As is typical, much of what we learn regarding mental health in our field finds genesis within the military. And, the idea of Ambiguous Loss is no different. Lead by researcher Pauline Boss, Ambiguous Loss grabbed foothold in the grief research world. She was able, in many ways, to put a title to something that so many spouses and families had felt over the years. Let us set the stage.
In any given stereotypical war story there is the fated scene where a military car speeds down a dusty old road to a farm house of a serving soldier. His wife toiling over something in the house grows grave; this symbolism is well understood by us viewers, as well as the character in question. She collapses into immediate grief, understanding that they are here to deliver the bad news. They solemnly approach. The scene cuts out.
We, as viewers, don’t even need dialogue to understand what is happening. That speaks volumes to our understanding of the various symbols and processes of “grieving” the loss of a solider. So, let’s replay the same scene over, but instead of “dead” we hear “missing in action”. There is a major catch here.
What is the difference? Surely, there must be one. These two scenarios are very different. One is finite, and conclusive. The other is elusive and vague. What does missing mean? And for how long, and how, and why and all the other cascading questions that become individual cuts in already large, hurting wound.
In a podcast interview, “On Being”, with Krista Tippett, Pauline discusses the nuances and major themes of ambiguous loss. She is quick to understand that this “loss” can be completely psychosocial in nature. What Pauline discovered and put forth, is that the person doesn’t have to be “gone” to be lost.
Now, for how this is important to the firefighter. We have had the upsurge in awareness around Post Traumatic Stress disorder. Certainly, by now, you’ve heard the term. You’ve also heard enough times to have memorized the large, looming, and devastating symptomology that is associated with this disorder. With this, I will resist giving yet another run down here. And while all these need to be addressed, discussed, and managed, there is an entire population of people who are affected in other ways that are too often missed.
What Pauline had found, and what many spouses may have experienced (especially in absence of treatment), is ambiguous loss. When a normally outgoing, involved, and talkative spouse who becomes isolating, withdrawing, and absent from the family life there is a loss felt by that family unit. To the spouse, it is the loss of the person that they have grown with. They are unable to easily discern whether the person will be there today, whether they will be able to get out of bed and help with the kids, or attend parent teacher meetings, help with other life stressors. The spouse has “lost” their partner, who still walks and breathes within the walls of their home.
This can make a way to cope and manage much more complicated and difficult. A loss when there is a physical loss to grieve, while immensely painful, has finality to it. That process, complex as it is, is more typical, expected, and associated with some sort of ritualistic goodbye. But, with ambiguous loss there is no such goodbye. The person is still there in the home.
Our spouses are left to carry on, in a lot of ways, as if their partner wasn’t there. And, herein lies where grief experiences collide and we recognize the pain associated for the partner. Our spouse may need to maintain the house, and income, manage the kids, and family, and friends. Cook and maintain the house and yard. Pay bills, manage problems, attending meetings. The list goes on. And, these were all something that their partners, prior to PTSD, would have supported and took a stake in to help with.
This creates some complexity as our grieving here requires two simultaneously occurring processes: grieving the loss, and maintain the loss is recoverable. Like Schrodinger’s Cat, both are true. And hope is an invaluable necessity. Hope is a component crucial in both the firefighter as well as the spouse in trying to develop a new normal within the household bringing equilibrium. What is being found in ambiguous loss research is that this process is a normal struggle and, unless in extraneous circumstances where it exceeds the grief response, this part of the path towards this healing.
Pauline, in her interview, also makes two important statements. First, she talks about the fact that “grief” in the individual is not pathological. That is, it is a normal response to the situation. And grieving is not something that she sees “needs intervention”. That is, being “sad” is much different than being “depressed”. Depression, of course, something that requires intervention and sadness is not. Yet, she adds, this is often viewed as the same thing when discussing grief.
Secondly, it may be really important to shift our view point from the black and white outlook of “a or b” to a more ambiguous outlook. Pauline identifies this is a necessary shift in perspective to help soothe the grief. That means, for instance, that for our spouses, the firefighter may return or they may not. Both are true. And our firefighters with PTSD can be treated successfully. Therefore, we are able to ameliorate much of the pain and suffering that our partners may find when we are in the midst of a struggle. If we keep that fight in us to seek out and engage in therapy, we have a high likelihood of overcoming our struggles. Limiting and ending the ambiguity for our partners, by removing ambiguity in the returning psychologically.
In our effort to support our members that are struggling from the impact of the stress of the job, we lose touch with the families. They are not bystanders watching the pain going down. If we look at who is likely to first notice problems, help manage them, live alongside them and often work and navigate around them, we recognize that the family is impacted second only to the struggling firefighter. We need to look to strengthen and offer support to families. That can become the biggest tool we have in fighting against the familial impact of PTSD and other mental health struggles.
We can now add slightly to the scene we started with: The wife receives the letter and engages in a grief response. They then adopt the viewpoint that “grief” is ok and normal and that her partner is both, “not here and can still come home”. She is able to manage and cope with the loss. Our partners, too, can benefit from learning about this process, which is a normal and expected outcome of a psychologically based loss. Perhaps, in this, they are better able to remain strong and powerful in their own psychological health which can translate into continued support for the firefighter as they move through their treatments and return back to the home.
For more information, go to www.afterthecall.org