Pauline Boss and Donna Carnes, The Myth of Closure:
Therapies for grief and loss have traditionally focused on the work of grieving. The goal was to reach an endpoint, now popularly called closure. There are, however, many people who, through no fault of their own, find a loss so unclear that there can be no end to grief. They have not failed in the work of grieving, but rather have suffered ambiguous loss, a type of loss that is inherently open ended. Instead of closure, the therapeutic goal is to help people find meaning despite the lack of definitive information and finality. Hope lies in increasing a family's tolerance for ambiguity, but first, professionals must increase their own comfort with unanswered questions.
Mystery persists with ambiguous loss, sometimes forever – and even across generations. People desperately search for meaning in the unrelenting confusion; the mind tries to make sense of the nonsensical.
Historian Drew Gilpin Faust calls the United States "a republic of suffering" . . . in addition to the ambiguous losses that Faust documents from the Civil War, there were many other bloody occassions when families did not know the fate of loved ones – the genocide of the American Indians, the forced separation for slavery for African American families, and the forces uprooting of refugees seeking asylum . . . . Adding to this traumatic, loss-filled history, we are also a nation of immigrants who are often cut off from the family in home countries[.] For all these reasons, it is no wonder that the phenomenon . . . of unresolved loss was – and still is – at the core of our societal hunger for closure.
Until we as a society acknowledge our psychological roots, temper our need for certainty, and learn to manage our societal anxiety about loss, clear or ambiguous, we will continue to pathologize and isolate people who are necessarily and understandably still grieving. We deny death by denying the need to mourn. Our fear of death my ultimately be the fear of ambiguity. It frightens us. We are left to suffer without a clear ending tothe story, thus we deny death as well as the need to keep the door open. This denial in concern with our historical legacy of ambiguous loss increases the stigmatization and isolation of the very people in need of compassion and human connection.
With all loss . . . the goal is to live with the grief rather than to close the door. We live with the lack of finality.
The therapeutic challenge then is not closure, but a paradoxical search for meaning in meaninglessness.
Paradoxically, the lack of closure allows people the freedom to both remember the lost person – and move forward with new hope and relationships.
Most people experiencing ambiguous loss are not clinically depressed, but they are indeed sad, chronically sad. While depression requires some medical intervention, sadness requires human connection and social support. With sadness, we intervene to help epople find meaning and hope in the company of others; with depression we intervene individually to alleviate symptoms and heal. Each has a different therapeutic goal.
When people live with such unresolved loss and grief, the goal is resilience for the long haul. There may be no clarification of the loss – ever. To strengthen one's resilience, one needs to be able to manage an irrational situation . . . . To live with even the most horrific ambiguous loss, we help people find meaning in their experience, no matter how baffling it is. They may say that their loss will never have meaning, but that, too, is a meaning. Horror and irrationality exist.
When working with ambiguous loss, we shift from the goal of closure to the search for meaning because there is no other choice. The therapeutic work becomes necessarily more collaborative as we are no longer the only experts in the room. In the absence of facts and certainty about the family's loss, we listen more and do less. We, too, learn to live with ambiguity and doubt – and hopefully find some meaning in their incurability.
To live with the paradox of ambiguous loss, both-and thinking becomes the most authentic way to think. Truth is relative and contradictions abound . . . . To manage the tension of such dialectical thinking, we encourage people to form their own both-and thoughts. But first we provide some examples: "My loved one is both gone – and still here; I am both married – and not married; I am both my mother's child – and now the mother of my mother; I am both married – and a widow(er) waiting to happen." Clients will be eager to add their own sentences. They know that contradictions are now the reality of their life.
Human perceptions matter because they are real in their consequences.
Neither of these rigid polarities – denial or early extrusion – is desirable. Instead, the goal is perceptual malleability. When facts are lacking, the only window for hope and change lies in a person's ability to shift perceptions. When a situation of loss will not change, one's view of it can. Through the shifting of perceptions, we can be empowered to see our ambiguous loss in a new way, one that no longer renders us powerless.
Remembering loved ones who are deceased is normal. It is common in all cultures except perhaps Euro American. It is, however, the Euro American culture that has produced the textbooks and diagnostic manuals that decree extended mourning and grief as illness. Better we learn from others – the Chinese Americans who have altars in their homes to honor their ancestors, the Ojubwa who see life as a circle and their dead as reincarnated, and the Mexican Americans who celebrate death once a year at the grave sites of their loved ones – that we do not need closure to live well.
Keeping deceased loved ones in your heart and mind like a sort of psychological family can be rich in meaning. It should not be branded as pathology.
For all loss, grief requires patience.
[L]ack of information breeds conflict. Be ready for it. Normalize it.
Personally and professionally, ambiguous loss with its lack of closure makes immense demands on the human capacity to cope and grieve. Perhaps our particular ambiguous loss will never make sense to us, but knowing that some losses are incomprehensible, and always will be, helps us to move toward change and some new measure of hope. Understanding that some losses are utterly senseless, and always will be, gives us the permission and freedom to let go of searching for the perfect solution. We bign to accept the paradox, find meaning in even meaninglessness, and hope in what we thought was hopeless. Increasing our tolerance for ambiguity and unanswered questions frees us from the burden of needing to close the door on loss.
And sure, in the wee hours of night . . . I feel deep loss and loneliness. But then I hear my greyhound pup snoring lightly by the fire, or I see the full moon rising, and I realize again how wonderful (and mysterious) being alive is . . . the lingering sadness I now carry is countered by an intense joy in living; they are side by side in me, an I am at peace with the duality.