Have you ever lost a loved one who was still a part of your life in some way? Did it leave you feeling confused or frozen about how to continue with life? If you have, you might find it comforting to know there is language to describe this experience. It's called ambiguous loss, or as some refer to it "grief limbo," and you may be experiencing this phenomenon right now as we face the losses associated with Covid-19.
Covid-19 has upended our sense of normalcy and safety in many homes across the world. In addition to the loss of security we are experiencing, people coping with loss before the pandemic are living in a very vulnerable position. For the first time in our lives, we are grieving in isolation. Loved ones are unable to be present with dying relatives to comfort them and say goodbye. Funerals and mourning activities are impossible without fear of catching the virus. Children in the child welfare system are disconnected from their birth families without visits taking place. These examples are only a few of the many.
As human beings, we've been coping with grief through group connections since the beginning of time. Grieving with others is a protective factor for our psychological health and provides closure for what we've lost. Because many of us are suffering alone with ambiguous loss, it can be helpful to understand how this impacts our lives and what we can do to find support.
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 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 or pets
Military deployment or work-related absences
A parent who is distracted all the time
Moving to a new community
Traumatic brain injury
Chronic mental health problems
These losses typically occur without rituals and social validation due to the unconfirmed nature of the loss that has happened. Because most of the world is quarantined, many people across the globe have lost their loved ones without being able to say their goodbyes. This experience leaves the bereaved isolated in their grief, and without an outlet for expression of these emotions. Rituals and public acknowledgment are a crucial part of healing and provide our brains with a sense of finality, and the ability to start the grieving process. Without a resolution for the loss, symptoms of trauma can arise.
"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:
Intrusive, racing thoughts
Preoccupation with thoughts of their loved ones
Difficulty committing to decisions
Inability to move forward with everyday tasks
Emotional overwhelm - frequent crying or outbursts
Difficulty accepting the new family role
Through my experience with foster and kinship families, and as a woman who experienced an ectopic pregnancy, I have first and second-hand experience with ambiguous loss. I've witnessed the pain and trauma caused in the lives of children who are uncertain if and when they will see their parents again. I've grappled with weeks of uncertainty waiting for tests to determine whether my pregnancy was viable or not, and the resulting isolation of feeling unable to express my grief openly when my fears came true.
These ambiguous wounds are not easily bandaged by the support of family and friends when we are unable to verbalize 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.
"Ambiguous loss defies resolution, creates long-term confusion about who is in or out of a particular couple or family, and freezes the process of grieving." - Pauline Boss, Ph.D
In American culture, we fear to receive judgment or backlash from others in return for our grief. 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.
HOW TO COPE WITH AMBIGUOUS LOSS
Recognize and label 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.
Connect 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 and closely monitor if children are involved.
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." Using an app like Calm for guided meditation, or Moshi Twilight (for kids) can be beneficial, but there are many apps available to try.
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. An example of this is the work I do with grief and trauma. I find comfort knowing that my own experiences help someone else. In a way, it makes me grateful for the hard times I faced in the past, because I know I wouldn't be able to help others without these experiences. It can take years to get to this place, and please be patient with yourself.
The key to remember is that you are not alone in your loss, especially now, as the whole world grieves. It may be helpful to remember that over time you will adapt to a new normal. 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.
To learn more about how to improve the emotional health of your family, come and join us in the Facebook group, Emotiminds. Think of it as a virtual classroom to build emotional resiliency for you and the children you love. Each week I share an social/emotional learning activity to help your family flourish.
Beth Tyson is a psychotherapist, childhood trauma consultant, and children's book author. She provides workshops on childhood grief and trauma. Beth is also the author of the children's book A Grandfamily for Sullivan, a book for children being raised by their grandparents or relatives. Join her children's mental health newsletter HERE.