many, many deaths, many illnesses, and just uprooting the entire world from what we used to do and how we used to live. We haven't had major loss, but not all the loss was quantifiable. Yet, it is real. So I completely understand the ambiguity of the pandemic and what's been happening to us over the last two years. But when somebody dies, or even if a pet dies, I mean, that's sort of an end point. Isn't that something where we should feel like it's done? Why is that still an ambiguous loss?

It feels different to me qualitatively than the other things that you were just talking about. It may be somewhat different, but there is no end point. That is, there's a transformation from breathing to not breathing, from life to death. That's a transformation. And there is no closure on the relationship you had with that person or that pet. Indeed, something has changed. and we need to recognize that. But we'll recognize it more likely if people can differentiate between the physical ending,

that is the breathing ends, versus the attachment. So I'm really coming out of attachment theory of Volvey, which says that once you make an attachment to someone or something, I couldn't even talk about someone's home. you make an attachment that even if that thing is no longer with you, if the person has stopped breathing or if you've lost that home or that pet, you can still feel attached to them. You can still say, I love that.

That was my favorite place. I love that person. That was my favorite pet of all times. I love that pet. I miss them. you know they're gone. And so we call that continuing bonds that came first from the edited book by K-L-A-S-S and and other his colleagues, that continuing bonds is what is normal grief. Getting over it is an artificial idea put upon, I think, of the people who are grieving in a culture

that has no patience for suffering. We might be that culture. You wrote in your book about your own experience of loss from your early childhood memories of your immigrant father, missing his Swiss homeland, your brother dying of polio as a child, and to your becoming a caretaker for your husband before he died in 2020.

How have these personal experiences shaped how you think about loss today? from the beginning and the earliest loss was my little brother who died of polio the summer before the SOC vaccine came out. My view already back then was that I didn't have to get over it. But then I was a bit of a rebel right then already. But I lived in a Swiss immigrant community, New Orleans, Wisconsin, where everybody came from, in that case, Switzerland.

They were all homesick. I lived in an environment of homesickness in the village, but also in my home. So I was kind of accustomed to the fact that you don't cut bonds. You remember them, even though I had the sad version of it, a little heavy on the sadness side, I thought. But therefore, the community, I think, was perhaps advanced at that time in this regard, in that nobody ever told me I should get over it. there was always remembering class reunions would remember my dead brother, his classmates.

And so I perhaps was lucky to live in an environment as I was growing up where there was no closure. You remembered people every memorial day. You went to the gravesites and remembered them and so on. Today it's a different story as I live in more urban environment now. and corporate ideas that, you know, we'll give you a week, three days maybe to grieve and then come back and be productive. That assumes you get over it. And the thing is, you don't need to get over it. Even with a clear-cut death, with a death certificate, with funeral after, and all the appropriate rituals,

you don't need to get over it. You can live with grief. and that's recommended. And Bonano and other researchers say, and Nimar say there's oscillation, that it ebbs and flows, grief ebbs and flows, or comes in and out. And over time, those ebbs and flows, oscillations will be farther apart. But they're never gone. There's never closure. So the latest research certainly is in the idea of living.

with loss, not getting over it. And then in the book, I write about the fact that Freud, in fact, gave us a different message in his personal letters to his friends than he did in his academic writings because when the client said to him, I'm sorry about your daughter who died. She died of the flu in 1920. And he said, no, she's still here. and he patted his vest pocket, wherein he must have had some momentum of her. Now, he never told us that in his academic writings. He talked about detachment, and I talk about more Kubler-Ross and others who write one way academically and write another way personally.

Kubler-Ross in the end of her life after she had nine strokes, many strokes, excuse me, but lived for nine years not being able to. walk. She said that dying was not the five stages, which she meant them to be, that it wasn't linear, that it's messy. And it was messy for her, and she was angry about it a lot. So we need to take another look at our historical stages who changed their minds in their personal writings. And I wrote this book more personally because I wanted to make sure I was congruent personally and professionally as much as I could. That's admirable. I appreciate you telling that story. Thank you. For many younger Americans, the pandemic was their first experience for existential threat and a communal large-scale loss.

Now, earlier generations live through a major depression, world wars. People used to experience much more loss a lot earlier in life. Women commonly died in childbirth or children died of communicable diseases that are no longer fatal because we have much better medicine and vaccines. But do you think that the pandemic has changed the way that the younger people today are thinking about risk, uncertainty, and loss? And do you think this will have lasting effects about how they approach loss and grief going forward? I think so. It's too soon to tell. But I predict there is going to be change as a result of this two years of turmoil and upheaval into our normal way of life. We already see changes and how we do things. And I have great faith in young people for being resilient, more resilient than adults. are or the older we get. And children are resilient too. They will remember this as I remembered

the polio epidemic, as I remembered the Depression, and as I remembered World War II as a child. I was afraid by watching my parents' faces, I would know how afraid to be. But in a way, what that taught us and what will teach the young people now, I think, is that you can't always have your way. You can't always have the world be the way you want it to be. There are tragedies. There are difficult times. And you know what? We can get through them. And I think what young people today may learn is that they got through this. Okay. I talked to quite a few of them who missed college graduations who were cut off from friends immediately without saying bye, et cetera, et cetera.

But they have a philosophic response to it that I find very mature. They found other ways to say goodbye to friends. They couldn't say goodbye to in reality. That they know they will have probably the best class reunions any of us have ever had down the line. They got stronger. because of it. And perhaps this generation I'm talking about, this is the first thing when things didn't go right for them, for many of them. Of course, there were exceptions.

I realized that. But we've had a parenting style for a while that, that I believe has interfered with the stress management development of the young people, whereby parents would make sure their kids weren't distressed. Well, being stressed and being able to cope with it teaches you that you are stronger than you think. And that's a very valuable lesson for the rest of your life. And I can see that in many of the young people now. They will be stronger for it. Not that I wish this on anyone, but once adversity happens and you were resilient in it, you bent like a tree and a storm, but you got up again. You are stronger psychologically for having been through that.

So after writing and observing so much about grief and loss during your career, do you consider yourself basically an optimist or a pessimist about the human condition? Oh, I'm an optimist. And I don't consider myself a grief expert because there's so many of them. I consider myself an expert on loss and the nuances of loss, the different kinds of loss and the stress it causes. I started out in the stress field and that's essentially where I come from. Ambiguous loss is not a medical model focused on pathology. It's a stress model focused on resilience. As a result of that, And having come from a family of hard times during the Depression and then, as I said, World War II, and seeing people, you know, stand up after that. And these were terrible things, by the way. And now with the pandemic, again, I see people in a way that they have more maturity than I've ever seen before, in the young people especially.

And in other people, they've coped in very creative ways. Indeed, some have not because some people believe in binary thinking. And, of course, the science of the pandemic, science is never binary. It's always based on probability. And they wanted a clean answer. They wanted closure. Am I in danger or not? Do I wear a mask or do I not?

Is the virus real or is it not? So we saw a part of the population that needs absolute thinking, more like closure. They think in binaries, you know, you're either with me or you're not. It's either dead or alive. It's either safe or it's not safe. That way of thinking didn't work right now. And these are not optimists, by the way. So I think if you can think in a more resilient way, if you can act in a more resilient way,

if you can act in a more resilient way, flexible, but learning from it, growing stronger each time, you will also be optimistic because what that means is you can cope with most anything that comes along in life, the death of your loved ones, accidents, loss of a job. I don't wish that on anyone, but by the way, death is inevitable. if only it's your parents getting older and eventually dying. And so life will bring its losses. And our practice with being resilient will pay off. It will let us know, as I wrote in the book,

you can be knocked down, but you can get up again. Well, Dr. Boss, I think that's a wonderful message of hope. I appreciate your bringing it to our listeners today. I hope that they have learned some things that will help them through these trying times, which I think have been difficult for many of us. So thank you for joining us today. My pleasure. You can find previous episodes of Speaking of Psychology on our website at speakingofpsychology.org

or on Apple, Stitcher, or wherever you get your podcasts. And if you listen on Apple, please leave us a review. If you have comments or ideas for future podcasts, you can email us at speaking of psychology at APA.org. that's Speaking of Psychology all one word at APA.org. Speaking of Psychology is produced by Lee Weinerman. Our sound editor is Chris Condayan. Thank you for listening.

For the American Psychological Association, I'm Kim Mills.