There are various definitions of ambiguous loss, but perhaps the aptest, some might say the most beautiful description of this type of mourning comes from Darcy L. Harris:
“Ambiguous loss is the type of grief that can be defined as an experience where there is a change in circumstances, perception, or experience where it would be impossible to return to the way things were before.”
Ambiguous loss
Under typical circumstances of bereavement, grief can be complex and messy – the death of a loved one annihilates all that we once knew to be true about ourselves, other people, and the world around us.
No matter the situation or circumstance, grief is senseless and traumatic – even in instances where the death of a loved one is anticipated, for example, in cases where a close relative or family member has been ill for some time.
Anticipatory grief
But, does this kind of anticipatory grief make our losses any easier?
The short answer is no.
However, one of the critical differences between “typical” grief and ambiguous loss is that the former appears to be more accepted in society.
A loved one dies, we mourn in a way that feels the most natural to us, and if we are fortunate, we may receive support and understanding from our loved ones along the way.
But what happens in complex grief when a bereavement experience doesn’t tick the boxes of typical grief?
Lost in a sea of grief fog
Ask anyone who’s ever gone through grief; they’ll likely tell you that the days, weeks, or months that follow the death of a loved one all seem to culminate into an intangible blur.
The above may include confusion, numbness, sleep deprivation, unwelcomed platitudes, feeling supported by others, or not feeling “got” by friends and family, and that’s only the first few weeks.
The immediate days that follow the death of a loved one don’t appear to have a beginning, middle or end, just fleeting moments of survival and endless periods where you feel like you might drown in the waves of the absence of your loved one.
Feelings and emotions
If you have ever experienced the loss of a loved one, in that case, you’ll likely be familiar with the amalgamation of feelings and emotions that grief tends to stir up, many of which may feel disturbing or shocking to the person experiencing them.
There’s anger, numbness, disbelief, feeling as though nothing is real, hearing or seeing your lost loved one, confusion, depression, and exhaustion; as you can tell, the litany of grief symptoms is endless.
There are many other symptoms assigned to “typical” grief too.
“Typical” in that your particular mourning experience is relatively understood and acknowledged more quickly than other types of loss, not any less painful or debilitating by any means, just accepted in communities as something that makes sense.
Essentially, grief follows after the death of a loved one.
However, ambiguous or non-death losses are not so acknowledged; thus, the grievers of this particular mourning experience often find themselves stuck in a microcosm of confusion, sadness, isolation, horror and disbelief, and every other emotion in between.
What is ambiguous loss?
Pauline Boss (1999) coined the term “ambiguous loss” to describe a grief experience that includes non-death losses.
Boss identified two types of ambiguous losses:
- The first is when a person is physically present but psychologically absent
- The second is when a person is physically absent but psychologically present
Lack of closure
Ambiguous losses do not necessarily follow the same trajectory as typical grief.
Since ambiguous losses are identified as “non-death losses”, the bereavement experience creates various challenges for grievers where there is likely to be no closure or a clear understanding of moving forward.
Physically present but psychologically absent
Let’s begin by examining the first type of ambiguous loss – “physically present but psychologically absent” such a definition may go a long way in explaining the grief experience that many families and relatives endure when a loved one is terminally ill.
For instance, suppose a person’s loved one is receiving life support for a critical illness- in this scenario, one might think that grief is an entirely reasonable response, yet the recipients of this bereavement experience often tell a different story.
For families of critically ill patients, the complexity of who their loved ones used to be, who they are now, and who they are yet to become causes the kind of disenfranchised grief that is unseen, unheard and very often unacknowledged by most medical and familial communities.
Essentially, the psychological sequelae of a patient’s physical presence and psychological absence can create much confusion and distress for grieving families and those trying to support them.
How does one adequately grieve when the person they are mourning is still alive?
Self-education
For most people, the death of a loved one features specific markers that can help them come to terms with the loss over time; there’s the funeral, sorting through personal belongings, and the collective grieving where most families unite together.
However, certain types of grief do not provide such markers for many. For example, in many ambiguous loss cases, death has not occurred or been verified -resulting in a kind of complex grief that may not be obvious, at least not straight away.
According to research, self-education for those experiencing ambiguous loss is vital if people hope to get the support and treatment they need and deserve.
Therefore, understanding the signs and symptoms of ambiguous loss is vital to self-education.
Signs and symptoms
Understanding what ambiguous losses are is the first step to making sense of your experience; therefore, breaking down these definitions in more detail might be helpful.
Physically absent but psychologically present
According to Pauline Boss, the second type of ambiguous loss is when a person is “physically absent but psychologically present”.
Examples of such a loss include cases where a loved one is missing – – people enduring this type of loss are often described as “the walking dead”. Their loved one is out there somewhere, but the destination and life status of their person are unknown.
Families of missing persons vacillate between hope and despair. When a loved one first goes missing, hope appears to dominate, albeit it might seem fleeting as other more unbearable emotions take over.
In the early days, police searches begin, psychics are brought in, and flyers go up.
Collective mourning jolts people into action when a loved one initially goes missing, but as the weeks and months go by, torment and despair set in.
Again, a similar question surfaces; how does one adequately mourn a loved one without a clear understanding of what has happened?
Managing uncertainty
Grief experts say that those with ambiguous losses may benefit from having counselling, a way to deal with the uncertainty of non-death losses.
Since ambiguous loss does not provide grievers with adequate closure, at least not right away, one of the keys is to work towards coming to terms with the uncertainty and find ways to move forward despite a lack of closure.
Are there ways to manage ambiguous loss?
The strain of living with chronic uncertainty and distress can cause various physical and mental health issues; the following tips may help you manage your situation a bit better until you know more about your loved one:
- Speak to your doctor about your concerns – they might prescribe a medication to help you sleep or eat better.
- Avoid self-medicating through drugs or alcohol; there are healthier ways to calm yourself when things get too much.
- Do not blame yourself for what has happened – you likely did all you could to prevent the situation, and blaming yourself for something outside your control will only heighten your stress levels.
- Take things in your stride – sometimes it’s all we can do to get through the next few minutes or hours; take things slowly by processing how you feel or the actions you want to take in small chunks.
- Keep a journal – it can be beneficial to track your feelings and emotions, especially during challenging times.
- Stay in touch with family and friends – you mustn’t isolate yourself. It might be challenging at first – but try easing yourself into past activities or doing the things you once enjoyed.
- Seek out the support and guidance of a professional counsellor or therapist – support groups are valuable as you can speak to people who may be able to relate to your experience, and this support can be invaluable.
- It’s okay to hope for the best – many people find comfort in faith, religion and prayer. Experts say that it’s okay to keep hope alive. You have to do what feels right to you.
How to support a loved one through grief
Many people are at a loss for what to say to grieving loved ones, especially in complex situations where someone is profoundly sick or missing.
Although knowing what to do or say can be challenging, the worst thing you can do is avoid your loved one or dismiss how they might feel.
The best thing you can do is to lend them a listening ear – a safe space where they can talk about how they are feeling and have someone witness their grief with them – trying to “blue sky” them out of bad feelings will only lead people to isolate themselves further.
A good rule of thumb is to offer to sit with your friend, run errands, and ask them what they need; although they may not know what they need at that moment, knowing that you are willing to support them and show up is enough.
There is much stigma around grief, which can impact how we support and nurture those we care about during a difficult season.
Acknowledgement is perhaps the most applicable term, yet so often understated; acknowledging our grief allows us to come to terms with our losses, no matter how complex they might be.
Likewise, making space for others in their grief is the purest act of love we could ever give.
Support doesn’t have to be perfect to be authentic and meaningful; it just has to be demonstrated, which may be the difference between coping and not coping for a grieving person.
Contact us
If you are struggling with grief or want more information about this article – contact a specialist at Camino Recovery who can help.
Helpful resources
- Ambiguous Loss; How to live with the pain of uncertainty: Psychology Today – Marilyn A. Mendoza, PhD, September 2015
- Ambiguous Loss UK: Darcy L. Harris
