Ambiguous loss

Ambiguous loss is a loss that occurs without a significant likelihood of reaching emotional closure or a clear understanding.^[1]^[2] This kind of loss leaves a person searching for answers, and thus complicates and delays the process of grieving, and often results in unresolved grief. Causes include infertility, termination of pregnancy, disappearance of a family member,^[3] death of an ex-spouse, and a family member being physically alive but in a state of cognitive decline due to Alzheimer's disease.^[4]^[5]

An ambiguous loss can be categorized into two types of loss: physical or psychological.^[6] Physical loss and psychological loss differ in terms of what is being grieved for, the loss of the physical body, or the psychological mind. Experiencing an ambiguous loss can lead to personal questions, such as, "Am I still married to my missing spouse?," or "Am I still a child to a parent who no longer remembers me?".^[7] Since the grief process in an ambiguous loss is halted, it is harder to cope or move on to acceptance from the type of loss experienced. There are various types of grief that can occur due to the type of ambiguity experienced and corresponding therapy techniques to address the certain types of grief. The overall goal of therapy to cope with ambiguous loss is to overcome the trauma associated with it and restore resilience.^[8]

Origin of concept

The term "ambiguous loss" was first used in the late 1970s by Pauline Boss, a researcher who studied families of soldiers who went missing in action.^[9] From 1973 to 1977, Boss had used the term "boundary ambiguity", but she later replaced that with "ambiguous loss".^[9]

Types

An ambiguous loss can be physical or psychological in nature.

Physical loss

A physical ambiguous loss means that the body of a loved one is no longer around, such as a missing person or unrecovered body from war, but is still remembered psychologically due to the chance of coming back, for example in missing person cases.^[6] A physical ambiguous loss can occur across generations, such as the families of victims of the holocaust, and can cause as traumatic distress as Posttraumatic stress disorder.^[10]

Psychological loss

The second type of ambiguous loss is where a person is still physically there, but is psychologically absent.^[6] This happens in cases where the brain is affected, therefore affecting the behavior or well-being of the individual. Psychological ambiguous loss does not just occur to family and friends of the person affected. Psychological loss can happen personally in terms of one losing sense of who they are. This can stem from having a traumatic brain injury and not knowing who they are, causing a lost feeling and uncertain identity issues.^[11]

Grieving process

The grieving process for an ambiguous loss differs from regular mourning in that one is unable to gain closure due to unresolved grief.^[12] In cases of a psychological ambiguous loss, the grieving process can be especially difficult because of the inability to accept or admit that there is a problem and confront the situation in the first place to deal with the issue.^[13] One key factor in getting over an ambiguous loss is resilience. In the normal grieving process, people obtain closure after dealing with a loss. In an ambiguous loss, closure does not exist, and should not be sought after in this case.^[6]

Resilience

Resilience and hope are important in the case of an ambiguous loss because paired together, they are able to allow the individual to come to terms with the loss and continue moving forward in life.^[12]^[13] One way to tell that someone is resilient in a case with ambiguous loss is that they actively seek out help when they know it is needed.^[14] Uncontrollable factors such as culture, age, socioeconomic status, and genetics are all factors that contribute to resilience.^[15] Trauma and ambiguous loss often co-exist together and if the trauma is not dealt with it can trigger unresolved emotions.^[8] Therapy will address a case of ambiguous loss by restoring resilience, and reconnecting with the loss and the relationship with whom the loss is associated.^[8]

Three types of grief

The difference between regular grief and grief from an ambiguous loss is the type of loss creates the type of grief experienced.^[9]^[16] Grief in ambiguous loss can be both beneficial and difficult. Since the grief in an ambiguous loss differs than the linear stages of grief there is no pressure to move on or achieve closure, and this allows for people to remember the lost loved one and move on with relationships and life.^[9] There are three specific types of grief that can develop from the type of ambiguous loss.

Anticipatory grief

Anticipatory grief occurs before bereavement, mourning after death occurs, and upon realizing that death may be imminent for a loved one, anticipatory grief sets in.^[17]^[9] This type of grief is common among families who have a loved one living with Alzheimer's disease. The grief becomes anticipatory due to the knowledge that the loved one's mental state will only become worse, so the grieving process can start very early.^[9]

Disenfranchised grief

The second type of grief that can develop from an ambiguous loss is disenfranchised grief.^[9]^[18] It is also known as unrecognized grief because it often occurs in the loss of a beloved pet and the grief is not taken seriously.^[9]^[18] Ecological Grief or Climate Grief has also been identified as a form of disenfranchised grief.^[19]^[20]

Frozen grief

Frozen grief is the third type of grief, it is a result of the ambiguity of death because of the physical or psychological disappearance and therefore one's grief is frozen since they do not get a chance to let grief run a normal course.^[9]^[21]

References

^ Boss, Pauline (2000). Ambiguous Loss: Learning to Live with Unresolved Grief. Harvard University Press. ISBN 978-0674003811.
^ Ball, Aimee Lee (January 12, 2012). "Exit Left, Wordlessly". The New York Times. Retrieved 25 July 2013.
^ Beam, C., & Dudly, D. (2014, August 1). Living With A Loved One's Disappearance. AARP The Magazine.
^ Gilbert, Kathleen R. (February 1996). "Ambiguous Loss and Disenfranchised Grief". Indiana University. Retrieved 25 July 2013.
^ Dudley, Brier (31 May 2008). "From the Jim Gray tribute: Searching the sea, coping with ambiguity and the Microsoft discount". The Seattle Times. Archived from the original on 3 September 2014. Retrieved 26 July 2013.
^ ^a ^b ^c ^d Boss, Pauline (April 2010). "The Trauma and Complicated Grief of Ambiguous Loss". Pastoral Psychology. 59 (2): 138. doi:10.1007/s11089-009-0264-0. S2CID 144242336.
^ Boss, Pauline (November 1999). "Insights: ambiguous loss: living with frozen grief". The Harvard Mental Health Letter. 16 (5): 4–6. PMID 10521908.
^ ^a ^b ^c Roos, Susan (2013). "Chronic Sorrow and Ambiguous Loss: Gestalt Methods for Coping with Grief". Gestalt Review. 17 (3): 229–239. doi:10.5325/gestaltreview.17.3.0229.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Boss, Pauline; Carnes, Donna (December 2012). "The Myth of Closure". Family Process. 51 (4): 456–469. doi:10.1111/famp.12005. PMID 23230978.
^ Boss, Pauline (April 2010). "The Trauma and Complicated Grief of Ambiguous Loss". Pastoral Psychology. 59 (2): 139. doi:10.1007/s11089-009-0264-0. S2CID 144242336.
^ Landau, Judith; Hissett, Jennifer (March 2008). "Mild traumatic brain injury: Impact on identity and ambiguous loss in the family". Families, Systems, & Health. 26 (1): 74. doi:10.1037/1091-7527.26.1.69. S2CID 53570214.
^ ^a ^b Boss, Pauline (November 1, 2000). Ambiguous Loss: Learning to Live with Unresolved Grief. Harvard University Press. pp. 9–10.
^ ^a ^b Abrams, Madeleine Seifter (Spring 2001). "Resilience in Ambiguous Loss". American Journal of Psychotherapy. 55 (2): 284. doi:10.1176/appi.psychotherapy.2001.55.2.283. PMID 11467262.
^ Walsh, Froma (September 25, 1998). Strengthening Family Resilience. New York: Guilford.
^ Boss, Pauline (2006). Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss. WW Norton & Company. p. 3.
^ "Pauline Boss — The Myth of Closure -". On Being.
^ Coombs, MA (December 2010). "The mourning before: can anticipatory grief theory inform family care in adult intensive care?". International Journal of Palliative Nursing. 16 (12): 580–4. doi:10.12968/ijpn.2010.16.12.580. PMID 21240101.
^ ^a ^b Cordaro, Millie (October 2012). "Pet Loss and Disenfranchised Grief: Implications for Mental Health Counseling Practice". Journal of Mental Health Counseling. 34 (4): 283–294. doi:10.17744/mehc.34.4.41q0248450t98072.
^ Davenport, L. (2017) Emotional Resiliency in the Era of Climate Change: A Clinician's Guide. London: Jessica Kingsley Publishers.
^ Cunsolo, A., & Ellis, N. R. (2018). "Ecological Grief as a Mental Health Response to Climate Change-related Loss". Nature Climate Change, 8(4), 275.
^ Boss, Pauline (11 November 2009). "The Trauma and Complicated Grief of Ambiguous Loss". Pastoral Psychology. 59 (2): 137–145. doi:10.1007/s11089-009-0264-0. S2CID 144242336.