In this moment I can actually hear myself telling more than one patient I’ve seen in the past, that it’s important to try new things. I’m a self-professed creature of habit though so sometimes I need to give myself as much of a push to try those new things as I do to them. With this in mind I embark on my very first attempt at writing a blog.
In my years working here at Morris Psychological Group my practice specialties have include treatment of adult depressive and anxiety disorders and mental health issues specific to women. Such issues have included but not been limited to, post-partum depression, post-surgery depression, menopause related depression, adjustment to divorce or single parenthood, and coping with chronic illness, losses or trauma. I have seen many patients over the years suffering from loss of a loved one and the resulting complicated or uncomplicated grief. However, in the last four years or so I have seen a growth in the number of referrals of people faced with a more complex type of loss called Ambiguous Loss, which has been written about and researched extensively by Pauline Boss.
It’s no secret that our aging population is growing exponentially. Older adults represent almost 13% (38 million) of the US population which is expected to increase to about 72 million by the year 2030. Simultaneously the number of people that develop Alzheimer’s / Dementia each year is growing as well. Dr. Boss has explored the large population of family members acting as caregivers to these generally older adults and a type of loss, Ambiguous Loss, that many of them need to learn to cope with. She has researched numerous other populations that have experienced this kind of loss as well.
Ambiguous loss is pretty much what it sounds like. It’s a loss that is unclear and has no resolution or closure. It can be physical or psychological but always results in some confusion as to whether the family member is “absent or present.” The family member may be physically absent but psychologically present as in those missing from disasters such as Hurricane Katrina or 9/11 OR, the family member may be physically present but psychologically absent as in the case of dementia or traumatic brain injury. Either way it exposes the family to ambiguous loss which is often the most stressful kind due to the inability to obtain clear answers, which can be immobilizing. After all, we live in a culture that values mastery and problem solving. This flies in the face of something that has been found to be a key task in learning to cope with ambiguous loss. Simply stated, when trying to cope with ambiguous loss one of the main components is to increase your tolerance for the stress of ambiguity. If it sounds a little like “accepting the things you cannot change,” it’s because it is, but it’s not simple. It’s a process. In these situations, embracing the ambiguity and knowing the world isn’t always fair and it isn’t your fault may help you get to the healthy belief that you are doing all you can.
Just months before she died of cancer, the legendary comedian Gilda Radner wrote, “Now I’ve learned the hard way, that some poems don’t rhyme and some stories don’t have a clear beginning middle and end…Like my life, this book is about not knowing, having to change, taking the moment and making the best of it, without knowing what’s going to happen next. Delicious ambiguity.” Gilda’s wise words remind us that life is uncertain and that’s not always bad. In looking at the ambiguity this way there is some hope. One may not be able to control disease and uncertainty but may be able to control how they approach each day.
In teaching people to cope with ambiguous loss, Dr. Boss has shared seven, very practical, guidelines especially for caregivers to help with the stress and grief they face each day. They include finding meaning, broadening your identity, managing your mixed emotions, holding on and letting go, imagining new hopes and dreams, and taking time to mind yourself. Along with embracing ambiguity I have used these successfully with family members on their caregiving journeys. Families need to know that caring for a loved one means that you sometimes have to accept imperfect solutions. My experience has also been that this type of loss and coping can take a great deal of time and patience with yourself and those you are caring for. However I have seen how worthwhile and life changing it can be for people who work at developing coping skills for these particular situations. Please feel free to contact me if you want to find out more.
