When you've lost a loved one or suffered trauma and there's no closure or explanation on why it happened, you might feel like you’re grieving forever. Without answers, you're left in a state of confusion and begin seeking other ways to explain your loss.
Jump ahead to these sections:
- What Is Ambiguous Loss?
- Where Does Ambiguous Loss Theory Come From?
- What Does Ambiguous Loss Look or Feel Like?
- Stages of Ambiguous Grief or Loss
- How to Help a Loved One Through Ambiguous Loss
- How Ambiguous Loss and Having a Loved One With Alzheimer’s Works
- How Ambiguous Loss and the COVID-19 Pandemic
- Examples of Ambiguous Loss
This type of grief, which seemingly has no end or conclusion to wrap your head around is called ambiguous loss. You're dealing with two potential types of losses — the physical loss of your loved one, and a psychological loss.
You may experience a psychological loss when your loved one is still present but may suffer from diminished mental capacity.
For example, those suffering from the effects of Alzheimer's may be physically there, but are unable to recognize you. As your loved one suffers from a cognitive decline, it may take longer for you to come to terms with your grief. While you recognize that they’re still alive, you may not know how to make sense of the loss that you’re feeling.
Working on ambiguous loss can be different than dealing with other forms of grief, but can be managed.
What Is Ambiguous Loss?
This type of loss is steeped in the unknown, as defined by the word ambiguous in this case. Not knowing what has happened to your loved one, not knowing what comes next, or not knowing whether you should be grieving or holding out hope.
With ambiguous loss, you will need to build strength and resiliency in order to lower your stress and anxiety associated with this not knowing. This feeling of ambiguity happens because you’re suddenly thrown into a situation where you have no control over what happens next.
Grieving while someone is still alive
It’s completely possible and common to grieve for someone while they’re still alive. You may experience grief over the loss associated with your loved one’s mental and cognitive decline, as they suffer through addiction, or as they battle a life-threatening illness.
How to console someone during this time takes on special challenges as they’re still living but may not understand what is happening to them. At the same time, you’re also in the unique position of trying to come to terms with processing what you are feeling.
What’s the difference between anticipatory grief and ambiguous loss?
At times, ambiguous loss can be confused with anticipatory grief, another type of grieving that may involve different circumstances.
The grief experienced in anticipation of death or some other life-altering event is known as anticipatory grief.
This type of grief is not necessarily only the result of anticipating the death of your loved one, but can also be felt over the loss of your career, income, home, relationship, or any other significant loss in your life. Other things that may cause grief are the fear of what's next, loss of companionship, and a change in finances.
Anticipatory grief differs from the grief you experience after someone you love dies. In some instances, it can cause you to react more violently. You may experience strong emotions such as anger, fear, and anxiety. You may also experience a loss of emotional control that comes with the expression of these emotions.
This type of grief can create confusion for you as you struggle with keeping hope and letting go of your loved one.
Ambiguous loss occurs when you suffer a loss that you're unable to process. It's a loss that's felt when you're left confused about what has happened or why it's happened.
It can leave you in this perpetual state of confusion without you knowing whether to accept the loss, what to do with it, or what position it leaves you in as a result of it. It's difficult to move forward with the stages of grief when you can't even wrap your thoughts around what is happening.
Where Does Ambiguous Loss Theory Come From?
American researcher, Pauline Boss, was the first to coin the term "ambiguous loss" in the late 1970s. She was studying the effects of grief-related loss on the families of war soldiers who disappeared or went missing in action. She began her life in the United States as a member of an immigrant family who suffered the loss of their country and family ties.
Her family lived in a neighborhood made up of predominantly immigrant families who all experienced the loss of close friends, relatives, and community. However, because almost everyone had some experience with this type of loss, there was plenty of community support. Nevertheless, these losses were a part of their new everyday life and existence. Mostly, everyone adjusted well to their changing environment, relying on their psychological families to quell the pain of losing their blood relatives, and families.
Boss went on to become a therapist and researcher in grief and loss. Her findings revealed that as individuals experience the loss of relationships, the ambiguity of these losses makes the experience profoundly devastating. This is because their grief is unclear and indeterminate. At first, she related this type of loss to boundary ambiguity. Still, she later changed the term to "ambiguous loss" to more closely describe the feelings of grief in two specific situations:
- When loved ones are physically absent but psychologically present when it's unclear if they're living or dead.
- When a person is physically present but psychologically absent in cases of illness, addiction, or disease.
These losses are never clear-cut, such as when a person dies. And the ambiguous nature of the loss creates abnormal grief that can be complicated and prolonged. The ambiguous loss theory has evolved since the 1970s, especially after 9/11, with thousands of lives lost in terror-related attacks and the collapse of the World Trade Center buildings.
Families of those missing in the rubble or otherwise unaccounted for experienced a different type of ambiguous loss than those families of missing soldiers of war. Modern-day researchers are pushing for further studies on how this loss applies in other scenarios, adding more diversity to the meaning and description of ambiguous loss.
What Does Ambiguous Loss Look or Feel Like?
Two types of ambiguous loss may affect grieving individuals. One is the type that has a physical absence accompanied by a psychological presence. And the other is where there's a psychological absence but a physical presence.
The first type might include a situation when a person's gone missing or the body wasn't recoverable at the time of death. Some traumatic examples of this are kidnappings, murders where the body's been hidden, dying in a foreign war, or drowning in the ocean. More everyday occurrences typically include non-death-related losses such as divorce, adoption, and moving to a foreign land.
The second type of loss occurs when a loved one is physically present but isn't psychologically there. Examples of this might include a person who's suffered through cognitive declines, such as Alzheimer's patients or those who have dementia.
Emotional unavailability also adds to this type of loss. A person who's emotionally detached from their loved ones may be suffering from addiction, depression, or even physical brain injuries.
There are always at least two different perspectives when it comes to recognizing ambiguous loss. One comes from the person suffering from illness or injury in those physically present but psychologically unavailable to carry on as before. And the other stems from those who are dealing with the factors contributing to this type of loss.
Other factors to consider are the death of a loved one, where it's impossible to gain closure either because the facts surrounding the death are missing, or the body's physical recovery was impossible due to situations beyond the family's control or authorities.
Persons trying to cope with ambiguous grief or loss may feel anxious, depressed, socially withdrawn, and hopeless depending on what they're suffering through. It's not unusual for a person to socially remove from their life, friends, and family while dealing with this type of loss. In many cases, a grieving person may find it challenging to return to their old lives until they've had some resolution to their loss.
Stages of Ambiguous Grief or Loss
How we grieve when we suffer the death of a loved one, and the way we grieve when we have suffered an ambiguous loss differs in that with one we have closure, and in the other, we're still trying to cope with understanding what has happened.
No two people grieve the same, and no two losses are suffered in the same way. Because of this, it's important to explore how we grieve, and how the stages of grief progress from one to the next.
With ambiguous grief or loss, these linear stages don’t apply to the way you grieve. The stages of grief become more like steps you should take to help you cope with your loss. There are eight things to consider as you go through your grief journey:
Stage 1: Regaining resilience
Making sense of what has happened is one of the biggest challenges as you begin to process your grief.
When your loved one is still physically present, but no longer the same person you remember before, or your loved one is missing, and you don’t know what has happened to them, it’s difficult for you to move forward with your grief. So, having a high tolerance for ambiguity and learning to live with not having closure becomes important in coming to terms with your grief.
Stage 2: Reaching out to others
In trying to find meaning and learning to cope with your loss, it’s important to keep moving forward with dealing with your grief.
Finding comfort in your continued relationships with others will help you establish a new normal way of living. Joining a support group is also something to consider. Being able to talk to others who are in similar situations may be helpful to you in understanding how you are feeling.
Stage 3: Practicing self-care
Taking care of yourself is also very important in dealing with your grief. Self-care includes getting proper rest and nutrition, finding the time to exercise, taking care of your personal hygiene and mental health, among other things such as learning about what you are going through by reading books on grief.
Stage 4: Practicing mindfulness
Being mindful means being present and accepting things as they are right now. This higher awareness leads to peacefulness and a sense of calm that will help you in coping during stressful times.
Mindfulness works because it forces you to let go of the past and it relieves you of the pressure and anxiety caused when you think about what will help you in the future.
Stage 5: Accepting and letting go
Accepting things as they are may be difficult to imagine as a possibility. It’s understandable if you aren’t able to immediately find contentment and peace with things as they are. However, the more you focus on practicing self-care and mindfulness, you will find it easier to accept that there may not be any answers to the loss you’ve suffered and that it’s okay if you never know.
Sometimes you don’t have control over the way things are, and you gradually learn to let go by not holding on to the possibilities of what could have been or what you could’ve done differently.
Stage 6: Sharing in memories
As time progresses, you may consider incorporating grief rituals like sharing in memories from the past and learning to make new memories in your current reality.
Consider pulling out photo albums and sharing pictures and memories attached to them with your family and friends. Take new pictures of those in your life right now and remember to live your life instead of being suspended in uncertainty.
Stage 7: Mastering what’s in your control
A great way to manage all the uncertainty in your life is to master the things that you are able to control. For example, keeping a clean living environment and cooking healthy meals will help you to recenter your focus on things that you already know you can do. It takes the pressure off of having to learn new things or new ways of living.
These simple steps can make you feel as if you’re in control and will alleviate some of the stress and anxiety you might be experiencing.
Stage 8: Making new memories
This step goes beyond just taking new photographs to add to your photo album. This is more aligned with you going out and actively forming new memories of your life now without your loved one in it.
As difficult as it may seem for you to accept their loss, it’s important for you to continue living your life and moving forward. Take small steps in this direction until you build the confidence to take larger, more meaningful steps in accepting your new reality.
How to Help a Loved One Through Ambiguous Loss
Helping someone you love get through this challenging time will take patience and understanding. Because there are so many unknowns with this type of loss, a person suffering may not readily accept words of comfort or attempts to appease the situation.
It helps to understand that their feelings and emotions stem from not knowing what'll happen or what to expect next. They may suffer from the anxiety created by helplessness and inadequacy, causing them to shut down emotionally. The following are some tips to help you help your loved one survive through ambiguous loss.
Gather all the facts
One of the best ways to help someone suffering through ambiguous loss is to help them get down to the basics of what has happened and why it's happened. Even when there aren't any definite answers, such as when a person's gone missing, it helps when you gather everything that's known.
You can then repeatedly present the information to your loved ones until it starts to reassure them that things are getting done to either find their loved one or get answers as to what's happened.
Talk about their loved one
People suffering from ambiguous loss may need to make sense of things by talking about their suffering. They may want to discuss the same things repeatedly to justify what's happened. This pattern of behavior is common among bereaved individuals who don't know all the facts or details surrounding their loved one's death or illness.
You don't have to have any of the answers when talking to your loved one. And, sometimes, it's best to refrain from giving personal opinions or reaching conclusions.
Encourage counseling
Many people who are grieving through ambiguous loss don't consider the positive effect of grief counseling or therapy as a means to get through this challenging time. For some people, the thought of getting help may not even cross their minds because they're preoccupied with all the things that encompass their loved one's illness or death.
An experienced, professional grief counselor or therapist can help your loved one process their grief to remain functional in their everyday lives, especially when there are no answers or explanations that will resolve any time soon.
Keep tabs on them
Depression is relatively common among those suffering from ambiguous loss, and sometimes it's challenging to recognize the signs. A person suffering from many of the unknowns related to their loved one’s death or illness will likely find it difficult to keep from falling into deep despair the longer it takes to get the answers they need for clarity.
Consider checking in on them throughout the day to say hello and to see how they're doing. A quick text message or phone call can make a big difference in the life of someone who feels hopeless.
How Ambiguous Loss and Having a Loved One With Alzheimer’s Works
Mental health professionals perceive persons with Alzheimer's disease as physically present but otherwise psychologically absent when treating ambiguous loss in their loved ones. There's a gray area that families of those with Alzheimer's must learn to navigate. They must create new realities to cope with the stress of losing their loved ones to this disease but who are still living.
Families of people with Alzheimer's have to deal with high levels of uncertainty and ambiguity when assessing their changing family dynamic and the roles each person fills. In families without these defined roles, coping and managing the stress of Alzheimer's increases, making it more challenging to navigate living with someone suffering from this disease. Individual caregivers face heightened stress, anxiety, and depression. This is especially true when they fail to assess how Alzheimer's affects their loved ones and the family dealing with this type of loss.
The uncertainty of Alzheimer's leads to a type of loss known as "boundary ambiguity." Boundary ambiguity closely relates to the causes of depression in caregivers and other non-caretaking family members because it creates confusion about who remains a part of the family and in what role or capacity.
These unclear losses cause a shift in how family members interact with one another. It also affects the roles family members assume when someone is diagnosed with Alzheimer's. Families must also adjust their lives to include the person with Alzheimer's.
You can expect unclear losses when a family member faces cognitive decline associated with Alzheimer's. Families not only shift their dynamics by reassigning roles but also learn to adapt to their loved ones changing mental, emotional, and social capacities. Alzheimer's creates many complex changes in how the brain works. It slowly robs individuals of the ability to think, function, and reason. When these capacities start diminishing, the person you once knew is no longer there even though they still live.
You can expect to mourn this loss and the subsequent or secondary losses attached to changes in your loved one's physical and cognitive abilities. The stages of grief start manifesting well before their physical death, leaving the family to deal with the pain and sorrow of watching their loved one deteriorate. Some of the more common ways of experiencing grief include feelings of:
- Denial
- Anger
- Guilt
- Depression
- Acceptance
When dealing with the symptoms of boundary ambiguity, it may be time to hold a family meeting to discuss everyone's roles and responsibilities. Families can learn to better support each other and the individual with Alzheimer's. The disease's progression is unpredictable, and a person with Alzheimer's may live many more years in a slowly diminishing cognitive state. It's essential to plan for contingencies as their condition evolves.
Plan out how you'll manage the day-to-day caregiving responsibilities and who'll step in and take over to give the primary caregiver respite from their duties. You should also talk about everyone's feelings and expectations regarding holidays, family traditions, and other important rituals to continue.
Some of you may have to step outside your traditional roles when taking on the primary caregiver role to more effectively and emotionally separate yourself from your loved one with Alzheimer's while providing them care. Your loved one's behavior and disposition may dramatically change as their conditions worsen, and they may become easily agitated, aggressive, or hyper-sexualized. Setting and maintaining boundaries should help you deal with these painful and confusing outbursts.
How Ambiguous Loss and the COVID-19 Pandemic
Ambiguous loss related to the COVID-19 pandemic is still a relatively new concept as we continue to learn the long-term effects COVID-19-related deaths and losses have on survivors. Families of individuals gravely impacted by this illness are still learning to process their pain and suffering.
The pandemic created unforeseen circumstances and instances of death and subsequent losses for millions worldwide. Here in our backyard, COVID-19 illnesses claimed the lives of hundreds of thousands of individuals and disrupted countless others' lives.
Early in the initial wave of illnesses to hit the U.S., the government separated sickened individuals from their loved ones through forced quarantining. Many hospitalized individuals weren't allowed to have visitors, and many died alone and afraid in hospital COVID wards or the ICU. Their survivors dealt with the pain of grief and loss without the benefit of saying goodbye to their dying loved ones and without the opportunity to gain closure.
Pandemic-caused deaths created voids in the lives of the survivors' families, resembling the ambiguous loss suffered by the families of missing wartime soldiers and victims of the 9/11 terror attacks. The psychological effects on these individuals create grief responses that show up as physical and emotional manifestations of loss and suffering found in the different stages of grief.
Collective grief has settled in our nation as we move through the pandemic together. Telling and recounting our stories of love and loss to those we know and virtual strangers we meet on the internet. There is a solidarity in grief that has emerged due to the very public handling of Pandemic-related cases of infection and death rates. Almost everyone in the U.S. has dealt with COVID-19 directly or knows someone who has.
People across the country had to leave their jobs, abandon their studies, or cancel their plans to stay home as required by their local governments. These unforeseen changes created many secondary losses impacting the health and mental well-being of individuals of all ages, races, and economic standing. COVID-19 is non-discriminatory, and many well-known, rich and famous people died due to their battle with COVID-19.
We are still learning to deal with these losses. The continuation of new and emerging cases continues to impact more and more people with no complete end in sight. Doctors and other mental health practitioners trained to deal with the psychological effects of loss work tirelessly to provide counseling and therapy to those struggling with their losses.
And the losses are many. Even when individuals and families haven't experienced direct loss from illness, they've seen other considerable losses. This includes economic loss, food insecurity, separation from friends and loved ones, and loss of freedom of movement and travel.
Some of these losses still lack clarity, and their full impact may not show up until years after the event. We've yet to see the full effect of how young children and teens will recover from their experiences. We're unsure how their futures have changed due to the pandemic's new ways of living, working, and socializing. For now, individuals must continue to find ways of surviving through these changing times until the world gets back to a new normal after this horrific event.
Examples of Ambiguous Loss
Some examples of ambiguous loss include, but are not limited to the following:
- Alzheimer’s disease: Losing someone to disease is difficult to accept. It’s as if you’re in limbo - they are still physically here with you, but their cognition has so far declined that the person in front of you is no longer the person you remember.
- Drug addiction: Losing a loved one to drug addiction is another form of loss that may leave you feeling helpless, confused, and conflicted. Addiction typically causes your relationships to rupture. Sometimes this loss is temporary, and sometimes it creates alienation and a permanent cutoff to your loved one.
- Missing person: When a loved one has gone missing, you are suspended in your grief. Not knowing what has become of your loved one leaves you confused as to what to do next. You don’t know if they are dead or alive, and as a result, you don’t know how to react and process what you’re feeling.
Dealing With Ambiguous Loss
Moving forward with life when you’re faced with the unknown is still possible when you consider that most of us have already dealt with this type of loss throughout our lives.
We experience ambiguity after a divorce, when we move from one city to another, or even when we change jobs. When you look at things this way, you begin to realize just how resilient you are and how coping through this loss can be managed.