making choices, learning skills & finding balancee -
Reflections

Coping With Ambiguous Loss: Resiliency Not Recovery

Lent in the Christian calendar is a reminder of loss. The Jews lost hope for a political king. Jesus’ disciples lost their leader. And Jesus lost his life. Loss is inevitable in life. As Queen Elizabeth II reminded "Grief is the price we pay for love” (2000, 5). If we attempted to avoid loss by never forming loving relationships with people, places and even pets what would life be like? The natural response to loss is grief. Rabbi Earl Grollman eloquently defines grief as “love not wanting to let go.” It tears us up to lose what we love. Grieving our losses covers a broad spectrum: the death of a loved one, miscarrying a baby, divorcing a spouse, losing a job, moving from home and so on. These are a few examples with one thing in common: The loss is clearly defined and is most often marked by rituals or rites. Though recovery is recursive with tidal waves of grief, the trajectory is toward closure. Which is why Kubler-Ross (1970) described recovery in five stages: denial, anger, bargaining, depression and acceptance.

The defined loss spoken of above is one category. But there’s a second category called ambiguous loss. It’s not as neatly defined. Pauline Boss a psychologist who grew up in an immigrant community coined the term in 1999. People experience ambiguous loss in two ways: 1) when a loved one is physically missing but emotionally present. Catastrophic examples are bodies missing due to war, terrorism, genocide, natural disasters, or kidnappings. Also absent parents due to divorce, adoption, and immigration. 2) refers to a person’s physical presence while emotionally or cognitively absent. Examples are mental illnesses, dementias, traumatic brain injury, depression and addiction. Translated into contemporary terms, the term also applies to deployed partners in military, estranged adult children from families, spouses living together having affairs, children incested by family members and transitions in gender identity.  

Ambiguous loss is not only messy to define but tougher to cope with. Unlike defined loss it has no closure. There’s no linear stages (Kubler-Ross,1969), non-linear stages (Stroebe and Stroebe,1993) nor tasks (Worden, 2002) toward recovery. And unlike the customs and rituals that accompany defined loss like funerals (Christian faith), shemiras (Jewish faith) and Janazah (Islam), there aren’t any. Since there’s no culturally acceptable ways to publicly grieve, people who want to care don’t know how to respond in compassionate ways. There are no cards, condolences, casseroles or even comforting words. Most ignore what’s happened or deny it altogether. It feels too uncomfortable to face. Some compelled to speak, seldom know what to say: should we encourage hope that the loss will resolve? Or do we advise acceptance that the person is gone and the relationship is changed forever? 

With no cultural norms to respond and little clinical research to inform the wider community, there’s a lack of information on so many levels. Often ambiguous grief morphs into Post Traumatic Stress Disorder or PTSD (https://www.mnadopt.org/wp-content/uploads/2014/03/Understanding-Ambiguous-Loss.pdf). The chronic ambiguity of the loss freezes the grief process, prevents self-insight, blocks decision-making and paralyzes moving forward. The griever feels helpless, hapless and hopeless. In this condition a sufferers  construct their own reality surrounding the loss and are anxious, depressed and stuck. The residue of this dynamic begins to effect all relationships. Summarizing Boss says that “People hunger for certainty…[therefore] of all the losses experienced in relationships ambiguous loss is the most devastating because it remains unclear and indeterminate.” (1999, 6). 

No. The way forward with ambiguous loss is not recovery. It’s resiliency. Based on Boss’ extensive experience working with over 4000 suffering families from New York to Bosnia-Herzegovina, best practices suggest not “going for closure,” but rather building strength for acceptance and tolerance for ambiguity (see http://www.amazon.com/Loss-Trauma-Resilience-Therapeutic-Ambiguous/dp/0393704491). For starters this requires resisting social pressure “to get over it” and garnering support of ‘family’ to provide safety and support. Here, family is loosely defined. It includes intimate relationships with people “whom we can count on for emotional closeness” and basically “be there” to normalize our experience (1990, 4). This family may or may not be blood relatives. Instead of the people we grew up with, it’s the community we choose in adulthood. This family of choice is critical to coping with ambiguous loss. And intentionally cultivating this family is one of the strongest predictors of resilience in the face of loss, crisis and trauma (Bonanno (2004), Boss, 2006). Below are more suggestions for coping with ambiguous loss for both grievers and caregivers:

For Grievers:

Educate yourself. Learn what you can about ambiguous loss and see how it fits for you: http://www.ambiguousloss.com/four_questions.php

Give voice to ambiguity. Put a name to your feelings of ambiguous loss. Acknowledge without apology how difficult It is to live with it. If you have no one to talk to who feels safe, journal about it, find a grief group or go to a 12 step program so you can speak freely and confidentially.

Identify and grieve what’s lost and celebrate what still is. Create a “loss box.” In her work with adopted adolescents, Debbie Riley (https://www.mnadopt.org/wp-content/uploads/2014/03/Understanding-Ambiguous-Loss.pdf) suggests designating a box where you place items representing what you’ve lost. Remember the good that people, places, pets have given without denying disappointments. This provides a ritual to process grief and transform it to gratitude.

Learn to live with ambiguity. Resist black & white. Steer clear of trying to fix, control and change the problem. Practice dual thinking or both/and thinking. Shift your paradigm for seeing life in terms of right/wrong; black/right. Realize that life is lived in a paradox of truth tensions. Finding meaning means learning to walk a tight rope toward accepting ourselves/others as flawed while at the same time setting boundaries and holding people accountable. Avoid self pity and seeing yourself as alone, recognizing that many people walk with you in the same spot. 

Rediscover agency & reframe family. Rather living with regret for what’s gone or trying to recapture what was by recycling old dynamics, recover personal power by making new decisions and exploring new relationships. In Boss’ words do “small good works (http://www.preventionworkscc.org/Email/FPCAmbiguous%20Loss%20-%20Finding%20Resiliency%20Despite%20Unclear%20Loss%2012-08.pdf),” reframe roles in your relationships, accept people as they are rather than how we want them to be and create new holiday/family rituals even if you’re single. Reframe ‘who am I’ in light of your loss. 

Cultivate spirituality. Living with this kind of loss often impacts our faith. “How could a good God let this injustice happen?” Hence our alienation is not just with people, but the Holy. Tell God straight out how angry, hurt, alone and sad you are. Simply say ‘help.’ Reconnect not just with yourself and others, but with God. Be defined. Stay connected. Just show up.


For Care-Givers:

Offer support. Rather than trying to say the ‘right thing’ just listen. Be physically/emotionally present. Avoid pat answers to bring closure like: “Don’t worry. This will all work out.” Instead be open-ended: “Just take it a day at a time” or “one step at a time,” and “I’ll walk with you in this.”

Normalize the loss. Avoid playing amateur psychologist and giving advice. Invite grievers over for a cup of coffee, for dinner, to watch TV or just for a shopping trip. Include them in your family.

Allow another to go at their own speed & in their own way. Resist the pull to push a griever into a position or perspective of their loss Avoid pressuring people to “get on with life” or put a lid on their loss. Let them grieve at their own pace. Sit with the ambiguity yourself rather than rushing to judgement and imposing your way on another’s process. 

Invite another to your church, synagogue or mosque, etc. Or go with them to theirs. Suggest a 12 step program if appropriate like Adult Children of Alcoholics (www.adultchildren.org) or Codependents Anonymous (www.coda.org). Go with them.

Calmly suggest that a mental health professional might help. All of us encounter periods in life when we feel lost and overwhelmed. We feel stuck and at our wits end. We can’t see the next best step. It’s normal and natural to reach out to an experienced professional. Doing so suggests emotional maturity not personal weakness. Suggest to look for a qualified and experienced professional in your area by going to this website: (www.psychologytoday.com)  and putting in your zip code. Or ask your medical doctor/spiritual leader for a recommendation. 

Take care of yourself and don’t promise what you can’t deliver. Follow-through is important for the sake of trust. So be clear about what you can/cannot do. If you don’t, you’ll not only re disappoint an already hurting person but burn yourself out. 

Summarizing, there are two types of loss: defined loss and ambiguous loss. In the case of defined loss a person, place or pet is gone for good. Ambiguous loss isn’t as neat. Instead its a tension between two truths: A person is either physically present but emotionally absent, or emotionally present but physically absent. Since ambiguous loss is not clear cut, recovery isn’t the goal. Instead the journey toward healing is resiliency through learning to tolerate ambiguity, accept the paradox of people’s presence/absence, and reframing a family of choice. These twilight themes of loss remind us of Lent. Jesus was a refugee with a Divine Parent who was both present and absent in his Passion on the cross. “My God, My God why have you forsaken me?” is Jesus’ cry of ambiguous loss. It's the soul struggle that faces us all. And with faith it leads us from the shadows of Lent into the spring of Easter. Not a closure, but a transformation. Not a coffin, but a ressurection. For “only people who are capable of loving strongly can suffer great sorrow. But the same necessity of loving strongly serves to counteract their grief and heal them” (Leo Tolstoy). 

References

Bonnano, G. (2004). Loss, trauma and human resilience: Have we underestimated the ability to thrive after extremely adverse events? American Psychologist. (59)1, 20-28.

Boss, P. (1999). Ambiguous loss. Learning to live with unresolved grief. Cambridge, MA: Harvard University.

Boss, P. (2006). Loss, Trauma and Resilience. New York: W. W. Norton.

Boss, P. (2007). Ambiguous loss theory: Challenges for scholars and practitioners. Family Relations. (56), 105-111. 

Boss, P. (2013). Resilience as tolerance for ambiguity. In D. S. Becvar (Ed.), Handbook of family resilience, (285-297).

Doka, K. J. (2002). Introduction. In K. J. Doka (Ed.), Disenfranchised grief: Recognizing hidden sorrow. Lexington, MA: Lexington Books.

Grollman, E. (2000). Living with loss, healing and hope: A Jewish perspective.  Boston, MA: Beacon.

Kubler-Ross, E. (1970). On death and dying. New York: Collier Books/Macmillan.

Queen Elizabeth, II. (Sept 21,2001). Grief is the price of love, says the queen. The Telegraph. D. Sapsted, P. Foster and G.Jones in New York.

Stroebe, M., Stroebe, W., & Hansson, R. (1993). Handbook of Bereavement. Cambridge, MA:
University.

Worden, W. (2002). Grief counseling and grief therapy (3rd ed). New York, NY: Springer.

Website Builder provided by  Vistaprint