Sunday, April 28, 2013

Ambiguous Loss and Unresolved Grief


Spring has arrived here in Colorado, at least for this week, and there are several books and events in this newsletter focused on grief. These are the fruits of winter’s darkness and en-wombment.
I have been thinking and writing a lot lately about ambiguous losses and the devastating circumstances surrounding such losses.  Patricia Boss, the woman who coined the term ambiguous losse, is author of Ambiguous Loss: Learning to Live with Unresolved Grief. I was so grateful to learn that this kind of grief has been recognized and named, as I have lived with numerous ambiguous losses and grief all through my life and I have worked with many in my practice who also know ambiguous loss intimately. I found that ambiguous losses often go unrecognized by family, friends, community, and helping professionals, and even by those experiencing it. Once recognized, I know from my own experience, that much healing can happen, even in the face of the lack of resolution and closure.

The most excruciating losses of my own life have not been the deaths of people or pets that I have loved, where there was a clear sense of finality and closure, but the ambiguous losses, the losses filled with confusion, fear, helplessness, and lack of finality. These losses and their accompanying unresolved grief are often suffered in silence and confusion and carried alone.

The grieving process with a death, however difficult, where the finality is evident, happens in stages and we eventually evolve to a place where we come into a new relationship with the death and with the deceased. There is recognition by self and others and support from others to grieve and then  move into a new life without our loved one. Most of the time, this does not happen with ambiguous losses and unresolved grief. For those facing this kind of loss, life becomes radically different or comes to a standstill, sometimes for many years. We find ourselves on the precipice of the unknown, not knowing what to expect, perhaps crazed with fear and fighting the worst, most horrible thoughts and feeling of helplessness, and caught in both hope and despair. 
There are two types of ambiguous loss:
The first involves the loss of a loved one who is physically alive but has some condition that makes them unavailable to us, and eventually to themselves, emotionally, mentally, and unable to make relational contact. They are physically present, yet not there as they used to be, not able to function as they did in their lives. As time goes on, their level of functioning in day-to-day life diminishes and we witness them gradually or rapidly leave us before they finally leave us in death.

This type of ambiguous loss includes conditions such as dementia, ALS, Alzheimers, mental illness, PTSD, addictions, work-aholism, chronic pain, brain injuries, as well as other traumas to brain, mind, body, and soul. While our loved one’s physical body is still present, the person we knew becomes inaccessible, no longer there in ways they used to be, and increasingly incapable of relational contact.
Spouses, children, family, and friends of people with these conditions usually experience some combination of increased stress, fear, phases of hope and hopelessness, despair, anger, depression, as well as the deep heartbreak and grief of losing their beloved. Whether the loss of functioning and contact is gradual and happens over the course of years, or it is from a sudden, unexpected trauma, it is devastating to us.

It can also be frightening, confusing, as well as emotionally exhausting to witness and experience people we love go through these radical changes of personality, functioning, and suffering, especially when it comes to the time when family can no longer manage the care and our loved ones needs 24-hour help. Knowing our loved one is leaving home to go into the care of others is a death itself, and launches yet another leg of this painful grief journey. Physical death may come as a relief, both for our loved one and ourselves, as it brings a sense of finality that allows for a deep outbreath and the knowledge that this very painful chapter is closing and some new way of life can begin. As family and perhaps the primary care-givers for awhile, we need to ask for and receive help for our loved on and for ourselves. Fortunately we live in a time when there are support groups, books, healers, professional helpers, and spiritual advisors who recognize and understand what it is like for those of us dealing with this kind of ongoing ambiguous loss and its attendant grief. 

The other kind of ambiguous loss arises when one or more loved ones are physically gone and unavailable to us for reasons known or unknown, yet their psychological presence is still here with us. There is great ambiguity about whether or not they will return, perhaps where they are or why they left, and we may not even know whether or not they are even still alive.

It is beyond devastating when people we love disappear from our lives and there are no answers or evidence explaining what happened or why, or what the outcome will be. Their whereabouts may be known or not, but there may be little or no communication. They are gone, but not really. They are in some ways dead to us, but not dead. They live in our hearts, yet we cannot put our arms around them. They are part of our family, but not. There’s an empty chair at the table and often a heavy pall of sadness and grief hanging in the family field during holidays and special family occasions. There’s no body or ashes, no ritual or funeral, no memorial or burial. There’s nothing but our broken hearts, grief, memories, and whatever items we have that were given to us or belonged to our loved one. They live and walk with us on a daily basis in some parallel reality, where sometimes we can sense their presence, and often there is nothing but pain and suffering. When our loved one is gone for a long time, for years, we don't know what to say when a new person in our lives asks a normal question like, "Are you married?" or "How many children do you have?" Simple questions no longer have simple answers.      

With this kind of ambiguous loss, we are caught between hope and despair, perhaps doing everything we can think of to understand what has happened, to get information, clarity, and resolution—but it doesn’t come. We feel crazy at times as it is all so surreal, we cannot understand how this could have happened to us, to our family. On the nights we don’t sleep, we sift through the questions and make up stories with answers that, by sunrise, are meaningless. It doesn’t matter if the stories are true or not, our beloved is gone, inaccessible, perhaps for reasons we do not know—and yet they are constantly in our presence.  We feel lost, forsaken by god/goddess, and we pull in, our lives become smaller and focused on this terrible loss which we cannot fathom or even speak about. We live with an undercurrent of waiting: for some news, for their return, something to be different than it is. We may go into high action in our looking for help, for answers, for something that will bring our beloved back. 
Endless questions arise: Will there ever be a reunion with our loved one?  Can we, or do we have a right to be happy again or feel joy? How do we put this out of our thoughts for awhile and have a life, even for a few days? Why did this  happen to us? What is really happening here?  Are they okay? Are they alive? Have they lost their minds? Where are they? How will I survive this? Do I want to go on living? How can I go on living with this? Did I do something wrong to cause them to go, and if so what? How can I change or heal this with them, or with myself? Can I forgive them? Can I forgive myself?  What do I do at 2AM when the terrifying questions that begin with “What if….?” Am I being punished for something I did? On and on, these thoughts can grind us down to the bones emotionally, mentally and physically, and turn our lives into a living hell--on top of the excruciating  loss and endless grief that is always the undercurrent of life in these situations.

These kinds of ambiguous losses are many and varied and may include children or adults sent away from their mothers, families, or their countries for reasons they don’t know or understand, including adopted children, as well as kids sent to relatives or orphanages. Women who have given their babies up for whatever reason often feel the devastating emptiness of having a child, but not.  Children feel ambiguous loss when a parent literally disappears with little or no explanation or goodbye, and does not, or cannot maintain contact, regardless of reasons: physical or mental illness, accident, alcoholism or other addictions, institutionalization. Children who suffer the death of a parent or sibling where they were too young to understand what was happening also grow up with this deep sense of loss and confusion about their own part in what happened. In these cases, the parents often disappear into their own grief, so it is a double or triple abandonment for the child.

Ambiguous loss and unresolved grief are suffered by spouses and families of people who have gone to war, are missing in action or political prisoners, victims of natural disasters, or just gone for reasons unknown suffer terribly, especially when they cannot get the truth from the powers that be. Ambiguous loss also occurs in those lost or separated from home and family, whether by their choice or not. Included here are people who are prisoners, institutionalized in one way or another, on active military duty,  have a physical or mental disorder that keeps them away from family under circumstance that they cannot control. 
Holocaust survivors and their descendants, as well as people who are born into families where there has been a lineage of genocide or other unknown losses over many generations, such as those from Indigenous communities, may end up carrying a heavy load of ambiguous grief for losses of people they never knew existed. The pain and suffering of these ancestral losses stay in the family field until they are somehow acknowledged, felt, and given a place in the family field. This frequently shows up in family constellations.

Immigrants who have left their homeland and their families to go live in another country often feel ambiguous loss, not knowing when, or if, they will ever again see their families or homeland again. Likewise, those left behind feel the same unresolved grief. People go missing under various circumstances, children are kidnapped and their families don’t know if they are alive or dead. This happens to families and friends of people lost in natural and man-made disasters where the bodies are not found or not identifiable.

Sudden, unexpected or untimely deaths, including suicides, can lead to a sense of ambiguous loss. Even when the body of the deceased is present and there is no doubt about the finality, there may be so many unanswered questions, guilt, anguish, and confusion about the situation that the loss has much ambiguity and grief remains unresolved for years.  We can also experience ambiguous loss when a beloved pet disappears and we wait and hope and keep looking for our sweet animal companion, not knowing if we will find them or their body or nothing at all.     
In so many ways, these are the cruelest, most painful ambiguous losses in our lives because there are often no answers and no closure. Our beloveds are gone physically but very real, alive, and living in our hearts, present to us psychologically and emotionally. They are kind of like ghosts that continue to haunt us and our lives fall into limbo, at least for a time. The empty chair at the table, the last journals they wrote in, the bedroom that has remained the way they left it, their clothes in the closet, are constant reminders and we may not be able, or want to change  things or give them up for a very long time--if we ever do. We may run screaming in all directions at once looking for answers, help, someone who knows something, or could do something, or tell us what to do because doing nothing feels impossible.  

Unlike the finality of death, there are no rituals or rites of completion. There are no sympathy cards and condolences may only come from family and friends at the beginnig of such a horrific journey. What makes it even harder is that there is little or no ongoing recognition or understanding of our ongoing pain by others, even by family and close friends who know what has happened. After awhile, especially after many years of this ongoing loss and incessant grief, there are fewer people we can share this with and our sense of isolation grows. Others do not always realize how deep and ongoing the pain is, how much grief there is every day or on holidays or birthdays. Life goes on for everyone around us while those suffering with unresolved grief and continual ambiguity are living in a parallel reality, somewhere between the past and future. The present is unbearable, at least until we get some help and learn to live with unknown day by day. We don't know whether to continue to hope for our loved one’s return or do we give up hope, and we often don't know what to do when we have done everything possible and now have to face that there is nothing we can do?

I want to say there is hope, perhaps not for reunion with our beloved on the physical/emotional level, but hope for coming into a new and different relationship with this person on the inner levels, with the situtation, with ourselves and our heartbreak, and with the sacred dimension of what this is. It is possible to not only survive, but to thrive, even with the hearbreak of this terrible loss and ambiguity when we learn how to take into the realms of spiritual initiation and practice. These heartbreaks are major teachers and teachings. In my next writing I will share how I have worked with ambiguous loss in my own life and with others.

 

 

 

 

 

1 comment:

  1. what a wonderful article, giving clarity to all types of deep grief in a new way. My body sighs in relief reading your words. Thank you, Sheila! I have tweeted the link to this post.

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