“Living an engaged life we experience dreams, hopes, meaningful attachments and connection, disappointments, joy, pain, along with a myriad of losses. As there are many types of loss there are many types of grief processes.” -Dr. Pauline Boss, 2022

It is only through our losses that we become fully developed human beings” -Judith Viorst, 1986

I began my health care profession as a physical therapist working in acute rehabilitation. Daily, I bore witness to and interacted with those living in the midst of traumatic bodily injury.

One day whole, the next struggling with losses of bodily control, such as paralysis, neurodegenerative illness, brain injury, amputations, and such.

I observed the various ways my patients struggled, physically and psychologically, to incorporate such change, loss and uncertainty within a healing context.

I listened as my patients became my teachers.

What we knew was there was no going back, as one said: “I am here, and yet I am not.”

I became drawn to the challenges of reconstituting self and identity while incorporating irrevocable loss in a grief and restoration frame.

As such, I embarked on studying psychology and psychotherapy. I wanted to unearth and confront the experiential truths of profound loss through conversation and mutual exploration. I yearned to understand what integration and healing meant amidst illness and loss.

I observed the human art of evolving and healing as continuous creative processes with no clear endpoint. I realized completion and closure were myths.

Currently, I am working with adults who are caregivers to spouses and loved ones afflicted with an illness that impairs the mind and self. A sample of what is expressed: “I love her, and yet cannot find the her that I love,” “He is on the streets again, homeless somewhere, I cannot locate him,” “I cannot bear watching her slip further,” and “He no longer knows me or even himself, his body is like a shell. I grieve who he was.” All are yearning and searching for a known loved one, strong in memory and heart, yet in body and being they are not found.

This is a specific type of loss, of being here and not here simultaneously, that Dr. Pauline Boss, a researcher and writer, termed “ambiguous loss.”

Ambiguous loss “remains without clear resolution. Those we love can be physically gone, but psychologically present (missing or abandonment) or physically present but psychologically gone.”

We feel loss and consequent grief within a state of uncertainty due to the vagueness of what really is. Such ambiguity can be enigmatic, indeterminate, opaque and inconclusive, and be felt as acute pain, despair, isolation, discombobulation, aloneness, disconnectedness, heartbreak or sorrow.

I see such natural manifestations daily in my practice. I have learned to be with, rather than fix, to be present and guide, as each person struggles to find their way creating a new internal compass. To seek meaning or feel the lack thereof, to manifest caring and love, to express anger, guilt, resentment, hurt and fear, to elucidate one’s values.

To break our heart open, rather than closed, so we can also touch goodness, compassion and tenderness when there.

We all have, are, and will experience a multitude of losses — some devastating, leaving us panting to find the healing inherent in life, evolving to create connection to self and others, and developing a jeweler’s eye to suffering and virtue.

No one is beyond such pain and challenge.

My hope is that we can bring such experiences to discourse and relationships, to feel the presence of being known and to know. I have learned that the answers are imbued in the seeking and that seeking in the right companionship holds an essence of shared humanity.

“Like enduring a lesson that one is resisting, I learned with each loss that ‘getting over it’ was not possible. I now walk with the tension of imperfect solutions and balance them with joy and passions in my daily life. I intentionally hold the opposing ideas of absence and presence, because I have learned that most human relationships are indeed both” -Pauline Boss,  Loss, Trauma and Resilience, 2006

Dr. Jilisa Snyder is a senior psychologist at the Anna March Clinic of the Brattleboro Retreat. She has been a healthcare professional for 48 years and continues to learn.