I think it is fair to assume that this reading audience has had an experience of loss in their lives. A family member, friend, mentor, community member, or a pet.  There is a predictable, though painful journey in the grief process when there is something tangible to grieve. There are rituals that surround the death, community, and family supports, groups, friends or therapists who can help those who are dealing with the pain of a loved one’s death. There are the teachings of one’s religion, faith, or spiritual beliefs, which guide our views about death and mourning. Traditional loss is more acceptable and easy to attain and understand. Traditional loss is finite. There are markers, like a funeral or a death certificate. There is some kind of softening or ending to the grief process.

What then about the type of loss which is unclear, has no formal rituals, no clear, accessible community supports, no collective understanding and might not even have a body to mourn or bury bury? Pauline Boss, a University of Minnesota researcher first coined the phrase “ambiguous loss” in the 1970’s when she was studying families of soldiers who went missing in action. The term boundary ambiguity was initially used and then replaced with the term ambiguous loss in 1977.

Boss writes about two types of ambiguous loss. One is the physical absence with a psychological presence.  Someone who is missing physically but they are kept alive psychologically.  These might be losses experienced through divorce, miscarriage, early childhood death, adoption, migration, service commitments, disappearance, and catastrophic experiences. There is usually an underlying hope that the loved one will reappear.

The second type of ambiguous loss is when a loved one is physically present but psychologically absent.  The aging process with accompanying loss of cognitive functioning, dementia, physical illnesses, brain injury, coma, addictions, and mental health issues are within this category. The loved one is physically there but absent psychologically. Being present with a loved one who we can touch, talk to but they are not there emotionally. There is an emotional death before the physical one.

The grief process with ambiguous loss is not finite. It does not have a set of marker events or closure. The grief process is colored with uncertainty and ambivalence. The experience of grief is different and the tasks are different.

Tasks of Ambiguous Loss (Boss-1999)

1.Find Meaning – Look at values, beliefs and traditions. Remove blame.

2. Accept Uncertainty- Change the way one thinks of the loved one- they are both here and not here. Balance need for control with acceptance of ambiguity, externalize blame.

3.Reconstruct Identity-Roles and family dynamics change.

4.Learn to live with ambivalence as a new norm-Conflicting feelings, accept emotional rollercoaster, develop coping strategies.

5.Revisit Attachment-Celebrate the missing and mourn the changes.

6.Discover Hope- Look at strengths, discover hope in different ways.

Those dealing with loss of any kind deserve understanding and support. Because a loss is ambiguous doesn’t make it less real or hurt less. The ache of stolen future memories and dreams are just as real. The graduations, weddings, or other family events that won’t happen because of mental illness or addictions. Caring for someone who has dementia, a chronic brain injury which robs a person of his or her personality. All these moments have significance in what won’t be possible. Hopes, dreams and plans change. How to help?

  • Be willing to listen without giving advice
  • Offer to bring food or run errands
  • Let them know you are there to listen
  • “I’m so sorry…. I’m here for you”

 

Ambiguous Loss-Learning to Live With Unresolved Grief, Pauline Boss, 1999

Journal of Marriage and Family Therapy (August 2004 551-566 pg)

www.opentohope.com

 

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