Ambiguous Loss: Grief, Loss, and Depression

Part 4 of a 4-Part Coping with Grief, Loss, and Depression Series
Human life is full of loss. In my earlier articles in this series, I discussed how we deal with grief and pain. I argued that we need to move toward our pain and find meaning and hope in it, and I shared my own experience of loss. In this article, I consider a more ambiguous type of loss and suggest ways of dealing with it.

A Different Kind of Loss

Most of us have been to a funeral or are familiar with what is involved at one. When we discuss the deceased person, we often use the word loss. It is almost expected for people to utter the phrase, “I am so sorry for your loss.” When people die, the deprivation we feel is usually so much more tangible. The person who was present is no longer available to us, and there is no changing that fact. Death is final. We know it and even the culture around us knows it. We send cards and flowers, make phone calls, bring meals, and engage with the bereaved on a level they rarely experience. We hold rituals of some sort in order to solidify the finality of the loss, whether this is a memorial service or some other act that signifies the passing of one age into the next.

All of us are aware of the pain and finality of death. Few would claim that the experience is anything other than what it is. However, we are less aware of the impact and pain of other losses that are less ritualized, and therefore less acknowledged. Here I am speaking of the phenomenon known as ambiguous loss.

Defining Ambiguous Loss

The term ambiguous loss simply defines one of two possible constructions: The person is either physically present while psychologically absent, or physically absent while psychologically present. The first could be applied to dementia or severe mental illness. The second could be applied to cases of kidnapping or prisoners of war. Whatever their construction, both share the following characteristics:

1. The loss means that life will never be the same again.
2. The culture rarely sees the loss for what it is, and its impact is not recognized in the same way as a known physical death.
3. There are typically no rituals that are acknowledged by the wider culture.

Ambiguous Loss Takes Longer to Heal

Having worked with multiple cases of ambiguous loss, I have become aware that it takes longer to heal, or has a more complex healing process. Pauline Boss, the psychologist who developed the concept, notes that: “The greater the ambiguity surrounding one’s loss, the more difficult it is to master it and the greater one’s depression, anxiety, and family conflict” (Boss, 1999). Mastery is the ability to fully know, make sense of the event, cope, and overcome. While healing from events such as a known physical death is difficult, our culture has a more predictable trajectory for healing the loss. But this is not so when it comes to someone who is physically absent but psychologically present, or physically present but psychologically absent.

For example, when a pilot is shot down and considered missing in action, every decision from that point on operates from the position of ambiguity. Questions surface and may haunt the survivor: Should she have a memorial service? And, if so, how long after the event? Should I get remarried? And, if so, how long after the event?

Or, consider someone suffering from Alzheimer’s. Have they actually died psychologically, long before their physical death occurs? How does the family deal with making decisions for their care, let alone grieving the loss of someone who is technically still there? These situations become more challenging because mastering the rituals and decisions associated with overcoming loss are less well defined.

Coping and Moving Forward

So, what helps us to overcome ambiguous loss? Seeking a qualified therapist is a must when encountering complex
losses. Moreover,  research has indicated that there are some other things that have been shown to bring healing. This is by no means an exhaustive list, but here are some suggestions of things people can do while seeing a therapist, taken from Boss (2006).

Create new connections. Anyone who knows me or works with me will tell you that I constantly emphasize being connected to others. Community is critical to our physical, psychological, and spiritual resilience. This means allowing others to support us so that we can bounce back from stress and loss. However, in the face of ambiguous loss we must not only rely on our own community supports but also create new ones. We need to create new attachment bonds that make us less dependent on our old ones or on the bonds that are not adequate to our new circumstances.
Explore faith and spirituality. Leading psychology researchers Pauline Boss (2006) and Brené Brown (2010) both agree that religious belief can be highly beneficial in facing loss. The exception, as always, would be beliefs and theological positions that are abusive. Based on her own research, Brown (2010) tells us that, “according to the people I interviewed … the protective factor … was their spirituality … without exception … a power greater than self … emerged as a component of resilience.” Pauline Boss (2006) notes: “I see religious and spiritual beliefs often increase people’s tolerance for unanswered questions … [promoting] resilience.”
Good works. Boss (2006) recommends doing small good works that allow one to grieve while not focusing only on oneself. An example could be starting or even attending a peer-led support group. When one walks alongside someone else who is experiencing a similar loss, each person can view both themselves and the other as a survivor rather than as a victim.

Christian Counseling to Overcome Pain and Loss

As a Christian counselor, I am privileged to accompany some of the people who are brave enough to confront and move through their pain and loss. If you are suffering from loss and are aware of your need to find healing, please seek help. You can find meaning in the midst of pain. Seek professional counseling and support from others. Your wounds may persist, but life can move forward and healing is possible.