Chronic sorrow and nonfinite loss (Olshansky)
Sorrow that comes back again and again around a loss that is still going on: a child’s disability, a partner’s long illness, one’s own chronic condition. Olshansky saw it in parents of children with intellectual disability and argued professionals should treat it as a natural reaction to a hard situation, and later writers added nonfinite loss for losses with no end point.
What drives it
Milestones bring the gap between the life expected and the life lived back into view: the birthday, the school that won’t take the child, a friend’s child passing a driving test. For identification it names a grief that never finishes because the loss never finishes, mixed with joy and ordinary days in between.
How it shows
Work
A parent steady all quarter who falls apart at a colleague’s graduation photos. Someone with MS who grieves again each time a task at work has to be handed over.
Relationships
Sorrow at each review meeting, school move or new diagnosis. Friends who expect the parent to have ‘accepted it’ years ago. Couples where one partner’s sorrow comes at milestones the other doesn’t notice.
Self
Notice when the sadness comes back and what set it off. Often it is a comparison: with other families, with what you pictured, with the person you were before the illness.
What tells it apart
Ambiguous loss (Boss): In ambiguous loss the confusion is whether the person is here or gone. Chronic sorrow is more likely when the person is clearly present and loved and the sorrow is for a life that differs from the one hoped for.
Prolonged grief disorder (ICD-11, DSM-5-TR): Prolonged grief follows a death and stays high almost every day. Chronic sorrow rises at triggers and drops back, with good stretches between.
Major depression: Depression colors most days and most of life. Chronic sorrow may be the better fit when the sadness comes at particular moments and the person still feels joy in the child or the life between them.
A test
Ask the person to list the last three times the sadness returned. If each one lines up with a milestone or a comparison, and life feels ordinary in between, chronic sorrow may describe it.
Questions to carry
- When the sadness came back this time, who or what was I comparing us with?
- Which picture of the life I expected am I still carrying?
Go deeper
- Read: The Other Side of Sadness, George A. Bonanno, 2009, revised 2019. Written for readers by a psychologist who has followed bereaved people for years. He questions the idea that grief moves through set stages and argues that most people come through a loss with more resilience than expected. Much of it rests on his own group's studies.
How strong the research is
clinical. The concept rests mostly on qualitative research. The middle-range theory (Eakes, Burke and Hainsworth, 1998) was built from a concept analysis, a review of research and 10 qualitative studies covering chronic illness, caregiving, parents of a child with a disability and bereavement. Later studies have looked at caregivers of people with cancer, multiple sclerosis, Parkinson’s disease and schizophrenia. We found few studies that measured it over time.
Where it comes from
Simon Olshansky, Chronic sorrow: a response to having a mentally defective child, Social Casework, 1962 (the title’s wording is of its time). Eakes, Burke and Hainsworth, Middle-range theory of chronic sorrow, Image: Journal of Nursing Scholarship, 1998. Bruce and Schultz, Nonfinite Loss and Grief: A Psychoeducational Approach, 2001. Susan Roos, Chronic Sorrow: A Living Loss, 2002