DR. BOSS: I think that’s part of our American culture that we don’t want to hear that. We don’t just deny death in our culture, I think we deny ambiguous loss that comes with things like immigration. And homesickness comes along with that and we really want people to get over it. [laughs]
MS. TIPPETT: Mm. I was listening to you — I think one of the questions that is on many people’s minds when you have this conversation is, “What do you know about what’s the best way to react?” And I was listening to you on a call-in show. And people would call in, and everybody had such a unique story. And I remember a woman whose brother, I think, went hiking and just never came back.
It was a wilderness area, and they never found his body. And it was a decade ago. And I just — I listened to you listening to her, and the question you asked was, “And how long has it been?” And it was 10 years, 14 years. I think that might be a question that, in kind of normal interactions, one might be embarrassed to ask, or feel like that would take them back, or something. So you asked that, and she answered it. And then you just said, “I am so sorry.”
DR. BOSS: There’s really nothing else to say. And I think we could help each other in society to learn how to speak to people who have missing loved ones. I think it’s perfectly good to ask them, “How long has it been?” Because they want to tell you how long it’s been, and sometimes it’s been decades.
And, for example, with the Holocaust, and slavery — shall we go back — and Civil War, and with the Native Americans, and any genocide throughout the world — it can be a hundred years, and they still remember it. And so it’s OK to say, “How long has it been?” And then to say probably the only honest thing you can say, if you feel it, and that is, “I’m sorry.”
DR. BOSS: There is no such thing as closure. We have to live with loss, clear or ambiguous. And it’s OK. It’s OK. And it’s OK to see people who are hurting and just to say something simple. “I’m so sorry.” You really don’t have to say more than that.
MS. TIPPETT: And what struck me as I was thinking about this, thinking about interviewing you is this is maybe another one of these areas where we could be kinder, where we could be better. Because I think when we talk about divorce or when find out somebody’s getting a divorce, I’m not sure that we treat it as we would a loss or that we acknowledge that grief in the room.
DR. BOSS: And sometimes I’ve made a mistake by saying I’m sorry, and they’ll say, “Don’t be.”
There is a difference between depression and sadness… Sadness is treated with human connection. People cannot deal with the problem until they know what the problem is. Need to put a name on the problem.
DR. BOSS: And in order to understand this, though, we have to make a difference between depression and sadness.
MS. TIPPETT: Right, right. To say that sadness is not depression.
DR. BOSS: And so far, that hasn’t been made. [laughs]
MS. TIPPETT: Right.
DR. BOSS: Yes. Depression is an illness that requires a medical intervention. It’s the minority of people who have depression. And yet, with the ambiguous loss of let’s say Alzheimer’s disease and 50-some other dementias, caregivers are said to be depressed. Most of the caregivers I have met and studied and treated are not depressed; they’re sad. They’re grieving. And this should be normalized. And sadness is treated with human connection.
MS. TIPPETT: Mm. So, one of the things that you say — and this makes so much sense, but it’s the kind of thing that makes sense — we have to say it — that people can’t cope with the problem until they know what the problem is.
MS. TIPPETT: You’ve said that dialectical thinking, that paradoxical thinking, helps. And I think that’s an example of that. But explain that, what you mean by that. Because — and again, I think that’s not necessarily instinctive for us as creatures, and certainly not in moments when we’re stressed.
DR. BOSS: Yes. I think it might be a more Eastern way of thinking, actually.
MS. TIPPETT: Yeah.
DR. BOSS: But yes, the only way to live with ambiguous loss is to hold two opposing ideas in your mind at the same time. And these are some examples. With the physically missing, people might say, “He’s gone, he’s probably dead, and maybe not,” or “He may be coming back, but maybe not.” Those kinds of thinking are common, and it is the only way that people can lower the stress of living with the ambiguity. And children learn it rapidly, and even adults learn it. It doesn’t take too long. It is not part of our culture, however.
We like finite answers. You’re either dead or you’re alive. You’re either here or you’re gone. And let’s say you have somebody with dementia, or a child with autism, and they’re there, but they’re not always there. And so once you put that frame on it, people are more at ease and recognize that that may be the closest to the truth that they’re going to get. To say either or, to think in a more binary way — he’s dead or he’s alive, you’re either here or you’re gone — that would involve some denial and lack of truth, so the only truth is that middle way of “he may be coming back and maybe not.”