Ambiguous Grief: grieving someone who is still alive (part 2)

Way back we wrote an article on ‘ambiguous grief’ aka grieving someone who is still alive. To keep it to reasonable internet reading length, we really only told half the story. If you know anything about Pauline Boss, the ambiguous grief guru, you know she talks about two (and really more like two and a half) types of ambiguous grief. One is what we covered last time – grieving someone who is physically still in your life, but who is ‘psychologically absent’. This means they are no longer the person they used to be (think dementia, addiction, traumatic brain injury, etc) If you are looking for more on that, you can check out that first post here. But Pauline Boss talks about a second, equally as significant, type of ambiguous loss – grieving someone who is physically absent. 

From grieving break-ups and divorces to runaways, incarceration, immigration, foster care, estrangements, military deployments, adoption, and others. The list of these types of losses is long, so it is no surprise we get questions about them all the time. Pauline Boss describes them saying they occur when someone is ‘physically absent but psychologically present’. By psychologically present she means that the person left to grieve is thinking about the absent person all the time. They are worried, they are distracted, devastated, sad, and stressed, and on and on.  

These losses are open-ended, and that is in large part what Boss explores. The nature of these losses is that they create a unique stress response because of the uncertainty – a person is “gone, but not for sure”. It is often unclear if or when the person will return, leaving those grieving confused and sometimes consumed by the loss. The safety of the missing person is frequently unknown. This leaves the grieving person left fluctuating between moments of hope and moments of feeling completely hopeless. 

This ongoing uncertainty, according to Boss’s research of over forty years, shows that this can “prevent resolution of the loss, and freezes the grief process, paralyzing couple and family functioning”. As with all grief, there are no universals and there are certainly many, many cases when this doesn’t occur. But the risks are increased because it becomes harder to use some of the coping strategies that work in grieving death-related losses. People often struggle to adapt or reconstruct their identity. They struggle to find meaning when circumstances or facts are unknown. 

This can be complicated further by the fact that society doesn’t have accepted norms or rituals around these losses. People don’t often don’t know how to acknowledge grief when someone has died, and they certainly don’t know how to acknowledge and support it in the cases of adoption or incarceration or almost anything else on the list. The uncertainty, according to the research of Boss and her colleagues, increases the likelihood for hypervigelence (when your senses are oversensitive), anxiety, anxious attachment (when you are overly clingy and attached to a person, because you worry they will disappear), and symptoms of depression. If you’ve been this, it might sound familiar – every time the phone rings you startle, thinking on some level it could be news about your loved one. You can’t focus because you are fixated on their safety. You extend your worries to other’s you are attached to and to yourself. You obsessively feel like you can or should be doing more or doing something differently, or you obsessively think they should be doing more or doing something different.

And to boot, sometimes this type of ambiguous loss is stacked on other types of ambiguous losses. Maybe someone has physically disappeared from your life because they couldn’t handle your grief after a death. Now you are left grieving both. Maybe someone with an addiction disappears for days or weeks on end, and then they do show up they are ‘psychologically absent’, leaving you managing both types of ambiguous loss. 

I hear you screaming, “Yes! This is me! I don’t need you to explain it, I need you to tell me what to do about it!”

I know, I know. The good news is, Pauline Boss has some concrete, evidence-informed guidelines. The bad news: there are no quick or easy fixes. Though she creates a nice little checklist of six tasks that can help in building resiliency, they are each an ongoing process and flexible, depending on your needs and the situation. 

She suggests those dealing with an ambiguous loss should:

  • Finding Meaning
  • Adjusting Mastery
  • Reconstructing Identity
  • Normalizing Ambivalence
  • Revising Attachment
  • Discovering New Hope

Easy enough, right? Hmmm . . . . maybe not so easy.

First, let’s consider what the goals are here. Boss tells us the unique challenge of this particular loss is that it is uncertainty that is ongoing and a lack of closure. Therefore, she says the goals of the above is to help people better learn to live with that uncertainty, rather than trying to resolve the situation. Since there is no clarity or solution, you have to learn to cope with that reality. Each of her six guidelines help with that. 

If you want to check these out in depth, check out Boss’s recent book Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss”. For now I just want to mention a couple of highlights. 

First, Boss things we can increase the flexibility of our thinking to help us cope with uncertainty when we learn to live with “two truths”. There are countless instances where she says we think we need to either be one thing or another – hopeful or hopeless, optimistic or pessimistic. There are times where we limit what our identity looks like by believing it must be all or nothing. Instead, Boss says that living with ambiguous loss means finding more flexibility. For instance, one might consider thoughts like:

John is both missing and still part of our family. 

I believe Jim is dead and I am hopeful Jim is not dead. 

I both a wife and no longer a wife. 

I both want certainty and don’t want Jen to be dead. 

Boss further tells us that many things that will help us are relational interventions. This might mean considering our identity now. Who am I now? Who is my family now? What are our roles? Is my identity more fluid that I once knew? What does it mean to be a good mother now compared to in the past? Looking at identity roles can help in finding ways to cope with the present, rather than being fixed in an identity that worked only in the past. 

She encourages us to reconsider mastery, suggesting that we often want answers and clarity, but it serves us to remember that sometimes there are no answers. Hard as it is to sit with, the world isn’t always fair and just, suffering is universal, and the temptation to blame (others and ourselves) to that we can create a sense of certainty is often inaccurate and doesn’t help us cope. Instead, she advocates using techniques to tolerate these realities of the world by focusing on taking care of oneself – yoga, meditation, and whatever self-care helps you just be. 

Boss suggests we also get real about our emotions. She thinks we need to admit the pressure we feel to ‘get over’ things and acknowledge that there are some things we never get over, we just learn to live with them. She encourages us to learn the difference between emotions and behaviors. She gives us permission to feel whatever we feel without judgment while becoming aware that we have control to make sure those feelings don’t turn in to actions or behaviors. Even though I might think no one understands what I am going through, I still have the control to reach out to others anyway to avoid isolation and find support I never would have predicted. 

Finally, she encourages us seeking ways we can both hold on and let go. She allows a space for grieving the ongoing and uncertain loss, while also making space for new attachments and hopes, being open and communicative about both. She reminds us that we can redefine hope, meaning we can become more comfortable and balanced in our ambiguity. This is no easy feat, but redefining our concepts of fairness and justice, finding space to laugh as the absurdities of the situation, and embrace hope where we can find it.

It all sounds so simple in a nice little list, when in reality is is long and complex and you may find a counselor is the best thing to help you through some of her suggestions. Alternately, some of this might already resonate and you might be thinking about where you can implement some of these ideas. Wherever you are, leave us a comment to let us know your thoughts about this type of ambiguous grief and how to cope. 

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April 11, 2019

8 responses on "Ambiguous Grief: grieving someone who is still alive (part 2)"

  1. I’m so happy that a good friend recommended this site for help. I have a son who was totally traumatized as a 12-year-old by the loss of his 14-year-old brother suffering sudden death in his arms .
    The first son was kept alive by being defibrillated and subsequent I lived in a coma for the next nine months. When this once happy go lucky and normal son reached the age his brother was at the time of his death he endured identification with the deceased . This happened many years ago and eventually spiraled into his decline… Along with many ups and downs… Into full-blown addiction .
    This is going on all through his life and now we have necessarily had to separate our lives from his because of the fact that there are younger children involved and he was living on the Fringe at all times and refused programs… Although he was incarcerated many times. I know he’s a sick human being that we still love… At the present time living on the streets. My question to you is Where can I find the book I need and maybe Even a workbook I could utilize to help me cope with this tragic loss of my second and only living son. I’m now at the age of 75 and the pain rages just as strongly as it did in the beginning when this much loved son took the wrong path through his own pain. Please let me know where I can purchase the necessary books… Thank you very much for your help.

  2. I am new to this website and am so grateful I found it. I am an adoptive mom and I worry about how best to help my 10 year old with the ambiguous loss of his birth parents who are living. I would love a book recommendation for parents of adoptive children, as well as books for adoptive kids that touch on the loss as opposed to feelings around “family” (which are great, but do not touch on loss). I have read “20 questions adopted kids which their adopted parents knew” which touches on loss, but would love some book recommendations for my child and our family.

  3. I’ve followed WYG for years and am so grateful to see another post about ambiguous loss as that is the type of grief I have. Please continue to cover this topic, I deeply appreciate it. Thanks for all your work! <3

  4. Despite all the grammatical errors in this post, which, sorry, really distracted me from the message since I’m a “wordie” at heart, this was a much welcome article!! There is so little written about such losses, and I’ve suffered SO many of these types of “unresolveable” types, it’s become ridiculous (can I label them “unfair”?), seriously debilitating and overwhelming to my entire being. Not having yet read Pauline Boss’s book, I don’t really understand what she means by both holding on AND letting go, simultaneously…a foreign concept I’ve not been able to reconcile or even begin to master, for all my efforts. Ambiguity is really difficult to deal with any area. So you’re right — it’s a “long and complex” process, for sure. I don’t have any ready answers, and as a person who prefers a higher level of certainty to enable a feeling of security, this is all an awfully tough road. At present, I feel I embody more of the “hopeless” type, and can’t even imagine what “redefining” my concepts of “fairness and justice” might look like. So much to chew on in yet another of your articles, so thank you.

  5. My partner has passed he died here in my room I did CPR untill the ambulance arrived. I found out he was seeing prostitutes which broke my heart . I got him to leave but I couldn’t cope missing the man I knew not the other one.Its been 6yrs but I go over it all the time I just couldn’t walk away I feel like a fool when I say I love him but I do is there something wrong with me .

  6. Yes, I hear what Beth is saying. Many types of ambiguous grief. My husband died of ALS in October,, he was diagnosed 15 months before his death So his body failed him but he was 100% himself mentally, .. So I had those extra 15 months of grief knowing he had a fatal condition. Where does that fit it ? Or is it ambiguous grief or something else. Anticipatory grief….maybe a better word.. In the meantime I had to support him through it all.. I was strong for him, not much time or energy to feel my own grief.. Did it give me time to accept it,, did it just add to the grief, will it make my grief now different??.. I don’t know myself. A day at a time.

  7. This article is so great, and I really like Pauline Boss’s work as I found her while doing my own grief research with non-death related losses. So thanks for posting this!

    And…I have to say that I was disappointed to once again not be included with my specific loss. Your title implied that it would…grieving someone who is still alive. My loss is my partner’s able body. He is a quadriplegic and is dependent on his power chair for limited movement and caregivers for mostly everything else. His has lost his able body…this is dead, and yet he is still so very much alive.

    Have you covered losses such as this due to disability issues? It feels like ambiguous loss and yet it doesn’t fit in this category of this blog post.

    This happened back in 2012. I am a therapist (I was at the time of the accident) and I now call myself the Grief Freak mainly because I am so passionate about helping people navigate this thing called grief. But today after feeling so hopeful that this article might speak to me, and then feeling my disappointment about once again not having my loss acknowledged, perhaps I call myself the Grief Freak because I am indeed a freak…someone who doesn’t belong, doesn’t fit it.

    I am not writing this with negativity and I am aware that I need to read Pauline’s book. But I just needed to write a comment about my thoughts.

    And I am curious if you have written on the subject of grief that comes with suddenly dealing with any kind of disability.

    Thanks so much for doing what you do. I love your blogs and posts on Instagram too.

    • Beth, I’m wondering if you looked at our first ambiguous grief post. It gets more to the experience that you are going through (though not entirely). That post is specially about being who are still in your life and you are grieving them not being the person they used to be, vs this follow up post which is about someone who has disappeared. Pauline Boss very clearly talks about both, though your loss is more specifically what they call ‘Non-finite Grief’, so searchs for that might help you to feel more connection. Sorry this wasn’t what you were hoping fo.

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