Pioneering educator and researcher Dr. Pauline Boss coined the term “ambiguous loss” to describe a form of grief that is common in caregivers of family members with Alzheimer’s and other forms of dementia.  It’s marked by a never-ending grief for the person with dementia who is “there but not there,” and it forces the caregiver to confront a new and confusing relationship – one ruptured by the dementia.  Dr. Boss tells us how the phrase “ambiguous loss” evolved and how she experienced it in her own childhood, growing up in Wisconsin in her Swiss immigrant family.  She explains why people who are mastery-oriented have a harder time with ambiguous loss, how Western culture has conditioned us to believe we can change things we can’t and how this mindset prevents caregivers from having “good enough” relationships with care partners who have dementia.  We’ll hear suggestions for how to lower stress levels and increase your tolerance for ambiguity, something Dr. Boss is working on in her own life as a caregiver for her husband, who is unable to walk.  When she’s not caring for her husband, Dr. Boss is working on a new book called, “The Myth of Closure.”  She recently launched her ambiguous loss online training program.  Dr. Pauline Boss is the author of five books including, “Ambiguous Loss: Learning to Live With Unresolved Grief,” and the book, “Loving Someone Who Has Dementia” which will be released as an audio book later this year.

Explore the work of Dr. Pauline Boss: Ambiguous Loss

 

Pauline Boss, PhD_Ambiguous Loss

Pauline Boss, PhD

 

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Music: “Arashi” by Kakurenbo | CC BY NC | Free Music Archive

 

INTERVIEW TRANSCRIPT:

[INTRO CLIP/MUSIC]

JANA  –  [SHOW INTRO] If you’ve experienced the death of a family member or friend, you know how hard the grieving process is. It’s different for everyone, but there are rituals we can take part in, like funerals and wakes, that help with the grieving process and make evident the transition from life to death. But how do you grieve the loss of a family member or friend who’s still alive but missing, either physically or psychologically? Pioneering educator and researcher Dr. Pauline Boss coined the term “ambiguous loss” to describe this state of a kind of grief that has no end. Dr. Boss is widely recognized for her groundbreaking research on ambiguous loss, a term she coined in the early 1970s while studying the families of pilots missing in action in Vietnam and Southeast Asia.

JANA  –  Among the many people Dr. Boss has worked with are the families of 9/11 victims in New York, families in Kosovo who have lost loved ones through ethnic cleansing and terrorism, and families who have psychologically lost a relative as the result of Alzheimer’s disease and other chronic mental illnesses. Dr. Pauline Boss is the author of five books including, “Ambiguous Loss: Learning to Live With Unresolved Grief,” and the book, “Loving Someone Who Has Dementia” which was written explicitly for family caregivers and paraprofessionals, and will be released as an audio book later this year. Dr. Pauline Boss is Professor Emeritus of Family Social Science at the University of Minnesota, and she’s a family therapist in private practice. Dr. Pauline Boss, it is such an honor to have you on the show. Welcome to The Agewyz Podcast.

PAULINE BOSS [PB] – Thank you. My pleasure.

JANA  –  So I saw your website, your video on your website, which shares that you grew up with ambiguous loss. I wonder if you could tell us about how this was framed for you.

PB  –  Well, it’s always hard to answer the question of how I came up with this idea. But the more I ponder it as the years go on, I think it has to do with the fact that I grew up in the family of an immigrant father and an immigrant grandmother, both from Switzerland, and in a village primarily made up of Swiss American immigrants, so that people were pining for some other family back across the ocean, or the mountains, or there was always this idea that there was someplace else and some other people who were a family. So as a child, I often wondered about that. And then I would see my father grieving, for example, when a letter came with a black border around it, which meant someone in his family had died. And I didn’t know who these people were, and yet I could see that he was truly mourning. So I never put a word to it at that time. I think I just felt it as a child and perhaps absorbed it in a way that a sensitive child might. And it was only when I was at the university years later, that I came up with that idea – that people can be present but absent psychologically, or they can be on your mind and missing physically.  And there was. It sort of popped out.

JANA  –  And you spoke of being a very sensitive child. So what was it about this particular topic that drew you in to the point where you actually pursued it in your studies at university? Or was it just that?

PB  –  No, we could have picked any topic.  Actually, I liked theory development, and I was studying family therapy at the time. But I realize now that I’ve always been fascinated, literally stopped in my tracks, going through an airport or watching people say goodbye to one another… that that always has fascinated me and drawn me in – that kind of loss when people have separation. Not necessarily the loss of death, but the loss of separation.

JANA  –  Yeah, and it’s quite interesting how it can really be ingrained in you even as a child. When I was growing up, my family is Greek, and it was important for my father to take us back to the homeland to see where we were from. And so, I kind of related to what you were talking about in your video about your own upbringing, because I had the sense too that I felt a kind of loss as a child myself for not knowing, until we went over there, and even when we came back thinking, I miss this homeland. But I wonder if you could talk about how ambiguous loss differs from ordinary loss.

PB  – Well, ambiguous loss is a loss that has no verification. Ordinary loss such as from death, there’s a death certificate, some official comes and verifies the death, perhaps there are remains to be taken care of, at least something that can be seen to verify that a transformation from life to death has taken place.  With ambiguous loss – and by the way there are also rituals with a clear-cut loss like death, where the community, our friends and neighbors may come in and give their condolences, or you may have religious services that have rituals that confirm the transformation. At any rate, other people recognize the loss.

PB  – With ambiguous loss, other people don’t recognize the loss. For example, with traumatic brain injury, I have been told over and over again by family members, how irritated they are when people say to them how lucky your loved one is still alive, when in fact, they are no longer the person they used to be. It’s the wrong thing to say to them. Indeed, they may be glad they’re still alive, but it is not the person that they married or the child that they once had. So that this confusion, this vagary, this doubt that people have with ambiguous loss is pervasive, whereas it is not with a clear-cut death.

JANA  –  And you distinguish among two types of ambiguous loss.

PB  – I do. Yes. The first type is where they’re physically missing, and it’s only first because that’s the first group I studied. And that was pilots missing in action in Vietnam – families of pilots missing in action in Vietnam. And so that is illustrated by a loved one being physically absent but kept psychologically present because you don’t know if they’re dead or alive. You don’t know if you can let go. You don’t know if they’re coming back or not.

PB  – The second kind I studied in the 1980s, with veterans who had Alzheimer’s disease, I studied their family’s reaction to it. And in that case, the person with the ambiguous loss is physically present. You can visit them or live with them or touch them. But they are psychologically absent due, in this case, to dementia. And that one has become very important. Because while Alzheimer’s disease is the leading cause of dementia, there are over 80 illnesses and symptoms and conditions that will have symptoms of dementia. And we have an aging population. So that is increasing.

JANA  –  Now your book, “Loving Someone Who Has Dementia,” you refer in it to your grandmother Elspeth, and I wonder if you could talk a little bit about what you remember about her and her dementia.

PB  – My middle name is Elspeth, and in Switzerland, they call it [Veti].  She never was happy with immigration. She was my mother’s mother. And she thought only of the homeland and her mother who doted on her.  She was the youngest of many children. And so she couldn’t stand the climate of Wisconsin, which was too humid. So when my mother would come home from school, my mother tells me that the breakfast dishes would still be on the table. So even as a grade schooler, she had to take over and really was not mothered.

PB  – However, I was born, the same year that Elspeth’s husband died. And she, how would you say, turned to me, the new baby. And so she held me a lot, and I remember a little bit older rocking in the chair on her lap, and we were the oldest and the youngest in the family. So we were the ones who got to snap beans and shuck the peas. And so I loved her. I loved her and other people found her difficult. As she grew older, she had what was called senile dementia at that time, and grew increasingly difficult. But I still loved her from that early attachment, and found it – how can I say – painful to see her fade from an unhappy immigration into obscurity through dementia.

JANA  –  What a powerful experience for you, too…

PB  – It was, uh huh.

JANA  –  …of childhood.  Very unlike that of your siblings, too, it sounds like. She really attached to you.

PB  – It was, yes.  And my mother, who of course was not terribly attached to her mother due to neglect, was pleased that I was. You know, in a way she was glad that somebody cared.  And indeed, I did.

JANA  –  Wow. So what inspired you to write this book, “Loving Someone Who Has Dementia”?

PB  – I wrote a book, published in 2006 by Norton called, “Loss, Trauma and Resilience: Therapeutic Work With Ambiguous Loss.” It is a book for professionals about what to do about ambiguous loss, and I thought that I should translate it for ordinary people. I’ve always liked writing in a more accessible way, perhaps because English wasn’t my first language and we spoke Swiss-German at home, the dialect. So I just sat down to redo the knowledge that was written for professionals into an accessible book that was available for caregivers because I saw the need so great. That book really is what I did in therapy with caregivers, many of whom came for therapy.

PB  – And then I thought to myself, this could be put in a book like the Dr. Spock book, which you would, as a young mother, reach for day and even in the middle of the night, when you were stuck with a question, and you couldn’t reach a professional. So I had that model in my mind of the Dr. Spock book. I think your listeners may know what I mean by that. It was just a very accessible book that was very helpful.  And so it happened. That’s how it happened. It’s now translated into Polish and Norwegian and German and French, I believe.

JANA  –  Many different languages.  You make the point in the book that dementia is more than just a physiological condition or something that affects the brain, that it’s also a relational condition that affects those who care for and about the caree. So to that end, I wonder if you could elaborate on what makes dementia a unique kind of loss?

PB  – Oh, it’s very unique, although it has a sort of sibling relationship with other diseases that take the mind away, such as addiction, for example, or preoccupation with the Internet – obsessions of that kind. But dementia itself is an outcome of diseases that affect the brain.  But the outcome, dementia, which is a more general term, takes the mind away, or maybe the emotions away, or the ability to converse – all the things that had various access in the brain’s function – and so that the relationship is ruptured. It ruptures the relationships that that person has with others. And it’s as if the person has gone far away, but they’re still present.

PB  –  I think the title of the German book, if I can translate it into English is, “here and yet so far away.” So that indeed is, how can I say it, a crazy-maker for the person who lives with that.  The person is there, but you can’t interact or converse with them, or they don’t understand what you’re saying, or you can’t understand what they are saying. And of course, dementia is usually progressive so that it gets worse and worse and they go farther and farther away.  Or even more confusing, they come in or out. Sometimes they’re here in a normal way, and then in a flash they’re gone again, psychologically.  That’s very hard to live with.  It’s very hurtful. And so caregivers survive best by joining with other caregivers who understand the kind of interaction they’re coping with.

JANA  –  And it’s such a huge adjustment. My mother has dementia, and I’m a baby boomer, and as a baby boomer I’m used to a lifetime of relating to my mother in a pretty direct way. So it was really confusing for me to get used to her as someone with missing pieces, so to speak. And yet at times, other people perceived her as being with it, because she was not noticeably impaired.

PB  – And then they wonder what’s wrong with you.

JANA  –  Exactly.

PB  – [laughs] I understand.

JANA  –  Exactly. So it’s like, you want to say, you know, you just you don’t get it.  And then you don’t want to take the time to explain because it’s more stressful for that. You have some great stories in here, and one of them is the story of Jenny, who I’m assuming is not her real name, who you saw in your therapy practice, whose partner had dementia, and you wrote that the main stress for caregivers like her is that neither the burden of caregiving or the severity of the illness was the greatest stress. The main stress was the stress caused by not being able to resolve the problem.

PB  – Yes.  Well, I think Jenny was a person who was accustomed to solving problems.  And what we’ve learned from seeing many cases like Jenny’s, and also in the research, is the more mastery-oriented a person is, the harder time they have with ambiguous loss.  And a lot of us are quite mastery-oriented; that is, we like to be in control of our own destinies.  We like to solve our problems.  We’re proud of our ability to solve problems, and maybe we even have an occupation where we were trained to solve problems.

PB  – And therefore, when you face a problem like Jenny did, that she has no solution, that would be in this case dementia of some sort from, again, one of the 80 different sources of dementia, that is an excruciating stressor for that person. So the more mastery-oriented we are, the harder time we have with a problem that has no solution. People from other cultures, Native American, for example and some more Eastern cultures, may sometimes have an easier time of it, in that people say that, for example, in a more Buddhist culture, that believing you won’t suffer is ego wanting its own way.

PB  – But we live in a culture, at least here in Minneapolis, I assume in West Palm Beach as well, a culture that believes for the most part, we can solve our problems.  And I like the fact that we have solved problems.  We have cleared the plains, put a man on the moon, and done a lot of things – curing illnesses and so on. But now and then a problem occurs that has no solution.  And dementia is one of them, at least still. And I’ve talked to the researchers, and they don’t foresee a cure for Alzheimer’s disease, but perhaps a prevention within the next 10 years. So at the moment, however, it is unsolvable. And we feel helpless in the face of that, like Jenny did. And we have to change our perceptions of ambiguity when we can’t solve the problem. And we’re not so hot at that.

PB  – My own tolerance for ambiguity, coming from this American culture in the Protestant ethic – I had no tolerance for ambiguity.  My mother taught me that you can solve any problem you want if you work hard enough.  Well, that’s not true, bless her heart.  It’s not true. There are, now and then, problems you can’t solve.  So we have to increase our tolerance for ambiguity. And how do you do that? You know, I’ve spent years trying to figure that out.

PB  – But when I went to the funeral of the psychiatrist, I studied with, Carl Whittaker in Madison, his grandchildren were talking about what they loved most about their grandpa. And they said they loved most about him when he would invite them one at a time to get in the car with him and go get lost. They loved it. And so I tried it with my grandchildren. They loved it too. And they’re now all over 20 and they still love it.  And my husband and I still do it quite often, maybe even weekly or bi-weekly.  We get in the car, you have to have enough gas, and you just go and meander. You have no plan, you have no agenda, you have no map.  You just meander.  And what fun it is to discover things this way, in ways you don’t expect. You don’t know what’s around the corner.  You discover what’s around the corner.

PB  – Improvisation class – taking an improv class – also increases your tolerance for ambiguity. Being spontaneous about something increases it. Take a new path when you go hiking, or in the water – take a new path in the water. There are many different ways we can increase our tolerance for ambiguity and we must.  We must, because there’s rarely a family now that has not been touched by dementia, some relative or close or extended.

JANA  –  And what you were saying before about this inability to solve the problem – specifically, the problem of dementia as it were – it’s not just that.  You really have to change how you see not just the person you’re caring for but yourself, right?

PB  – Absolutely.

JANA  –  So you’re in a relationship with the person who has dementia, but you’re also in a relationship with yourself. And I think that’s something that we don’t really think about very much, because you’re suddenly forced…

PB  –  … and that’s a personal ambiguous loss, as opposed to relational. The relationship with ourself changes.  Our identity changes. I think that’s one of the first ones that hits.  Who am I now?  You know, I found myself – in my case, my husband can’t walk – I found myself saying, when people say, you know what you do? I’ll say, caregiving. And well, I’ve done a lot of other things, too. And it’s like your identity shifts. And so we need to examine, how are we seeing ourselves?

PB  –  And I’ve heard – clients I’ve worked with will say, am I still a husband if my wife no longer knows me?  Can I start dating? Can I take someone else to dinner? These are all very important questions.  Or adult children will say, Who am I? I’m now parenting my parents. And so it gets confusing. Identity is one of the major ones that need to be examined. We talked about mastery, but identity is turning out to be one of the guidelines that I wrote about, that is hugely impactful on caregivers, especially.

JANA  –  And what do you say?

PB  –  Did you say what do you say?

JANA  –  Yeah, what do you say to that caregiver who says, I don’t know who I am now?

PB  –  I think you need to meet with peers.  Other people who are caregivers, or other friends… a reading group – some other group, so you have them as a looking glass, giving back to you who they see you as. That is, healthy people. You need to be around healthy people who can give you feedback that helps you to then revise your identity. So you may say, I’m a caregiver and I’m also etc., etc. You need more than that. You need something else.  And you need to be able to identify it, acknowledge it and say it to other people. It’s most quickly found if you talk with other people. If you’re isolated, it’s very difficult.

JANA  –  One of the chapters in your book has to do with the myth of closure. Let’s talk about that, and where this idea of closure comes from and why it is so dangerous for dementia caregivers.

PB  –  I’m beginning to think it’s a misnomer. When people say I wish I had closure, I think what they mean is I wish I had certainty.  Are they absent or present?  Are they with me or not with me? I wish I had certainty.  But they say closure. So I think it’s a misnomer. I think closure is a perfectly good word in real estate and business deals and road closings, but not in human relationships.

PB  –  And I think that the way to live with ambiguous loss, and especially with the ambiguous loss of dementia, is to be able to think “both/and” – more dialectically, or more like a paradox. My loved one is both here and gone. He might not get better, but now and then he flashes back. I can both be a caregiver, and I can begin developing a new life without this person. So that “both/and” thinking is critical to lowering the stress of living with ambiguous loss.  It’s critical to that, and it’s not the way we tend to think.  We tend to think people are either alive or dead. You’re either here or gone. We tend to think in binary terms.  And “both/and” thinking is non-binary. It’s both, and.

JANA  –  Right. So I know you can’t really talk specifically about your practice and who you’ve seen, but I wonder if you could talk a little bit about what you’ve seen as far as common coping measures with people who have had to deal with dementia caregiving in the course of their lives. You’ve seen so many people who have to find a way through this. Have you been pleased to see some people arrive at solutions? And what have people shared as far as you know, the journey getting there?

PB  –  If I could summarize and give some specific examples: what I just said about “both/and” thinking is almost always evident in people who are holding up well, despite caregiving for a loved one who has dementia. They both do a good job at caregiving – though they have reached for help, they don’t feel they need to do it 100% themselves – and they have made some connections with other people outside of the caregiving role. Now that can be a peer group, you know, a caregiving group, a grief group, but it can also be a book club group, a bowling group, a bridge group – I’ve seen it be many different things.  It doesn’t seem to matter as much as just having human connection outside of the caregiving role.

PB  –  And this needs to be with healthy people who can communicate without struggle, which you probably do in the caregiving role. So you need to be with people who are fully present for you. And that needs to be not periodically; it needs to be several times a week, if not daily. And that is to protect your own cognitive sensibilities, because you can start failing yourself if you don’t have this connection with people who can be cognitively present for you.  And your loved one can’t be.

PB  –  So instead of being angry at your loved one, or instead of staying isolated, or instead of feeling like a martyr or feeling trapped, you have to move to the “both/and” stance, and take care of what you can, perhaps have some help or respite, and get out yourself to have a social life of some sort. You have to do that, for your own health and welfare. I think everyone knows by now that caregivers die at a rate 66% higher than their same age group. So caregiving is dangerous to your health, unless you also at the same time, have a social life of some sort.  Social human connections.

JANA  –  This is a little bit off topic, but what do you think the reason is for the failure to recognize what I see as an epidemic?  I mean, the statistic you just cited, in any other context is enough to really raise alarm bells.

PB  –  You’re talking socially?

JANA  –  I’m talking about the 66% higher death rate than your peer group for caregivers versus non-caregivers. The idea is, really we’re in a caregiving epidemic. So what is your view on why it’s so hard for this to really get traction, in terms of the caregiver – their needs being addressed in social policies?

PB  –  I think it’s a good question. And of course, there may be political issues or societal issues here. So the larger society is just beginning to pay attention to the fact that dementia is a health crisis for the entire society. They’re just beginning to know that research needs funding, and that the government should be also funding, and so on. That research is needed to come up with some answer and that this is a health crisis.

PB  –  So, only secondarily are they beginning to recognize that there is a crisis in the caregiver as well. So they don’t even see the crisis fully yet in the sick person, let alone the caregiver who’s taking care of the sick person. However, I noticed some differences already that I hadn’t seen before, now and then. But you are correct that it’s not nearly enough. There are some celebrities who are talking out about this, about the difficulties of caregiving. There are caregiver groups springing up all over. The entire state of Arizona is considering ambiguous loss training. I’ve given trainings in New Jersey and in New York City.  That is, there’s concern now, and funds for, training caregivers to take care of themselves.  Not neglecting the ill person, but at the same time taking care of themselves.

PB  –  Years ago, when I would talk with clients or trained therapists and you brought up “you have to take care of yourself,” there would be groans and comments like, “not this again.”  I don’t hear that anymore. I haven’t heard that in the last five years, I would say.  So that there is more awareness now, that caregiving is dangerous to your health, and I think maybe it has been translated into dollars at some level. That is, if we don’t take care of family caregivers, it’s going to cost society millions and millions of more dollars to take care of ill and dependent people. And so we had just better take care of family caregivers, because they are making a major, major contribution to the welfare of our society today.

JANA  –  And the stability of our healthcare economy.

PB  –  That’s right. That’s right.

JANA  –  So this is a good point to pivot to your online training program. Let’s talk about the ambiguous loss online training program, which you just launched in conjunction with one of your other books. Tell us about that.

PB  –  Well, the University of Minnesota contacted me, and it is their launch, really – their doing.  They have recognized my age and my need, as I tell them, to retire… which I haven’t yet done. [laughter]  They recognized that, and asked if I wanted to put my training course online, and I said, Yes, it’s time to give it away. And so I gave it to the University of Minnesota.  It is online now at www.ambiguousloss.com, and it’s about the meaning and application of ambiguous loss.

PB  –  And the university will give continuing education credits for it to professionals who may need it, or simply a certificate of completion. It is designed for professionals and for family members who are caregivers. So lay people can take it as well. And it deals with, what is ambiguous loss, what are the symptoms that families experience, what to do about it, and the guidelines to live well despite having an ambiguous loss. So it is online and available to everyone globally at this time.

JANA  –  And it’s taught in coordination with your book, “Loss, Trauma and Resilience,” correct?

PB  –  It is. It is.

JANA  –  It sounds like a fascinating course.

PB  –  And that’s online.

JANA  –  And that’s online.  So your work in this area has been done all over the world and in so many different contexts. And that’s not even counting your family therapy practice, where you’ve counseled individuals, couples, families who have had some kind of ambiguous loss. I wondered in the end, Dr. Boss, what impressions have you walked away with, about the human condition and our ability to grapple with ambiguous loss?

PB  –  Well, you know, as a caregiver myself now, I’ve learned that it’s easier to write a book about it than to do it. And that I’m more mastery-oriented than I even thought. And that one needs to, perhaps all of us, especially in Western culture, can learn to be less so and perhaps benefit by it; that is, become even stronger or might you say more mature.  Something happens, where you suddenly decide to accept the idea that you’re not in charge over this thing. And when that happens, I think you’re a stronger person. I think you suddenly grew in resilience. As you grow in tolerance for ambiguity you grow and resilience for life in general.

PB  –  That is, there’s a benefit at the end of this caregiving. But remember, it can also weaken your health. But if you take respite, if you have friends, if you have a social life while you’re doing it, and then you make this internal cognitive shift, of way of thinking, then I think you’re even more ready to face a stressful world, or the stress of aging. I’m not sure which, but maybe it’s both. I think you grow, you mature in a way that is good. If you can get over that hump of saying, I’m in charge, I’m going to do this right – well, you’re not in charge. You are actually going with the flow.

JANA  –  That sort of speaks to one of the chapters, which stood out for me in the book, was the “good enough” relationship. It’s sort of suggests an acceptance, which maybe goes against our nature as control freaks. I put myself in that category.

PB  –  Yeah, the way I figured that out is… I decided to accept.

JANA  –  [laughter] That’s good.  I like that.

PB  –  I didn’t surrender, is what I’m saying.  I decided to accept the “both/and” of my life now.

JANA  –  Wow. That’s really ingenious. I like that. Have you been surprised at your own response to your caregiving, of your husband?

PB  –  Indeed. Indeed.  You know, it wasn’t so hot at first, and it took me to some self-reflection.  I even said to myself, I better read some of the pages I wrote.  And then you suddenly catch on, you know.  And maybe it was talking with other people, I’m not quite sure, and talking with each other, of course, in my case, because he can’t walk. That’s the ailment he has. So we could talk with each other about it.  And then laughing at times about it, even. And then suddenly you’re at the point where you say to yourself, like I said, I’ve decided to accept the situation. And I can do this “both/and” thinking… so, still have a good enough relationship, a good enough life that I’m grateful for. I’m very grateful for it.

JANA  –  There’s a line in your book at the conclusion, which really hit home for me and just sums it up. And if I may, it says “the goal is not to regain your independence, but rather to stay resilient and healthy, in a relationship that is now less than perfect, with a loved one physically present, but psychologically absent.”  This idea of resilience is really, really important.  And letting go.

PB  –  It is.

JANA  –  Well, you mentioned your website.  How can listeners find out more about your work if they want to jump to it right now?

PB  –  Almost all of that is on the website. There are different sections on the website, so all the articles and books I’ve written are listed there. And I may get a little more autobiographical in the book I’m writing now, which is “The Myth of Closure,” but it’s going slowly, because I’m a caregiver.  But I both write, and I’m both caregiving.  So it’ll just take longer.  But it will happen.

JANA  –   Well, do you have any closing thoughts before we go?

PB  –  I don’t. I think this has been a pleasure talking with you. And I think of your listeners wherever they are, and hope that the caregivers find this useful.  Thank you, so much.

JANA  –  We’ve been speaking with educator and researcher Dr. Pauline Boss about her groundbreaking work around ambiguous loss, a term she coined in the early 1970s to describe a grief that has no end. Dr. Boss is the Professor Emeritus of Family Social Science at the University of Minnesota, and she’s a family therapist in private practice. She’s the author of several books including “Ambiguous Loss: Learning to Live With Unresolved Grief,” and the book “Loving Someone Who Has Dementia,” written explicitly for family caregivers and paraprofessionals. That book will be released as an audio book later this year. We’ll have a link to Dr. Boss’s website on the Agewyz website, where you can learn more about her work and find out about the newly-launched ambiguous loss online training program. Dr. Boss, thanks so much for your amazing work. It’s been a pleasure having you on the show and truly an honor.

PB  –  You’re welcome. It was my pleasure.