Cancer Insights: The myth of closure – by Stephen J. Forman

July 21, 2015 | by Stephen J. Forman M.D.

Stephen J. Forman Stephen J. Forman, the Francis & Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation, reflects on loss and the "myth" of closure.

There are few among us who have not experienced loss of a friend or loved one, often without warning, or like those of us who care for people with cancer, after a lingering illness. It is a time when emotions run high and deep, and as time passes from the moment of loss, we often hear how important it is for those who have most directly experienced the void to gain closure in order to move on with their own lives. We seek that closure as a way of tidying up, fearing that the memory of that person or a well-meaning comment may provoke unintended pain or undo what time is said to heal. The reality is, closure is a myth.

My personal and professional experience with those who have lost family and friends, including children, has taught me that going on with life is not the same as gaining closure. The wound of loss is indelible and a part of each person's life forever, punctuated by many moments of recollection. It is sometimes predictably provoked by a date on the calendar and, less predictably, by a sight, sound, aroma, melody or a place that evokes an immediate awareness of that person, long after their physical presence in our lives has ceased. We continue to think about those dear to us, perhaps not every day, nor with the same intensity, but our lives are populated by those whom we know and, sometimes more profoundly, by those whom we remember. The experience of these personal moments, seemingly forever paused in time, can cause us to feel alone, even while in the presence of others. This aloneness is heightened by a false expectation that these experiences should, and will, at some point be over.

No matter how long it has been, we do not stop recalling such people, who remain a presence in our lives, these echoes from the past, and they may even help define the very direction we follow as we do go forward in life. To deny such memories or experiences is to deny precious moments of love, of fellowship, of gratitude and inspiration. Grief changes the experience of loss, but does not close or eliminate it, and is not intended to do so. To close the memory does not sustain the healing nor help in proceeding with life. Such echoes from the past are voices in the present and are sometimes warmly felt.

As humans, we are connected to each other and despite differences in culture, religion or ethnicity, we all yearn to remember. Nearly every culture has its way of preserving memory and we build memorials as perpetuators of collective memory, whether it is the Vietnam Memorial on the Capitol Mall, the Holocaust Museum or the 9/11 Memorial in New York. Cemeteries offer a communal "safe" space where grief is openly welcomed and expected. Visitation rights to a plot do not suddenly expire six months after a burial, a time marked by some in the medical community as the "normal" grieving period. In the Jewish tradition, the acknowledgment of the annual Yahrzeit, the anniversary of the death of a family member, is always done in the presence of others, with a name announced, provoking a collective memory of a person, providing a shared memory of a life within our own. None of these occasions, sometimes formal, but more often spontaneous, are about closure, but rather they are about the fullness in each of our lives that came from our family, loved ones, friends and those whose lives were touched by that person's presence in our own lives.

In my work as a cancer physician, I often will write to the family of a loved one who was under our care, months after the death, a time when most of the people who were there in the days and weeks after the death have gone back to the busy-ness of their own lives, and the bereaved is left alone with their own feeling and thoughts. The letters are a chance to remain connected, but also a way to convey that the life of their loved one is an important memory for us, too. They remain an important presence in our own lives, too, and neither they nor their loved ones are forgotten. These letters, words of acknowledgment and memory, are always welcome, reassuring those whose lives have become interwoven with our own, that their loved one is alive within us, as they are in them.

A few months ago, I ran into a woman who many years ago had, at a very young age and early in her marriage, lost her husband to cancer. She had moved away, met another man whom she adored and married, had a family, raised their children together, along with a successful career, and seemingly had found closure from the tragedy of her early life. As we finished talking and she began to walk away, she turned around, and with eyes full, said: "I think of him almost every day."


Stephen J. Forman, M.D., director of the Hematologic Malignancies and Stem Cell Transplantation Institute, is the Francis & Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation.


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