Finding Hope after Pandemic Losses

“I am knocked down. And I will get up again” (Pauline Boss, 2022, p. 47)

These are the words of one of the world’s wise women, whom I have admired since doctoral student days when studying her theory of ambiguous loss. Pauline Boss, now in her late 80s, is an eminent social scientist with a long curriculum vitae. She became known for her investigations of ambiguous loss in the families of missing military pilots (MIAs), and families of people with Alzheimer’s disease. However, her new book (Boss, 2022) broadens her thinking from families to the national level (the murder of George Floyd in her hometown) and the global level (the COVID-19 pandemic). She also reveals her personal experiences of loss, including fresh widowhood. She speaks to grieving readers from the heart and offers them hope.

Publication of the Boss book comes at a time when millions have lost a loved one to COVID-19. The death toll has reached 1 million in the USA, 6.2 million in the world (NBC Nightly News, May 4, 2022; World Health Organization, May 6, 2022).

In addition to the staggering number of people who lost loved ones to COVID-19, a brutally clear type of loss, Boss (2022) illuminates the other pandemic-related losses that are characterized by ambiguity and unanswered questions. Losses have been experienced by all of us who survived COVID-19: the students who lost the camaraderie of in-person schooling, the performing artists exiled from their concert halls, and the families who were forced to cancel celebrations of weddings, graduations, and birthdays. We have a residue of emotions ranging from ruefulness to rage, depending upon the magnitude of our losses and our own resilience. The number of pandemic survivors across the globe is immense, and psychiatric-mental health nurses will be dealing with unprecedented, and perhaps prolonged, grieving phenomena among these survivors.

The middle-range theory of chronic sorrow is relevant here. Developed in 1998 by Eakes, Burke, and Hainsworth, chronic sorrow theory contradicted previous theories of grieving that emphasized a final stage of acceptance or resolution of loss (Eakes et al., 1998). This consortium of researchers showed that sorrow can become chronic, based on their research with bereaved parents, mothers of disabled children, and women living with the increasing debilities of multiple sclerosis. The chronic sorrow theory normalized the periodic recurrence of grief, triggered by events such as anniversaries (Eakes et al., 1998). I suspect that many COVID-19 survivors will feel acute pain on the anniversary of the death of their loved ones in nursing homes or ICUs, with whom they could not be present and for whom no funeral services could be held.

Boss (2022) asserts “there is some new hope now for all of us who survived” (p. xiv). However, closure after loss is a myth, and mastery-oriented thinking is not helpful. Writing for the lay public, Boss provides clear guidance for increasing resilience to live with loss. This is a book that mental health care providers can recommend with confidence to many clients. However, Boss (2022) does point out that some individuals will require grief counseling or psychotherapy, if they feel that life is no longer worth living or begin to heavily misuse substances. They are not making “the slow climb back to some semblance of normalcy” of which Boss speaks (p. 115). Chronic grief disorder has been newly recognized in the DSM-5-TR (American Psychiatric Association, 2022). Criteria for this diagnosis include intense longing for the deceased, along with problems reintegrating into previous relationships, identity disruption, and meaninglessness.

Psychiatric-mental health nurses must astutely assess for this disorder and promptly institute evidenced-based interventions, such as cognitive-behavioral therapy, when individuals cannot recover a sense of meaning and purpose in life after loss. Your articles about treatment of chronic grief disorder will be welcomed.