Coping with Ambiguous Loss: Symptoms and Strategies for Resilience

In the face of life's uncertainties, particularly those brought on by unforeseen circumstances like the COVID-19 pandemic or other significant life changes, individuals often experience a profound sense of loss that is not always clearly defined. This is known as ambiguous loss, a concept developed by Dr. Pauline Boss of the University of Minnesota. Ambiguous loss can lead individuals to question whether a real loss has even occurred, creating a lingering sense of uncertainty and overwhelm. It involves unforeseen circumstances that create a lingering sense of uncertainty about what is being felt and what has been lost.

Understanding Ambiguous Loss

Ambiguous loss is a type of loss that remains unclear and lacks resolution. It differs from traditional grief associated with death, where societal norms provide a framework for mourning and support. In ambiguous loss, the absence of these norms can lead to feelings of minimization and under-recognition of grief.

Dr. Boss identified two primary types of ambiguous loss:

Physical Absence with Psychological Presence (Type One): This occurs when a person is physically gone but remains psychologically present in the minds of their loved ones. Examples include missing persons, incarceration, military deployment, or loss due to natural disasters.
Psychological Absence with Physical Presence (Type Two): This occurs when a person is physically present but psychologically absent, such as in cases of dementia, addiction, mental illness, or traumatic brain injury.

The experience of ambiguous loss can be incredibly challenging, leading to unrelenting confusion and torment as individuals attempt to make sense of the nonsensical. Paradox and contradictions abound, and closure becomes a myth.

Symptoms of Ambiguous Loss

Ambiguous loss manifests in a variety of ways, affecting individuals emotionally, cognitively, and behaviorally. Some common symptoms include:

Questioning the reality of the loss
Feelings of uncertainty and confusion
Difficulty coping with grief
Persistent sadness
Blocked cognition
Ambivalence
Hopelessness
Anxiety
Insecurity
Lost trust

These symptoms can be intensified if the event activating the loss is internalized as embarrassing or shameful, leading to isolation and a reluctance to seek support.

Strategies for Coping with Ambiguous Loss

Despite the challenges posed by ambiguous loss, there are strategies individuals can employ to build resilience and navigate the complexities of their grief. The key to coping with the stress of ambiguous loss is to build resiliency. Resilience can be defined as the capacity to prepare for, recover from and adapt in the face of stress, challenge and adversity. The defining characteristic of resilience is flexibility.

Here are some guidelines for coping with ambiguous loss, presented in a cyclical, non-linear order:

Acknowledge Your Current New Normal: Recognizing and accepting the present reality is a crucial first step. Sometimes we feel if we acknowledge what the current new normal is that there will never be another new normal that resembles the life we want. This involves acknowledging the changes in daily routine, relationships, and overall life circumstances brought on by the loss.
Acknowledge What You Feel: Allow yourself to experience and express the emotions that arise from the loss. Feeling distressed due to uncertainty is normal. Feeling sad or angry or worried are also normal responses to uncertainty. Ambiguity is the problem, not your emotions. Whatever you feel is neither good or bad, right or wrong, but rather what is and informative. Share what you think and feel. Share your stories.

Read also: Navigating Grief
Share Your Stories: Connecting with others and sharing your experiences can provide validation and support. Although COVID-19 has affected daily life on an unprecedented scale, this is not the first time you have lived with uncertainty. In the past, when confronted with the challenges of ambiguity, how did you make it through? What did you learn through what you experienced? Making-it-through stories are resilience stories that can provide hope, highlighting a way to deal with your present situation, as well as a way to frame your experience in meaning.
Engage in Both-And Thinking: Reframing your perspective to embrace paradox and ambiguity can be helpful. Seeing life and a particular situation in terms of either-or is a sign of stress. Stress narrows our view of life, taking the large horizon before us and shrinking it down to the size of a postage stamp. Either-or thinking can lock you into definitive views regarding your COVID-19 experience, such as “either everything returns to the way it was before, or I can never be happy again;" aimed at trying to make sense of uncertainty, either-or thinking can instead increase feelings of hopelessness and helplessness about your ability to cope. Engaging in both-and thinking can provide a more positive way to live with ambiguity by helping you to hold two opposing ideas in your mind at the same time, effectively helping your balloon of worry to deflate.
Construct New Routines and Rituals: Creating structure and meaning in your life can provide a sense of stability during uncertain times. Feeling adrift on the sea of life is a common response to ambiguous loss. The structure of routine can help create a sense of certainty in uncertain times. Consciously constructing new routines and rituals rather than foregoing them can anchor you in the present by creating a sense of normal within a new context. For example, develop schedules for meals, home-schooling and working from home, including break times, as well as schedules and assignments for chores and leisure activities. Rituals provide fun, excitement and meaning in our lives.
Look for and Find Meaning and Purpose: Identifying a sense of purpose and meaning can help you persevere through challenges. Finding meaning in challenge and adversity can help you persevere. Finding meaning can also help you make sense of something you will never have all the answers for regarding the hows and whys of what has happened. Taking positive action gives purposeful direction to meaning. During the COVID-19 crisis, thousands of people made masks for healthcare workers as a way to contribute something positive in the midst of so much suffering. Others checked in on elderly neighbors and brought them groceries. Some business owners chose to close their business to avoid spreading the virus, while others chose to stay open to ensure their employees livelihood (while at the same time putting protective measure in place to keep them safe).
Adjusting Mastery: Recognizing your degree of control in the situation. “If we like control, we need to lower it,” Boss says. “We may have to live with not knowing for years, decades, or a lifetime. During the pandemic, people could not control the virus. It was no accident that so many people were baking bread.

Read also: Inclusion for Students with Hearing Loss
Reconstructing Identity: is how a person comes to understand their new identity. “Who am I now that my husband has been physically missing for 20 years? Am I still married? Or with Type Two ambiguous loss, can I have a relationship with someone else if my mate no longer knows who I am?
Normalizing Ambivalence: refers to coming to terms with conflicting feelings. When a person doesn’t know if a missing loved one is alive or dead, they often wish for the ambiguity to be over, but then realize that means they are wishing the person were dead.
Revising Attachment: is recognizing that a loved one is both here and gone. “He may be dead and maybe not. She may come back to the way she used to be and maybe not,” Boss says.
Discovering New Hope: “You can’t just wait for the missing person to come back because that would mean putting your life on hold,” Boss says. “You have to discover something new to hope for.

The Importance of Seeking Support

Navigating ambiguous loss can be incredibly challenging, and seeking support is essential. Talking to a therapist or other trusted member of your care team is a courageous step forward.

Therapy: Mental health professionals can provide guidance and support in processing grief and developing coping strategies. Cognitive behavioral therapy (CBT), behavioral activation, or acceptance and commitment therapy (ACT) can be effective in treating ambiguous loss.
Support Groups: Connecting with others who have experienced similar losses can provide a sense of community and validation. You may be able to find a support group focused on a particular type of ambiguous loss, such as divorce, estrangement, addiction or missing persons.
Family and Friends: Sharing your experiences with loved ones can provide emotional support and understanding.
Faith Community: Engaging with your faith community can provide spiritual guidance and a sense of belonging.

Ambiguous Loss in Specific Situations

Ambiguous loss can manifest in various life situations, each presenting unique challenges and requiring tailored coping strategies.

Divorce and Estrangement

Divorce and estrangement can lead to feelings of loss and sadness due to the change or end of a relationship. The relationship you had with the person is over or substantially changed. It's important to validate your ambiguous loss. One way to do this is to write down everything in your life that has changed or will change due to your loss. Nothing is too small to include. Don't minimize your list, as that can short-circuit your journey. A list for a parental estrangement may include wedding dress shopping together, sending Mother's Day cards or holiday gifts, having inside jokes and more.

Incarceration

The incarceration of a loved one creates a physical absence while the emotional connection remains. The list for an incarcerated loved one may include lost holidays and milestones, vacations, daily conversations and physical intimacy.

Dementia and Chronic Illness

Caring for a loved one with dementia or chronic illness involves grieving the loss of the person they once were. The list for a loved one suffering from dementia may include planned trips, sharing holidays, living in the same place and shared memories.

Missing Persons

The uncertainty surrounding a missing person case can be particularly agonizing, as family members grapple with the unknown. Family members may have no information about whether the person is alive or well, yet no confirmation of their death.

The COVID-19 Pandemic

The COVID-19 pandemic has brought about widespread ambiguous loss due to changes in daily routines, loss of social connections, and uncertainty about the future. Not being able to go to the health club - is that a real loss? What about feeling isolated whereas before you felt a sense of belonging, safety and security? Desired foods and products no longer available at the grocery store?

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