Ambiguous loss is a theory developed by Psychologist Pauline Boss, and it began in the 1970s while she was researching fathers who were detached from their families due to work or military deployment. She later expanded her research to include all losses involving unresolved circumstances. Dr. Boss’s theory is still a relatively new concept in the field of psychology, and we are only beginning to bring awareness to how we can move through this type of devastating loss.

We typically think of loss as a black and white event – your loved one is alive or they’re not. But ambiguous loss is an uncertain loss without clear boundaries or resolution. It is an event that can leave you in a thick fog of grief limbo, and it makes finding closure exceptionally difficult for the people involved. Boss believes that ambiguous loss is the most stressful form of grief, and warns that it can result in mental health problems similar to post traumatic stress disorder (PTSD).

Dr. Boss defines an ambiguous loss in two distinct ways. The first is when a person is physically present but psychologically absent (as in dementia, autism or drug addiction), and the second is when a person is physically absent but psychologically present (as in foster care/adoption). Other examples, just to name a few, include:
• Missing people (kidnappings, unrecovered bodies)
• Military deployment or work-related absences
• Emotional detachment/abandonment
• Divorce
• Traumatic brain injury/memory problems
• Chronic mental health problems such as schizophrenia
• Miscarriage/infant death
• Immigration
• Incarceration
• Child/parent alienation

The pandemic has left a lot of people isolated in their grief. This adds to the isolation and loneliness that a person is already feeling because more often than not other people do not see the loss and grief or just do not know how to support someone who is going through this type of loss. A divorce can be as traumatic as a death, having a miscarriage can be just as traumatic as someone who else who loses their child, a person who has experienced the grief of losing someone through a chronic mental health disease will experience a loss of the person they once were. With physical death there is closure, you know that person is never coming back, but with ambiguous loss there is no end, it is ongoing and not knowing what the outcome will be is a truly awful place to be at the best of times. Others do not know how to help you, they do not realise that just by being available to talk is enough, they hide away or make excuses why they cannot meet or talk to you, other family members are also going through their own loss so speaking to them is more difficult.

“The lack of information and “not knowing” can create chronic hypervigilance, anxiety, anxious attachment, chronic sorrow, or depressive symptoms” (Boss, Roos, & Harris, 2011).

It is helpful to be able to recognize the symptoms of ambiguous loss so we can help friends and family who may be suffering alone during this time. When we put a label to a devastating experience, we can set realistic expectations for ourselves and others with empathy and compassion.

Some of the symptoms of ambiguous loss include:
• Hopelessness
• Intrusive, racing thoughts
• Anxiety
• Depression
• Anger/irritability
• Confusion
• Preoccupation with thoughts of their loved ones
• Difficulty committing to decisions
• Inability to move forward with everyday tasks
• Emotional overwhelm – frequent crying or outbursts
• Insomnia
• Difficulty accepting the new family role
• Sabotaging relationships

These ambiguous wounds are not easily bandaged by the support of family and friends when we are unable to verbalise or feel sure about the loss that has taken place. These are the wounds we lick clean by ourselves, and because so, can take much longer to heal.

There is a shame built into an ambiguous loss that silences our voices and halts our emotions. As parents, we shy away from these topics with children out of an urge to pretend everything is okay, and “not rock the boat.” As adults, we keep quiet to not discredit ourselves as “weak” or compare ourselves with others who have been through worse. But what experience and research show is that confronting the ambiguous loss and providing an outlet for these emotions can be a healing experience for everyone involved.

We need to pull back the curtain and reveal the impact this unimaginable loss has on our lives so we can move forward. The silver lining is that being aware of the coping mechanisms available to us and having the courage to apply them to our life can ease us through the hard times.

• The first step is recognizing and labeling the experience you or the child are going through as an ambiguous loss. Labels can provide some relief because you are no longer in this unusual experience alone. Knowing others have coped with this challenging experience and survived can instill hope in the hopeless.

• The next step is connecting with people experiencing an ambiguous loss. Support groups are particularly helpful for this type of grief due to the external nature of the trauma. Loss is something that happens outside of you and impacts your internal state and is not stemming from internal distress. Because of this, Dr. Boss believes that group therapy can be beneficial for those coping with ambiguous loss. If you can’t find an in-person group, consider reaching out to groups online. Research to make sure the group is a positive, supportive environment.

• Give your mind a break each day from trying to find a solution. Our minds can be a hectic place when there is no categorization for the loss. Your brain will instinctually work in the background, gnawing away at the question marks in your life, resulting in mental exhaustion. This preoccupation with worry makes it hard for adults and children to learn, follow instructions, and regulate emotions.

• Set aside 10 minutes a day for meditation or conscious thought that doesn’t involve the ambiguous relationship you are grieving. Protect that time. Use it as space where you will accept that in life, we don’t always get the answers we need or deserve. We can start to get comfortable with the idea that this person is both here and not here. A mantra could be “they are here, and they are gone.”

• Talk to someone you trust about your grief, including the shame you might feel about sharing it openly. If this does not feel possible, start with journaling about it. Your brain will benefit from processing the information outside of your body, in word form, so that it can make sense of what is happening. This act alone could provide some immediate relief for the stress you are feeling.

• Discuss how the roles in the family may shift and define new roles. When a family member is no longer present for an indeterminate amount of time, it is natural to want to carry on in your usual family roles. Still, at some point, it might help to reassess the functions of the family members. A mother may have to take on roles the father was providing. A middle child may suddenly become the oldest or youngest in the family. Think about how this shift impacts each person in the family and patiently adjust to the new expectations placed on the family unit.

• Find meaning in the situation. Think about what this experience has taught you about life and how you might use it to impact the world around you. Finding meaning is not usually possible in the early stages of grief, but as you mature on your grief journey, you may find ways of using your experience as a tool for helping others. Pain can lead to growth if we are open to assigning value to what we’ve been through.

It will take time, but Boss’s research found that we can lead productive lives without clear answers. The goal is to become comfortable with not knowing, and while this is far from easy, it is possible. There is always hope.

If you feel you would benefit from some counselling around this topic then please feel free to contact me. I am working face to face and online.