Ambiguous Loss

This post describes, in part, the effects of a degenerative neurological condition called Huntington’s Disease. Any negative behavior on the part of my wife should be attributed to that condition. Any negative behavior on the part of myself should be attributed to my need for God’s ongoing grace.

So what can I say about this week? Should I go into the details of what it is like to be quarantined with a woman that says the words, “I love you” but in actions says the exact opposite? No, there is no point in plowing that field again, so let’s talk about something else. The weather? No, that is too local. Politics? No, that is too divisive.

I have it: Risk. That is a good topic, but it is a dangerous one. To risk is to put something, perhaps everything, on the line. Risk means to put up or shut up, to commit yourself regardless of the cost. Risk is a timely topic right now too, as every newscast seems to be about it.

I haven’t mentioned it before publicly, but I have started learning Italian. Why? Partially because it is a risk, though an admittedly small one. But love, marriage and life – those are big ones. When Janet and I were going on our honeymoon, we decided to go to Tahiti because Janet had a job where she flew a lot, to the point that the airlines were almost paying us to go there. While there we met an Italian gentleman Signore Mantovani. As I recall he was some sort of official with the EU. He was alone because he had just lost his wife after a long illness and was traveling, revisiting all the places they had gone together as a couple. When he heard Jan and I were newlyweds he immediately “adopted us” taking us on obscure tours that he knew about and one night took us to dinner.

For those of you who have never had a real Italian dinner, it is not a quick sit-down to a plate of spaghetti at Olive Garden. A real Italian dinner is an all-night affair. So we had been “dining” for a couple hours and had just finished our appetizers and a bottle of very good wine, when Signore Mantovani looked at me and said, “You know what the problem is with Americans?” I had to admit that I did not know. He said, “You eat too fast! In Italy, we talk a little, we eat a little, we have some wine – and then we talk some more. In Italy, dinner holds us all together! Dinner isn’t about feeding the body. It’s about feeding the soul.” What he meant, of course, was that in Italy eating is always about more than food. Meals are about famiglia, family – and that understood in the broadest possible way. The dinner table is where traditions, lessons, love and recipes are passed on from one generation to the next.

Questo è per te Signore Mantovani!


Last week, I mentioned a term, more or less in passing. I had heard it from a friend online but have since found out that it is a real thing. The term is ambiguous loss, and it provides the title for this post. To my surprise, a psychologist, Dr. Pauline Boss, has been writing on this topic for nearly 20 years. One of the points that she makes in her work is that while “ambiguous loss” certainly applies to situations such as people suffering from dementia, there are also many other sources. For example, for someone who is divorcing, there is an ambiguity about the loss in terms of what exactly is going to be the relationship going forward. Likewise, she has worked with wives of MIAs about the ambiguity of their own marital status. Are they still married, or are they, in fact, widows. Even a child leaving home for college can produce a sense of ambiguity. Do we set a place for them at Thanksgiving, or should they be included when you say “we” (meaning the family) are going to do something? In the end, we see that ambiguous loss is actually much more prevalent than the “normal” kind where we can, for instance, see a body lying in a coffin.

For this reason, I have been looking into the matter further and the result is (at least) this post. While I haven’t done a book report since high school, that is what you are getting this week. Specifically, I’m going to be talking about Dr Boss’s first book on ambiguous loss called, appropriately enough Ambiguous Loss, Learning to Live with Unresolved Grief. This book is available on Amazon in hard copy or as a Kindle download, which is how I read it.

The first thing I want to point out about this book is that, while its primary audience is the psychological “clinician,” Dr Boss has a writing style that is nevertheless accessible and very easy to read. For example, the “case histories” that she presents are as likely to come from her own or her family’s experiences as from those of a client. Which is another good point, she never refers to the people or families that she sees as patients. Likewise, she doesn’t refer to her sessions as therapy because, in her view, words have meanings and to use the word “therapy” would imply that there is something wrong with the person or the family that needs to be fixed. In truth, she points out, the problem is not dysfunctional people but a dysfunctional situation. It is the situation that needs to be addressed. Consequently, rather than being the problem, the people are always part and parcel of the solution.

Dr Boss, likewise, doesn’t try to rephrase discussion of psychological matters in “layman’s terms.” She says, and I agree wholeheartedly, that talking down in that way is condescending to the people with whom she is working.

In addition to the psych-jargon and condescending attitude, also missing from this book are long drawn out discussions of the brilliant solutions that she developed for a family’s problems. Instead she presents solutions that people developed on their own to address their own needs. For example, she cited the case of a woman whose husband had an advanced case of Alzheimer’s Disease and who, despite not remembering who she was, was continually making sexual advances to her. In the end, the accommodation that the woman developed on her own, was to remove her wedding ring and put it in her jewelry box. She had realized that the thing that was causing her so much grief was the ambiguity between the conflicting roles of “wife” and “caregiver.” This simple act of removing the ring gave herself permission to temporarily set aside the wife role so she could concentrate on being the caregiver that her husband needed. Eventually, when her husband died, she retrieved her ring and took up her new role as “widow.”

Now obviously this solution will not work for everyone, but that very fact demonstrates an important point. Just as the loss is ambiguous, so are the rules that govern dealing with the loss. Therefore, the person or persons grieving will often have to cast a wide net to obtain the information that allows them to (prayerfully) synthesize for themselves a way forward. Such input can come from psychological professionals, family/cultural traditions, and their faith community.

In another case history, Dr Boss points out a fact that in hindsight is rather obvious: ambiguous losses are cumulative. In other words, most of us will go through multiple losses that would fall into this category and ones that are not resolved adequately add to the mental load imposed by the later ones. This stacking of loss upon loss can mean that dealing with a current loss can easily turn into an archeological expedition digging up and healing old unresolved grief that is being triggered.

So what is my final evaluation? I would say that this book would be money well spent for anyone who is being troubled by uncertainty – and who isn’t these days? You won’t find in it pat answers or how-to “recipes.” What you will find is information that will help you understand, and come to grips with, what is going on in your life.

As I was finishing up this post, it occurred to be that right now the whole world is in the midst of dealing with a massive ambiguous loss – so ambiguous that we can’t even be sure what it is that we might have lost. I am speaking, of course, of the pandemic that may (or may not) be raging across the globe. Is this the greatest threat to civilization since the bubonic plague, a hoax thought up by a shadowy global elite to enslave mankind, or a biological warfare experiment that went horribly wrong? Whom do we trust for information? Friends, family, media that can be owned by the government that it is reporting on, or the proverbial “guy in a bar”? Due to the ambiguity inherent in this situation, these ideas, whether we believe them or not, can and do create question marks in our minds that we have to deal with.

And then there is the question of what we may (or may not) be losing, or be in danger of losing: our life or the life of a loved one, freedom, country, religion or perhaps something larger like our sense of community and trust? Clearly we all have a lot of work to do.

In Christ, Amen ☩


A prayer for when you are feeling uncertain…

“Blessed are You, Lord God, King of the Universe. It is right that I should at all times and in all circumstances bless You for the certitude that You provide. But today I want to bless you especially for ambiguity. You are at once the central exclamation point of my life and the biggest question mark. There are so many things of which I can be absolutely certain, but at the same time so many things about You that are (to use the theological term) mysteries. Lord, help me to learn to be comfortable resting in the mysteries of who You are, and give me Your words to reach out to others. Amen”

Rules and More Rules

This post describes, in part, the effects of a degenerative neurological condition called Huntington’s Disease. Any negative behavior on the part of my wife should be attributed to that condition. Any negative behavior on the part of myself should be attributed to my need for God’s ongoing grace.

To get us started this week, let’s hear from the ’70s Canadian group, The Five Man Electrical Band.

Sign, sign, everywhere a sign
Blockin’ out the scenery, breakin’ my mind
Do this, don’t do that, can’t you read the sign?

Those words are the chorus to their 1971 hit song “Signs”. I’m bringing it up because these words highlight our cultural/global dependence upon rules. Of course this tendency is nothing new. In fact, rules go back to the very beginning when God told Adam and Eve the one thing that they were not allowed to do, to wit, “Do not eat from the Tree of the Knowledge of Good and Evil”.

I can’t image the number of words that have been expended over the centuries in attempts to fully explain that passage — and I am certainly not going to definitively resolve the matter with my poor ruminations. But one thing that always stood out to me is the inclusion of the word “Good” in the prohibition. Why would God want us to not know about things that are good? But I believe that question misses the point. Instead, I think that in that early innocent time, God wanted to spare us from was having to know the difference between good and evil. God wanted us to know good without an alternative, good that was unidentifiable to us as water is to a fish.

Unfortunately, we all know how the story turned out. Our ancestral parents disobeyed the one rule they were given, and then to make matters worse, when they were found out, they responded with recriminations rather than repentance. Adam, even tried to lay some of the blame on God! In the end, the knowledge of good and evil became for us a bell that couldn’t be unrung, and need for rules to govern our behavior entered the world.

Later, God gave Moses the Ten Commandments. But people being people, the Israelites immediately started asking for “clarification” of what this rule or that, really meant. Soon God’s simple commandments turned into a list of no fewer than 613 carefully crafted rules that you, literally, needed a lawyer to interpret for you.

By the time Jesus came along, even some members of the religious establishment realized that things were getting out of hand so they began the intellectual exercise of ranking the importance of the various rules by trying to identify the greatest of the commandments. During His conversation with a group of religious leaders, this enquiry gave Jesus the opening to whittle the rule count back down to just two:

  1. You shall love the Lord your God with all your heart, soul, and mind
  2. You shall love your neighbor as yourself

Very good rules indeed. Unfortunately, this moment of clarity didn’t last long. Rather, people (again being people) continued compiling their own lists of rules — and trust me, today there’s a lot more than 613 of them.

Although a rule-based society, can be troublesome for anyone, it is especially problematic when you consider the various “Alice in Wonderland” aspects of taking care of someone with a neurodegenerative disease such as HD. For example, of late, there has been a lot of conversation on the various support forums, dealing with the trials of applying for disability services. I have noticed a few things that most of these conversations hold in common.

First, the experiences are all remarkably similar, regardless of the country where the patient lives or the disease involved.

Second, the people overseeing the process are bureaucrats that have as their legally mandated role, not to help people get the services that they need, but to ensure that the “unworthy” are kept out.

Third, anyone that doesn’t meet the rules for the respective agencies are by definition unworthy and therefore bad (and possibly, criminal) people who are trying to sponge off the hard-working taxpayers and/or beneficent government.

The problem here is that rules create their own reality. For example, if you have a rule that defines a disabled person as being someone suffering from a disease on the official list, but your disease isn’t on the list, you aren’t disabled. It doesn’t matter if you can’t walk, or talk, or think rationally. It doesn’t matter that you have to wear a diaper and have no short-term memory, you are officially deemed to be able-bodied and so are expected to go out and get a job. I have read this same story coming out of the US, the UK, Ireland, Australia and even (especially?) Bulgaria.

For what it’s worth, I personally have memories of trying to get SSDI payments for Janet when HD wasn’t on the list. Even now, in the US, we are still struggling to get HD to a point of full parity with other diseases.

Then there is what we do to ourselves with rules over issues like suicide. I believe that the current sorry state of affairs exists largely because nobody likes to talk about suicide. The medical and psychiatric professions don’t deal with it well (perhaps because they see it as failure?). Families try to ignore, and hide, suicide due to the stigma attached to it. And the church, which should be a place of refuge and hope, is just as likely to be the place where you find rules that condemn the suicide to eternal damnation in the “fires of hell”.

But let’s be honest, it just isn’t that simple. My Janet can’t swallow without choking and is contemplating simply not eating again, ever. She has been fighting this disease for 11 years and has never wanted extreme measures used to maintain her life. Consequently, she believes that if you can’t even eat that is God telling you that it’s time to come home. Who am I to say she’s wrong? Where am I to draw the line between what is “justified” and what is not? What even gives me the authority to be drawing any lines in the first place?

It may have been there, but I don’t remember promising to, “Love, honor and draw lines until death do us part.”

Finally, we need to look at how rules can even impact the support that caregivers can receive. I have shared in the past that there was a time when Janet would get over the top, angry and violent. During one of those episodes, Janet grabbed my arm and dug her nails in so hard, that it broke one of her nails and left me with 4 bleeding cuts across the top of my arm. Not knowing what else to do, I called my pastor and started to tell him what happened. Before we got very far, my pastor interrupted me.

“Mike, you need to understand something. If your are about to tell me that Janet did something to you that broke the skin and caused you to bleed, I am legally bound by the laws of Texas to call the police and report it. Janet will be arrested.”

To say I was dumbfounded, would be putting it mildly. I thought this is the kind of intrusion into pastoral relationships only occurred in totalitarian countries. So after thinking for only a moment, I thanked Pastor for his time and hung up — we have never spoken about it since. In fact, we don’t talk about Janet’s condition very much at all.

Now believe me, I understand the supposed point of the Texas law, but I also fundamentally don’t give a damn about the state’s sanctimonious justifications. I know that Janet didn’t need or deserve jail, she needed help, but going forward with this so-called “pastoral counseling” while the state was in the room monitoring the conversation would have ensured that she got the first right away, and the second only later, if at all. It would have all depended on some bureaucrat agreeing with me about what Janet needed. So I had to ask myself, how much do I trust bureaucrats? And my answer: “About as far as I could throw them…”

Although my choice might not have been the best decision in the eyes of some, it is the one I made, and I would make it again because, to me, it satisfies Jesus’ second rule. But even so, I would not recommend it as a blanket solution, and I would certainly not judge anyone for making a different choice. However, I guess, in the end, that’s my real point.

Good rules serve as metaphorical guard rails along the sides of the road, that provide the room for reflection and prayer to determine the right path. Bad rules are like checklists that work to produce a result that conforms with what the rule’s author desires. To hell with what you or your loved one really needs — let alone what is the right thing to do.

This conversation about rules even applies within the Church. Different groups have different rules — the function of which is often to differentiate themselves from the heathen worshiping across the street who only, “call themselves Christians”. By the way, I haven’t mentioned it before, but I worship in a Lutheran congregation, so as a Lutheran I am well-aware of at least one glass house that is down range for the rocks that I am throwing…

The bigger problem is that in the world today, this attitude of rule-based spirituality is literally getting people killed. Persecution of people of faith, and Christians in particular, is up dramatically across the globe. Unfortunately, we don’t hear about it nearly enough because comfortable First World churches rest secure in the knowledge that the injured and dead aren’t really “one of us” — since when did that matter anyway?

Good rules are about prayerfully discovering God’s intent for a particular set of circumstances, like say you have a man that converts to Christianity in a culture that allows multiple wives. What should be the church’s response to his “extra” wives? What course of action would conform to the rule, “…Love your neighbor as yourself…”?

Bad rules are about social engineering and fitting every circumstance and every one into the same one-size-fits-all box, whether that box be secular or religious. No grace, no mercy, no justice, no mitigating circumstances — just the rule, the whole rule and nothing but the rule.

In Christ, Amen ☩


A prayer for when you feel boxed in…

“Blessed are You, Lord God, King of the Universe. It is right that I should at all times and in all circumstances bless You for the spiritual freedom that I enjoy. But today I want to bless you especially for not creating the kinds of rules that we do. We create rules that categorize and segregate people. You create rules that bless, guide and direct people. Thank you too, for showing me that regardless of how many times I break the rules, I can always depend on your grace and mercy. So please Lord, let me see others as You see them. Give me the courage to speak up for the oppressed and weak, and I humbly ask that you would bestow on me the privilege of being an advocate for them in the world. Amen”