ambiguous loss

{{Short description|Loss without closure or clear understanding}}

Ambiguous loss is a loss that occurs without a significant likelihood of reaching emotional closure or a clear understanding.{{cite book | url=https://archive.org/details/ambiguouslosslea00boss | url-access=registration | title=Ambiguous Loss: Learning to Live with Unresolved Grief | publisher=Harvard University Press | author=Boss, Pauline | year=2000 | isbn=978-0674003811}}{{cite news | url=https://www.nytimes.com/2012/01/15/fashion/exit-left-wordlessly.html | title=Exit Left, Wordlessly | work=The New York Times | date=January 12, 2012 | access-date=25 July 2013 | author=Ball, Aimee Lee}} 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,Beam, C., & Dudly, D. (2014, August 1). [http://www.aarp.org/home-family/friends-family/info-2014/loss-of-loved-ones-grief.html Living With A Loved One's Disappearance]. AARP The Magazine. death of an ex-spouse, and a family member being physically alive but in a state of cognitive decline due to Alzheimer's disease.{{cite web | url=http://www.indiana.edu/~famlygrf/units/ambiguous.html | title=Ambiguous Loss and Disenfranchised Grief | publisher=Indiana University | date=February 1996 | access-date=25 July 2013 | author=Gilbert, Kathleen R.}}{{cite web | url=http://blog.seattletimes.nwsource.com/brierdudley/2008/05/shankar_sastry_tenacious.html | title=From the Jim Gray tribute: Searching the sea, coping with ambiguity and the Microsoft discount | publisher=The Seattle Times | date=May 31, 2008 | access-date=26 July 2013 | author=Dudley, Brier | archive-url=https://web.archive.org/web/20140903141709/http://blog.seattletimes.nwsource.com/brierdudley/2008/05/shankar_sastry_tenacious.html | archive-date=3 September 2014 | url-status=dead | df=dmy-all }}

An ambiguous loss can be categorized into two types of loss: physical or psychological.{{cite journal|last1=Boss|first1=Pauline|title=The Trauma and Complicated Grief of Ambiguous Loss|journal=Pastoral Psychology|date=April 2010|volume=59|issue=2|page=138|doi=10.1007/s11089-009-0264-0|s2cid=144242336}} 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?".{{cite journal|last1=Boss|first1=Pauline|title=Insights: ambiguous loss: living with frozen grief.|journal=The Harvard Mental Health Letter|date=November 1999|volume=16|issue=5|pages=4–6|pmid=10521908}} 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.{{cite journal|last1=Roos|first1=Susan|title=Chronic Sorrow and Ambiguous Loss: Gestalt Methods for Coping with Grief|journal=Gestalt Review|date=2013|volume=17|issue=3|pages=229–239|doi=10.5325/gestaltreview.17.3.0229}}

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. From 1973 to 1977, Boss had used the term "boundary ambiguity", but she later replaced that with "ambiguous loss".

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. A physical ambiguous loss can occur across generations, such as the families of victims of the holocaust, and can cause traumatic distress as Posttraumatic stress disorder.{{cite journal|last1=Boss|first1=Pauline|title=The Trauma and Complicated Grief of Ambiguous Loss|journal=Pastoral Psychology|date=April 2010|volume=59|issue=2|page=139|doi=10.1007/s11089-009-0264-0|s2cid=144242336}}

=Psychological loss=

The second type of ambiguous loss is where a person is still physically there, but is psychologically absent. 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.{{cite journal|last1=Landau|first1=Judith|last2=Hissett|first2=Jennifer|s2cid=53570214|title=Mild traumatic brain injury: Impact on identity and ambiguous loss in the family.|journal=Families, Systems, & Health|date=March 2008|volume=26|issue=1|page=74|doi=10.1037/1091-7527.26.1.69}}

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.{{cite book|last1=Boss|first1=Pauline|title=Ambiguous Loss: Learning to Live with Unresolved Grief|date=November 1, 2000|publisher=Harvard University Press|pages=9–10}} 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.{{cite journal|last1=Abrams|first1=Madeleine Seifter|title=Resilience in Ambiguous Loss.|journal=American Journal of Psychotherapy|date=Spring 2001|volume=55|issue=2|page=284|doi=10.1176/appi.psychotherapy.2001.55.2.283|pmid=11467262|doi-access=free}} 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 in this case. Rather than seeking closure and a return to a former reality, it is more helpful and desirable to come to terms with the fact that the world has changed, it will never be the same, but this new post-loss world can be lived with meaning and thriving.

=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. 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.{{cite book|last1=Walsh|first1=Froma|author-link1=Froma Walsh|title=Strengthening Family Resilience|date=September 25, 1998|publisher=Guilford|location=New York}} Uncontrollable factors such as culture, age, socioeconomic status, and genetics are all factors that contribute to resilience.{{cite book|last1=Boss|first1=Pauline|title=Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss|date=2006|publisher=WW Norton & Company|page=3}} Trauma and ambiguous loss often co-exist together and if the trauma is not dealt with it can trigger unresolved emotions. 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.

=Three types of grief=

The difference between regular grief and grief from an ambiguous loss occurs because the type of loss creates the type of grief experienced.{{cite journal|last1=Boss|first1=Pauline|last2=Carnes|first2=Donna|title=The Myth of Closure|journal=Family Process|date=December 2012|volume=51|issue=4|pages=456–469|doi=10.1111/famp.12005|pmid=23230978}}{{cite news|title=Pauline Boss — The Myth of Closure -|url=https://onbeing.org/programs/pauline-boss-the-myth-of-closure/|newspaper=On Being}} Grief in ambiguous loss can be both beneficial and difficult. As the grief in an ambiguous loss differs from the progressions of regular grief there is no time pressure to move on or achieve closure. This allows for people to remember a lost loved one and move on with relationships and life. 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.{{cite journal|last1=Coombs|first1=MA|title=The mourning before: can anticipatory grief theory inform family care in adult intensive care?|journal=International Journal of Palliative Nursing|date=December 2010|volume=16|issue=12|pages=580–4|pmid=21240101|doi=10.12968/ijpn.2010.16.12.580}} 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.

==Disenfranchised grief==

The second type of grief that can develop from an ambiguous loss is disenfranchised grief.{{cite journal|last1=Cordaro|first1=Millie|title=Pet Loss and Disenfranchised Grief: Implications for Mental Health Counseling Practice.|journal=Journal of Mental Health Counseling|date=October 2012|volume=34|issue=4|pages=283–294|doi=10.17744/mehc.34.4.41q0248450t98072}} It is also known as unrecognized grief because it often occurs in the loss of someone or something not taken as seriously by others, e.g. a beloved pet. Ecological Grief or Climate Grief has also been identified as a form of disenfranchised grief.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.

==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.{{cite journal|last1=Boss|first1=Pauline|title=The Trauma and Complicated Grief of Ambiguous Loss|journal=Pastoral Psychology|date=11 November 2009|volume=59|issue=2|pages=137–145|doi=10.1007/s11089-009-0264-0|s2cid=144242336}}