— BOOK AND MEDIA REVIEWS —

The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change

Holly Salzman, MD

Fam Med. 2022;54(3):235-236.

DOI: 10.22454/FamMed.2022.599018

Book Title: The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change

Author: Pauline Boss

Publication Information: New York, W.W. Norton and Company, 2022, 181 pp., $21.95, hardcover

The years of 2020 and 2021 have been times of great loss in our world. COVID-19 death tolls exceed 5 million worldwide, climate change threatens our ways of life, and political unrest and racial injustice are daily in the headlines. How do we cope, or even thrive, in this turbulent world? Pauline Boss, PhD, a revered pioneer in work on ambiguous loss, helps us to find this answer in The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change.

Dr Boss describes ambiguous loss as a loss that remains unclear, without official verification or immediate resolution, and for which resolution may never be achieved, and makes the case that this applies to the tumultuous time in which we live. If we look for closure, for return to normalcy, we become anxious, angry, and depressed. The lack of having one precise answer is especially challenging for those of us in the medical field, who have been trained to aim for perfection. Instead, she encourages us to reframe our perspective on ambiguous loss, which will lead to resilience and growth.

So how do we do this? Dr Boss guides us through six principles for developing the resilience to live with and thrive despite these ambiguous losses. She makes it clear that these are not steps to be achieved sequentially, but to be used as needed as we navigate these times. Finding meaning and discovering new hope are key, supported by adjusting mastery, reconstructing identity, normalizing ambivalence, and revising attachment. Finding meaning in our loss makes tragedy easier to bear. Adjusting mastery allows us to control what we can control. We may need to reconstruct our identity, changing how we define ourselves. We learn to accept that ambivalence and conflicting emotions and feelings are normal and move forward despite this. We revise our attachment to the way things were and accept change to find a new steady state. Ultimately, we learn to hope for something new and move forward rather than living in a state of suspended animation.

Many of us will be able to work through these principles on our own, or through discussions with close friends or colleagues, but others may require professional help. The author addresses normal grief and its cultural variations and provides a list of symptoms indicating need for professional help. For those considering suicide, she encourages seeking immediate help, and provides the toll-free number to the National Suicide Prevention Lifeline.

Finally, Dr Boss provides hope for the future. Loss and change are closely linked. After loss, there is change, and those changes are often positive. “It is in times of absurdity, when people are unmoored, that positive change is possible” (p. 109). She goes on to describe such tragedies as the bubonic plague, World Wars I and II, and civil unrest, and the decidedly positive changes that followed. As we as a nation find new meaning and hope, we can aim for change “to make life safer and better for everyone in the human family” (p. 113).

Overall, Dr Boss’ book achieves her stated goal of this not being a therapy book, but a book that is therapeutic (p. xvii). Applying her principles of living through ambiguous loss to the pandemic can indeed help us to heal our souls and to move forward into our new semblance of normal. Her message, however, is diluted by trying to be overly inclusive of all the woes in today’s world, and would have been stronger had it focused solely on the COVID-19 pandemic. Despite that critique, this book will be a powerful resource for all who are grieving losses brought by COVID, from human life, to way of life, and will guide the development of resilience and encourage growth. As physicians, it will shape our perceptions of this pandemic, as well as help us to understand and address our patients’ perceptions, and will make us better healers.

Lead Author

Holly Salzman, MD

Affiliations: San Diego, CA

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