How to Cope with Ambiguous Loss

[Sara Huizenga]

How to Cope with Uncertain Loss or Death of a Loved One

By SUZANNE PHILLIPS, PSY.D., ABPP

Not knowing if your loved one is alive or dead absent or present, knowing or needing you is painfully traumatic. It is the suffering faced when soldiers are missing in action, thousands of bodies vanished after 9/11, a child is kidnapped, a partner is diagnosed with Alzheimer’s, and most recently, it is the anguish facing thousands of Japanese people as they search or wait for news of loved ones.

In my work with couples and families after 9/11, their inability to verify the death of loved ones created longing, hopes and often complicated grieving. At the beginning, many held off on funeral services, children refused to believe that Daddy wasn’t coming home, some went to psychics, many had a similar dream –“The doorbell rings and she/he is back – looking like they once did. ‘Where have you been?’ The dreamer is relieved and overjoyed … then wakes.”

It was never easy but most found the resiliency to move forward again. How? How do you cope with unresolved loss?

Pauline Boss, who has worked for years with those whose loss has no finality, identifies this as ‘Ambiguous Loss’ in her 2006 book Loss, Trauma and Resilience: Therapeutic Work with Ambiguous Loss. She underscores that in these cases traumatic loss is intensified by fear, confusion, immobilization and a lack of closure.

Drawing upon Pauline Boss’s valuable contributions, here are some ideas for caring for yourself, your partner and others in the face of such loss:

Connection vs. Closure
In the face of unverified or ambiguous loss, people often feel persistent emotional pain because they can not get closure- there is no known end, no body to bury. An approach that fosters healing is to seek connection instead of closure.

Whereas unresolved traumatic loss often isolates, connection with others who share a similar pain recreates a sense of belonging. For the couple with a missing child, those waiting to hear of lost relatives, those coping with Traumatic Brain Injury of a partner, being with others who have faced such suffering offers a place to bear witness to the fear, anger and grieving. There is a normalizing of reactions and a reduction of feelings of shame and blame. There is healing in the telling and listening of what is hard to accept or understand.

The Psychological Family
An important feature of Pauline Boss’s model of coping with ambiguous loss is identifying your Psychological Family. This is the personal and internal family that you carry in your head and your heart. This family may not be those you live with, or only people related by blood. They are people with whom you have significant emotional ties. They are the people who inspire you, support you, people you carry with you – the Grandma who lives in another country; the best friend who reminds you of your strengths from miles away; the brother that you only see on the holidays.

Although there is great pain and panic if such a person is thought to be injured, lost or dead, their psychological presence can be a source of strength and resiliency. “What would he say?” “How would she want me to handle this?” “He’s with me.” This is not preoccupation or obsession with the lost loved one – it is a use of the bond and significance of the relationship to help you go forward, to hold the good memories, to use connection instead of closure.

Resilience vs. Control
Unresolved loss assaults people with feelings of helplessness, at times intensifying a desperate need to regain control, at other times immobilizing and creating despair. As Pauline Boss suggests, when we can not change or control a situation, our goal becomes to increase our resilience for dealing with it.

Resilience can be defined as the capacity to find a way back to successful adaptation and functioning even after a period of disorganization and disruption (Roisman 2005). To do this people draw upon resiliency traits as physical strength, intelligence, social skills, independence, sense of humor, creativity, music, art, problem solving, family ties, love of nature and spirituality, etc.

Drawing upon your strengths consider the following:

Differentiate what you can and can not control and put your energy into what you can make happen.

Regain a sense of mastery by accomplishing definable tasks that can be done on a daily basis – no matter how big or small- cook, clean, read, pray, help those around you. Helping others is an antidote to feelings of helplessness.

Focus on the Children The most important motivator for resilience and antidote for despair is the care of children- all children. Too often the anguish of parents is so great that children become their parents’ caregivers. Remember, children are lost without you and they will use their own resilience to try to keep a parent emotionally and physically intact. This is not their role. If you see your partner is struggling, step up for them and the children. Draw upon other resources in the family, and community for help and support.

Self-Care, Partner Care, Family Care Build and restore your physical strength and that of your partner and family’s to reduce the physical impact of traumatic loss (Tension, sleeplessness, eating difficulties, intrusive thinking, avoidance, substance abuse etc.).Model the need to remain strong to handle the challenge you face and as a testament to the value and spirit of those you miss.

Find Meaning Beyond Life’s Circumstances in spirituality, nature, art, music, creativity, athletic challenge. Pray, draw or write about your loved ones, encourage your children to do the same. Sing, run for life, reach for a way to cope and move beyond unresolved loss. One woman found her lost sister in every butterfly she saw!

Hope vs. Certainty

If we look into the future only for answers to unspeakable trauma, we face a hopeless picture. If we can accept uncertainties as inevitable, believe there can be options, carry those we love in our heart and bond with others to make life matter – we can begin to go forward even without closure because we have hope.

For Further Reading:
Boss, P. (2006) Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss New York: W.W. Norton & Co.
Roisman, G.J. (2005) Conceptual Clarifications in the study of resilience. American Psychologist 60:264-65.

http://blogs.psychcentral.com/healing-together/2010/01/how-to-cope-...

[Lisa DeSherlia]

I think I get the meaning of this article and about "ambiguous loss" where there is no closure, no answers and that this is by no means limited to the agony of the familes of missing loved ones. There is one "ambiguous loss" that so many in the "lost generation" of many adults have experienced for many years. That is, many of us grew up with clusters of differences and disabilities that were counted as being bad, stupid, lazy or crazy, because the autism spectrum DSM-4 was not around prior to 1980. And so many in this "lost generation" have grown up with agonizing feelings of never belonging anywhere, fears, shame, confusion, and a persistent feeling that something was "nerver right" but never being able to explain or understand what it was. As a result, many have faced unemployment, underemployment, mental health issues, even homeless. Such adults typically have been more vulnerable to becoming victims or perpretrators of crime. It is truly a "hidden epidemic" of a "hidden population" and truly an "ambiguous loss" and often the only thing that can bring needed answers to many, is being tested/evaluated for autism as adults though such a diagnosis usually is to provide answers and vindication more than anything.

[Malinda Hoyt]

Thanks, Sara, for a great share and resource.  Six and half years into an "ambiguous loss" I feel I can confirm validity of the suggested ways to draw on your strengths posted here.  Yes, some times it is moment to moment - then you can deal with day to day.  I never thought I'd be facing year to year, but can say that even though it is never "good", it does get better.  Learning to recognize and accept what you can and cannot control, among those learning that the  greatest "controllable" is yourself, has been the hardest, yet the best tool in this journey for me.  In the early days and months when we couldn't get anyone's attention to help -  it was consuming and terrifying.  Even after we had law enforcement attention and help, the anxiety, fear and frustration seemed to rule my every thought and action and made me an angry, sad person.  I "stuffed" and focused the anger and sadness on working, working, working trying to chase the thoughts, fears and sadness away.  Fortunately for my health and sanity I discovered the community of the missing - "Peace", Project Jason retreat and Duane Bowers key among this new "family".  Over time and with growing understanding, most of the things mentioned in your blog became natural "coping" venues, but Duane's education into the pysiology of emotion and gaining "control" of the physical reactions to emotion have helped me truly re-enter the world and "cope" with hope.  I still get sad and sometimes still very angry, but I know what to do with it to make it productive and not destructive (to others AND to not be destructive to me). 

AND, no matter where you are in the "ambiguous lost" journey, reminding yourself of your strengths and options is needed for validation and continued hope.

Thanks for all you do.