As Dr. Loo and Dr. Silver wrote about in our previous two entries, grief and uncertainty are two of the most challenging emotions for humans to cope with, particularly in our modern world of quick fixes and immediate answers. “Ambiguous loss” - a form of unresolved grief whereby there is no certainty or closure to the loss - embodies both of these experiences. It is a concept first defined by Pauline Boss, Ph.D. in the late 1970s, as she interviewed wives of pilots missing in action in Vietnam and Southeast Asia. As Dr. Boss identified the unique features of grief and mourning experienced by these women - whose husbands were “gone but not forgotten” - she began formulating a theory to explain how and why losses of this type inflict such a heavy emotional toll on the loved ones left behind.
According to Dr. Boss, “ambiguous loss” can be of two different, but similar types. A physical ambiguous loss describes a type of grief in which loved ones are physically missing or bodily gone, but their psychological presence remains. Some common examples frequently treated at CTWPS include divorce, miscarriage and abortion. A psychological ambiguous loss is when a loved one is physically present, but psychologically absent, such as with dementia, severe mental illness or addiction.
During the course of life, we may find ourselves affected - either directly or indirectly - by several of the more common types of ambiguous loss. At a minimum, these experiences are upsetting and stressful. At their worst, the emotional complexities of these losses can be devastating, leaving those in their wake feeling helpless, hopeless, and more prone to depression, anxiety, and relationship conflict.
Ambiguous losses are not like “ordinary” losses in several important ways. With “ordinary” losses, the symbolic rituals surrounding death (e.g. funerals, burials) often serve to validate one’s grief, provide opportunities for the community to provide emotional and practical support, and may represent closure for those in mourning. However, after an ambiguous loss, no such rituals exist; oftentimes leaving those suffering feeling isolated. Further, because of the stigmatized nature of some ambiguous losses - for example, drug addiction or chronic mental illness - loved ones may choose to suffer in silence and shame.
Uncertainty regarding when a loved one might return (to health or their physical return), and whether an ambiguous loss is temporary or final also exacerbates the grieving process for those left behind. Uncertainty complicates the experience of loss by blocking one’s ability to problem-solve out of the “problem,” rendering typical coping strategies ineffective. Further, individuals experiencing ambiguous loss often liken the uncertainty of the situation to a roller-coaster of emotions. They may experience extreme ambivalence about their “lost” family member - in one moment feeling hopeful for their return, and in the next longing for an end to the waiting. Sometimes anger develops toward the loved one because of their absence or illness, only to be followed by guilt and shame for thinking negatively of them. Certainly, the tension caused by these competing, conflicting emotions can inject additional stress into what is already a very taxing emotional experience.
Enlisting the help of a professional is advisable as one navigates the emotional complexities of ambiguous loss. A skilled psychotherapist will be a compassionate ally to their client, providing the acknowledgement and recognition of the loss that may be lacking within an individual’s personal life. The therapist will also encourage the client to seek additional emotional support from her community, urging her to include family and friends in the mourning process. This might be done by creating a personal, symbolic ritual to mark the loss, even if traditional forms of closure are not yet possible. Psychotherapy would also aim to help the client develop acceptance of the current situation, and the imperfections of life more broadly. By providing a safe place for “naming” the loss and the range of feelings one is experiencing, psychotherapy can help free one from the emotional constraints of relentless uncertainty.
At CTWPS, we understand how challenging it can be to tolerate uncertainty, particularly when the wellbeing of loved ones is at stake. As such, the focus of psychotherapy for ambiguous loss is to help clients increase their resiliency in the face of this challenge - to increase one’s tolerance for both ambiguity and change. The ultimate goal of therapy is to support the client in moving forward, through the loss, even in spite of so much uncertainty.
If you are experiencing distress related to ambiguous loss and would like support as you navigate the mourning process, we welcome the opportunity to be of service to you. Please reach out to CTWPS if you would like to connect with one of our highly skilled psychologists.