— Mourning Without Closure
Learning about ambiguous grief may help in trying to make sense of loss that lacks conclusion or feels unresolved.
by Gina Ryder
- Ambiguous grief is unresolved grief where circumstances lack a clear conclusion or closure.
- It can effectively be treated with the support of a mental health professional through eye movement desensitization and reprocessing (EMDR), cognitive behavioral therapy (CBT), or acceptance and commitment therapy (ACT).
Grief can take shape in so many ways, and it can also be shapeless. If you’re facing or have ever faced a loss that isn’t clearly defined, you may be experiencing what’s known as ambiguous loss.
Our cultural script says grief follows a linear path, from loss to acceptance, but anyone who has faced loss will likely tell you that isn’t always true.
“The most important thing to remember when dealing with ambiguous loss is: It’s not your fault. Sometimes people need to hear this multiple times. It’s so common to blame ourselves in the wake of trauma,” says Jessie Stern, PhD, a postdoctoral research associate at the University of Virginia.
“Ultimately there’s much in life that’s neither just nor predictable, and much that’s beyond our understanding and control,” Stern continued.
Ambiguous grief is unresolved grief that might have resulted from complex trauma where circumstances lack a clear conclusion or closure.
Coined in the ‘70s by famous psychotherapist Pauline Boss, PhD, when she was a doctoral student, the term ambiguous grief has provided language for and acknowledgment of ambivalent loss.
“Labeling it as ambiguous loss can be very healing when we have terms to describe what we’re going through. It helps us cope better,” says Beth Tyson, a psychotherapist based in Pennsylvania.
Boss developed her theory of ambiguous grief across decades in her work as a family therapist in Minnesota. In 1999, she published the seminal book “Ambiguous Loss: Learning to Live With Unresolved Grief,” which outlined the two types of ambiguous loss: type one and type two.
Type One
Type one ambiguous grief happens when someone is physically gone but psychologically there. This might refer to people who are missing or people whose bodies are gone in some way.
Examples of physical ambiguous loss may include tragedies, such as:
- kidnapping
- war
- genocide
- terrorism
- natural disasters such as floods, hurricanes, and earthquakes
- ethnic cleansing
Type Two
Type two ambiguous loss happens when there’s a lack of psychological presence while someone is physically there. This might refer to people who are emotionally unavailable or cognitively gone.
Examples of type two ambiguous loss may be identified as:
- losing a baby to miscarriage
- having a parent with substance use disorder
- losing contact with a loved one via immigration
- being a child of the foster care system
- loss of dreams and plans due to setbacks or uncertainty
- having a loved one facing a disease like Alzheimer’s or other illnesses that impact memory
- experiencing a loss without closure such as suicide and infant death
If you experience ambiguity that persists in the grieving process you may notice:
- blocked cognition
- difficulties with coping
- the grief process might feel “frozen”
- persistent sadness for uncertain reasons
Ambiguous grief can effectively be treated by Eye Movement Desensitization and Reprocessing (EMDR) to reprocess the trauma of the loss and then install a positive belief as opposed to a lingering unhelpful belief.
Trauma-informed cognitive behavioral therapy (CBT) may also be helpful, as well as acceptance and commitment therapy (ACT), to practice acceptance of the confusing feelings and gain some distance from ruminative thoughts.
Anticipatory grief is when you experience grief before a loss occurs. Anticipatory grief might be felt by people waiting for a possible terminal illness diagnosis or by loved ones of someone nearing death.
In some cases, ambiguous grief can overlap with anticipatory grief. Anticipatory grief can even turn into ambiguous grief.
Researchers studied the emotions of loved ones of missing people in Italy. They noted the presence of both ambiguous grief and anticipatory grief.
The studyTrusted Source, published in 2020, found a prolonged state of uncertainty contributes to both anticipatory and ambiguous grief. In other words, experiencing an endless wait for news in tragic circumstances can contribute to both forms of grief.
When the study participants finally heard the news of missing loved ones, they reported their sense of imminent loss decreasing while prolonged grief settled in.
Boss’ theory of ambiguous grief includes a framework for how to best cope with grief that may lack a clear path.
Seek meaning through creativity
“One of the most powerful ways that humans make meaning out of ambiguous loss is through art: we sing, dance, write poems, produce theater, make art, grow tulips in the garden,” says Stern.
“We listen to the music of our ancestors and our role models, which expresses something deeper about our own grief while showing us how others made their way through it.”
Explore a new identity for grief
Psychologist Susan David, PhD, once said, “Grief is love, looking for a home.” Remembering that your grief can take on a new meaning with time is key.
Tyson says, “Finding something to love can be a coping skill, such as a small pet or other beloved objects to stand in for the person who’s missing. Mentors and family members can also take on this role.”
Try to become OK with ambivalence
Ambivalence is a deeply human part of life. It’s natural to feel ambivalent in the wake of grief. What matters is how we handle our complicated emotions.
“In the aftermath of ambiguous loss, there can be a strong tendency to numb — with overwork, social media, Netflix, food, or alcohol. It’s human to want to turn away from painful emotions,” says Stern.
“But the problem with numbing is that it turns us away from the important work of grieving. Numbing shuts down a deep part of ourselves,” she adds.
Consider changing your relationship to loss
“It can be helpful to redefine the roles within a family after a loved one has gone missing or separated from their family of origin,” says Tyson.
“So, for example, if you have a child who is being raised by their grandparents, they’re no longer in the grandparent role, but the parent role.”
Pursue hope
There are lots of ways to experience hope. One way to find hope is to acknowledge your and others’ grief by setting aside time to intentionally ponder memories or allow certain emotions to arise.
Tyson suggests setting aside 10 minutes to deliberately think about the person who’s missing from your life. This may help relieve your mind of constantly searching for solutions.
If your brain knows you’ll have a specific time to think about the problem, it may allow more time for you to focus on other tasks.
Ambiguous grief is a theory of grief that may help us make sense of grief or trauma that can feel senseless or shapeless.
Even if things never seem to make sense, having hope that we can learn to be OK with our ambivalence can help with coping.
“Everyone walks their own path, cycling through many stages over years or a lifetime. There’s no one path through grief; every loss is unique, and our responses to it vary depending on our culture, upbringing, personality, and stage of life,” says Stern.
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