During one of my loved one’s initial manic episodes, I looked into her eyes and felt a disconnect; I didn’t recognize the person looking back at me. Painfully, it seemed she didn’t recognize me either. Thus began a tumultuous cycle of extreme highs and lows, restlessness, and despair, typical of bipolar disorder. Although this condition manifests uniquely in each individual, her depression often extended far longer than her manic episodes, sometimes for years. One of the most challenging aspects of these unpredictable times was the overwhelming sense that I had lost her – the very person whose advice I deeply valued and to whom I could reveal my true self. Instead, the person I interacted with was either in a state of high agitation and mania, or sunk in despair and hopelessness – unable to provide the support or comfort I longed for. In those moments, even though she was physically present, I couldn’t expect much from her; it took all her energy to maintain her own well-being, leaving little for others. While I grasped this concept intellectually, it was difficult to manage the mix of emotions – sadness, helplessness, disappointment, and frustration.
Years later, I finally identified this feeling: ambiguous loss, a term introduced by social scientist Dr. Pauline Boss in the 1970s. Ambiguous loss pertains to losses that lack the clarity and finality found in an unambiguous loss, such as death. This type of loss doesn’t offer closure and leads to unresolved and confusing grief. According to Boss, there are two primary varieties of ambiguous loss. The first involves physical absence coupled with psychological presence, which can occur with a missing person due to abduction, war, or disaster. The second involves physical presence alongside psychological absence, which can happen when someone is lost to Alzheimer’s, dementia, addiction, or severe mental illness. Events like divorce can also create ambiguous loss, reflecting the dissolution of a once-unified family.
Frozen grief: “leaving without goodbye” and “goodbye without leaving”
Losing someone, in any form, is difficult. However, Boss argues that ambiguous loss can be especially tough because it lacks closure and resolution. For instance, when someone goes missing, their loved ones may feel they have to choose between living in a painful state of uncertainty while clinging to hope or seeking some resolution through mourning and trying to move forward. People react differently to ambiguous loss, and each must find coping strategies that suit them. Nevertheless, the pervasive uncertainty typically fosters prolonged grief, anxiety, and feelings of helplessness. Boss refers to this as “frozen grief” and underscores the hurt in both “leaving without goodbye” (like in cases of missing individuals) and “goodbye without leaving” (as seen when someone succumbs to conditions like dementia).
How to cope: revising expectations and adapting to a new reality
How can we navigate ambiguous loss? Boss suggests that the first step in recognizing and validating this experience is to specifically name the ambiguous loss and describe it as such. She also encourages individuals to embrace the uncertainty and the changes resulting from the loss by adjusting their expectations to better align with their new reality, rather than remaining in denial. For instance, a wife who once shared an active lifestyle with her husband diagnosed with Alzheimer’s may need to modify her expectations about their future activities together. While they can still savor quiet moments, she might need to fulfill her outdoor and social desires in different ways, perhaps reserving a designated day each week for such outings while her husband is cared for by someone else.
As she acclimates to her new reality, there is a possibility of discovering moments of joy and hope in this phase of life. This adjustment will likely require time and grieving over the past, which is completely normal. The goal will be learning to accept the uncertainty while taking empowered actions that shift her focus away from the unpredictable elements in her life (like the progression of the illness) toward aspects within her control (such as her self-care practices and support system). Building a support network may include connecting with groups of individuals facing similar challenges, turning to friends and family, or seeking help from a therapist to navigate the wide range of emotions that may arise. In my practice, I support those processing grief, both ambiguous and clear-cut, as it influences individuals as well as couples and families.
Any form of loss, whether ambiguous or clear, can be traumatizing. As noted by trauma researcher and psychologist Peter Levine: trauma is less about what occurs to us and more about what transpires within us when we lack an empathetic witness – thus, a support system can play that crucial role of being an empathetic presence.
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