Impairment and attachment: When closeness seeks security

People don’t react solely to what is happening in the present moment.

A large part of our mental life is organized around predictions, planning, and ideas about the future.

When a young person starts studying, they are not only investing in their education. They are also investing in a specific vision of their future life.

When someone enters a partnership, they are not only living that current relationship. Often, an internal image of a shared future also emerges.

When we take care of our health, save money, or plan a trip, we behave as if a certain future is likely enough to warrant investing energy in it today.

These envisioned futures are not mere illusions.

They give direction to our decisions. They help us understand current efforts, postpone needs, and create a connection between our present life and the person we want to become.

Therefore, the loss of a future can be just as painful as the loss of something that already exists in the present.

When an illness changes our possibilities, which were important to us, we don’t just lose individual plans. We also lose a part of the story about who we believed we would become.

The American family therapist, professor, and researcher Pauline Boss developed the concept of ambiguous loss, also known as “ambiguous loss” in English.

The term describes situations in which a loss is real, but it is difficult to clearly define or limit.

With a chronic illness and disability, a person can simultaneously possess something and yet lose a part of it.

The body is still present, but it no longer functions in the same way.

A relationship continues, but it has changed.

A professional career continues, but perhaps not in the originally planned form.

Life goes on, but not in the way the affected person expected.

This simultaneity makes the loss so difficult.

There is no clear dividing line between what remains and what is lost. The person is caught between two realities: a future that no longer seems possible, and a new reality that has not yet taken a recognizable form.

The relationship with one’s own body can also become contradictory.

It is still the same body.

And yet, it may no longer feel like one’s own body.

One may be grieving for a body that one still possesses.

In this space of uncertainty, grief has no clear object. People feel that something hurts, but sometimes they can hardly explain what they have lost.

When people talk about chronic illnesses, the focus is often on the physical symptoms.

However, psychological stress often arises from losses that develop around the illness.

A person may lose the feeling of spontaneity, because every outing requires preparation.

They may lose a professional part of their identity that they have built up over many years.

They may lose the feeling of physical security or the trust in their own body.

Social roles can also change.

The ability to support others, to travel alone, to take on certain tasks, or to participate in activities that were once taken for granted, may be limited.

Sometimes, the experience of independence also changes.

This does not necessarily mean that a person becomes completely dependent. Even the need to ask for help more often or to plan more time for everyday tasks can challenge one’s previous self-image.

Such secondary losses rarely occur simultaneously.

They often appear gradually. Therefore, grief does not follow a structured or predictable course.

Grief is not a recipe.

It does not necessarily include every supposedly typical phase and does not reliably progress from a clear beginning to a final conclusion.

In the case of a diagnosis, this process can be particularly complex because the reality of the illness, life circumstances, and personal priorities continue to change.

A person may believe they have accepted their illness and later be confronted with a new limitation that makes old losses visible again.

This is not proof that the adaptation has failed.

It is a natural consequence that life does not stand still even after a diagnosis.

One of the most common ideas about grief is that it must eventually be definitively concluded.

As if there were a point after which a person should be completely reconciled with their loss.

Experience with chronic illnesses often shows a different picture.

New life stages give old losses new meaning.

A young person who has adapted to their illness may experience grief again when the desire for children returns.

A person who has accepted limitations in their professional life may experience a new sense of loss when peers achieve goals that were once also part of their own life plans.

Birthdays, weddings, career changes, physical deterioration, or new social roles can reactivate memories of a lost future.

The grief returns not because the person has not accepted reality.

Ultimately, it returns because life has changed, and the loss takes on a different meaning in new circumstances.

From the perspective of meaning-making, this is not a regression.

It is a continuation of an adaptation process that must respond to new conditions.

Robert A. Neimeyer, an American clinical psychologist and psychotherapist, is one of the most influential contemporary theorists in the field of grief research.

He proposed that grief should not be understood solely as an emotional process.

Grief is also a process of re-evaluating meaning.

A loss disrupts the way we understand ourselves, other people, and the world.

The previous life story suddenly no longer adequately explains the new reality. Events, goals, and decisions that were previously meaningfully connected lose their familiar order.

Therefore, grief is also an attempt to create a new framework within which life can regain meaning.

This aspect is particularly important in the context of chronic illnesses and disabilities.

The problem is not only that certain possibilities have been lost.

The person affected must reorient themselves in a world that no longer looks the same as before.

Who am I if I can no longer do what previously defined me?

What does my life look like if my plans cannot be realized in the expected way?

What do success, closeness, independence, or a fulfilling life mean under these new conditions?

There are no universal answers to these questions.

Each person must develop their own answers. That is precisely why the grieving process is different for each person.

The term “acceptance” sometimes creates the false impression that a person must stop grieving or completely abandon their previous desires.

However, acceptance does not mean approving of what has happened.

It also does not mean retroactively describing a loss as necessary, meaningful, or positive.

Acceptance means being willing to see reality as it is, without constantly fighting against the fact that something has happened that you didn’t want.

Only then can the question change.

No longer exclusively:

“How can I get my life back, the life I’ve lost?”

But rather:

“How can I live in the reality that is now mine?”

This change does not eliminate the pain.

However, it opens up a space for possibilities that may not have been visible during the struggle against reality.

Therefore, acceptance is not the same as resignation.

Resignation declares the future as over.

Acceptance acknowledges the current limitations and, at the same time, allows for the search for a future that can actually be lived under these conditions.

Heinz von Foerster, an Austrian-American physicist, philosopher, and cyberneticist, and one of the most important founders of second-order cybernetics, was born and worked in Vienna.

His work influenced, among other things, psychotherapy, family therapy, constructivism, systems theory, epistemology, and the development of artificial intelligence.

His ethical imperative can be formulated as follows:

Act in a way that increases the number of possibilities.

When a person loses a part of their envisioned future, the attention understandably focuses initially on what is no longer possible.

In the early stages of adaptation, this is difficult to avoid.

The loss must be acknowledged. It needs a name and a place in one’s own story.

However, long-term adaptation is not solely about acknowledging the lost possibilities.

It also involves gradually discovering the possibilities that still exist or can emerge under new conditions.

This does not mean that the new future will be the same as the old one.

It also does not mean that it will automatically be better.

But it can be real.

This new future can include relationships, belonging, creativity, love, contribution, and meaning, even if its form differs from what a person might have expected in the past.

This does not become a process in which the lost future should be forgotten.

Instead, it becomes a process in which the relationship to that future changes, so that alongside the loss, other paths gradually become visible again.

Perhaps one of the biggest mistakes in dealing with chronic illness and disability is to assume that the goal is to stop grieving as quickly as possible.

Grief is not the opposite of adaptation.

It is often the way a person acknowledges how important what was lost was.

Someone who grieves for a life not lived does not necessarily prove that they are unhappy with their current life.

Love for the present life and grief for a different possible future can coexist.

Only when the affected person no longer has to fight against their own grief or try to “resolve” it as quickly as possible can space be created for something new.

Not necessarily for optimism.

Not necessarily for happiness.

But perhaps for the possibility that life becomes open to the future again.

Perhaps not in relation to the originally planned future.

But in relation to a future that can still be lived.